After working in a drug and alcohol treatment rehab for over five years straight (and living there for 2 years before that) I can honestly say that one of the biggest problems with rehab is what happens after people leave.
I mean, there are very few things that can actually go wrong while you are in treatment. The idea is pretty straightforward: The alcoholic or drug addict comes into detox, they are medically supervised while they go through withdrawal, and the staff at the treatment center does everything that they can in order to insure that no drugs or alcohol are allowed on the premises. It’s pretty simple really, at least while you are in treatment. It’s a controlled environment and you don’t use any drugs or alcohol for a few weeks.
The problem is in leaving rehab. It is easy to stay sober while being in treatment (in my opinion). Anyone can get a few days or even a few weeks of sobriety without really trying too hard. If you think this is false, then just go get arrested for committing a serious crime. You will sober right up as they incarcerate you and control what you are allowed to put into your own body. Sobriety is not hard to achieve. It is simply difficult to maintain. This is especially true given that you are walking around in total freedom, able to self medicate at will. The real challenge is not in simply getting to rehab (though some people do have blocks in that regard too), the real challenge is in finding that lifetime of sobriety. How to say “no” to your drug of choice when you have the full freedom and power to be able to take it or leave it.
When you leave treatment, you don’t expect things to tempt you so fiercely and quickly. But they always do. This is the nature of the beast, this is our addiction at work.
Back into the real world with all of the temptations and triggers
I believe there is a “drama amplifier” that happens when you first get sober. The same thing happens if a cigarette smoker suddenly quits smoking cigarettes. Upon quitting, the person will immediately become more sensitive to the world around them. They will suddenly be thrust into all sorts of drama that they never noticed in the past. They will not be able to figure out why the drama appeared or where it is really coming from.
But it is all based on their withdrawal. In fact, the drama is no different from their everyday life. What is really going is that they are just more sensitive to the drama because of their state of withdrawal.
It is very difficult to prepare for this in advance. It is very difficult to recognize it and compensate for it without freaking out. I had to try to quit smoking cigarettes several times (and failing of course) in order to really figure what was going on. I had to keep trying until I got to the point where I realized that this was not just a bunch of unlucky coincidences, and that this was just normal like being amplified by my withdrawal. It was only after I realized this that I was able to consciously overcome the drama the next time I tried to quit smoking.
Overcoming any addiction is going to be much the same. You will suddenly have any and every excuse that you ever wanted in order to go back to your drug of choice. This will be especially true after you leave rehab and are back in the real world for a few days. This is your most vulnerable time when you need to be extremely cautious regarding relapse. There is a reason that they tell you to go to AA meetings every single day, and one of the big reasons is because most people need the support.
It is unbelievable to me that we can forget that we are alcoholics or drug addicts. I am not a stupid guy, but during my journey of recovery I have realized that every alcoholic and addict, even the really sharp folks, can easily forget that they are addicted. They only forget for a split second, but that is enough to create misery. What is going on here? Allow me to explain.
If you leave rehab and you are going to AA or NA meetings every single day, talking with your sponsor, and associating with your peers in recovery, and reading recovery literature every day, then you are “plugged into the program” so to speak. You are taking actions every day that help to remind you that you are fighting for abstinence, fighting for a better life in sobriety, and so on.
During this time you will experience triggers and urges. This is inevitable. Every alcoholic and drug addict will think of using or drinking again. That cannot be helped or avoided entirely. It is going to happen. The question of course, is: “What are you going to do with that craving or trigger?” Because you can stop yourself immediately, and remind yourself that you are moving towards a better and happier life in recovery now, and that you are not going to drink or use drugs no matter what. This is what you want to do, every single time you get a craving. If you can do that consistently then you can avoid relapse and stay happy.
Now the problem comes in during that split second after your brain gets that craving. Your brain suddenly sees an advertisement for the kind of beer that you used to drink. And without your permission, your brain may even remember what it tastes like, what it felt like when it was cold and going down your throat when you were really thirsty. This is all within the first 2 or 3 seconds of the craving. At this point your conscious voice steps in and realizes that your brain is having this craving. Now you can decide what you want to do with it, if you want to indulge the fantasy of what your beer used to taste like (bad idea) or if you want to remind yourself about what you are trying to do now in recovery and how you are living a happier life sober (much better idea).
Now here is the thing:
When you are “plugged in” to the program and going to meetings every day and reading literature every day and talking with your sponsor every day or doing whatever it is that you do for recovery, then your reaction time in this craving situation is going to be LIGHTNING FAST.
Seriously, I want you to test this. I have tested it. I have played with this a lot over the years. If you are fully plugged into your program then such cravings are just a mere nuisance and they will not affect your happiness. At all. You will simply move and after you remind yourself that you have good things happening in your life today and that you do not need alcohol or drugs.
I have also tested this when I was not really “fully plugged into my program.” There have been periods of time during my 12 years of recovery when I was a bit lazy, when I wasn’t really doing much of anything for my recovery, and I was just sort of living passively for a while. When I would get a craving during those periods of time, the craving affected me differently.
How? The craving made me miserable. Simple as that.
I noticed this and I was probably lucky that I realized what was going on. It was not like I ran out and drank or anything. But I could clearly see how eventually I would if nothing changed. Because the cravings and triggers that I was getting were random and they would never go away entirely. Life keeps throwing you curve balls until you die. And I could see how the misery would just keep piling up if I did not do anything to change it.
Where was this misery coming from?
It came from the fact that I knew I was not going to drink or use drugs. I knew I was not going to relapse. So when I had this craving or trigger, my brain was allowed to fantasize about it just a split second too long. My brain was indulging itself. And yet I always reminded it that I was sober now, and that I was going to deprive my brain of what it wanted. So my brain was upset that I was denying it of this fantasy.
So the secret is to not let your brain have that fantasy at all.
You have to shut it down quicker. This is a matter of only one or two seconds. Seriously. Test this out if you don’t believe me.
Really pay attention to your cravings and triggers. Pay attention to them when you are being lazy and not “working a program.” See how the triggers make you depressed, because you are simply denying yourself the drug or alcohol that your brain was fantasizing about during that trigger.
Then, do the opposite. Take action and make positive changes every day and really get involved with your recovery. Do whatever you can in order to “work a better program of recovery.” Get a sponsor and talk with them every day. Start reading recovery or inspirational literature. Talk with peers in recovery every day. Go to daily meetings if that is your thing. Role up your sleeves and really get involved with the recovery process, as much as you can. Commit to this for at least 30 days. And then pay attention to how you feel after a craving or trigger. See what happens to your mind and if you are as depressed or not. I can bet you any amount of money that the trigger or craving will have almost no impact on your happiness. You may still get the craving (nothing will prevent those permanently), but at least you will be miserable because of it.
You may think it is silly for your brain to become depressed or miserable after indulging a fantasy for only an extra second or two (before you remember that you are sober now). But this is the truth, this is how it really works. If you are fully “plugged into your program” then you are telling your brain that it cannot forget (not even for a split second) that you are in recovery.
But if you drift away from the program (or from your daily recovery practice, whatever that may be) then the next time you have a craving or trigger (which is inevitable) then it will cause you to be miserable, as you are denying your brain of that fantasy.
Throwing yourself into a support group
Therefore the solution is pretty straightforward, right?
When you leave rehab, you need to throw yourself into recovery.
You need to embrace it like it is your new full time job.
You must take recovery seriously. More serious than any job you have ever held in the past. You must dive in head first and embrace the positive changes that need to be made on a daily basis.
Most treatment centers recommend 12 step programs, and are based on the 12 step model. There are advantages and disadvantages to this, but one of the biggest advantages is that daily meetings offer a ton of support.
If you leave rehab and you really want to stay sober then you should give the meetings a chance. Start going every single day and make a commitment to keep going for a long time (most recommend 90 days continuous). There are worse things you could do. If nothing else, going to daily meetings can help you to stay “plugged in.”
Of course, many people who go to meetings frequently end up relapsing anyway. Why is that? Because they are not taking positive action outside of the meetings. They are not applying the principles of recovery in their daily lives. Going to a meeting every day is like “talking the talk.” But what happens outside of those meetings is where you have to actually walk the walk.
It is sort of like going to treatment. Anyone can go to rehab (or get thrown in jail) and string together a few weeks of sobriety. The same is true of going to AA meetings. Anyone can start going to meetings every day. Some people are even sentenced to do so by a judge. But this does not mean that they have embraced recovery with all of their heart and are going to go to extreme lengths in order to maintain sobriety.
Being in a support group (such as AA) can come with the added bonus of accountability. If you are in a support group and you get heavily involved with the people there then this can help a great deal as far as keeping you accountable. This is useful in the short term and less useful in long term recovery. But if that is what it takes for you to get through your first year of sobriety then you should definitely do it. Embrace whatever works for you. Find a support group and stick with it.
Immersing yourself in recovery 24/7
I would start by looking at your “book ends.” What do you do first thing when you wake up for your recovery? Last thing at night before you go to bed? You should make a special effort to make sure that those times are heavily associated with recovery. Literature may be the easiest way to do this. Many people have a daily book of readings of inspirational recovery literature. You can make a habit of reading this at your “book ends.” Or you may have a recovery forum online where you check in and post every day. This could be the last thing that you do before going to bed each night. In terms of the 12 step program this can function as a step ten–sort of your daily review, your daily inventory.
After you have your book ends sorted out, you should look to the middle of your day to make sure you are doing at least one thing to help or benefit your recovery directly. The easy answer would be to go to an AA meeting, but it doesn’t have to be a meeting necessarily. You may talk with someone else in recovery, connect with your sponsor, write in a journal about your recovery, write in the steps, study some recovery literature, and so on.
When I finally got clean and sober for good I was living in a long term treatment center for the first 20 months of my recovery. Talk about immersion! But surprisingly, most of my peers that lived with me there ended up relapsing. So there is more to it than just living and breathing recovery all day long. You have to actually commit to the changes, not just go through the motions. If it were only about going through the motions then long term rehab centers would have a 100 percent success rate. But they don’t, because in reality is all comes down to commitment and surrender. Have you surrendered enough to be willing to live, eat, sleep, and breathe recovery every single day? If so, then you have a chance at sobriety.
Seeking out more intensive treatment if you fail to remain sober
They have a saying in recovery, “keep coming back.” They say this at meetings. They also say it at rehabs, if people have failed or they relapse.
But I think this is wrong. I think the saying should be more like “if you relapse, seek more intensive treatment.”
Implying that if you fail and relapse, don’t just come back to the same treatment center you were at, and go through the same motions again. That did not work. Time to do something different. Time to try something new.
For me, that meant going to more intensive treatment. After a 28 day inpatient rehab failed for me, I had to look at the idea that I needed more help than that. That I needed more support than that. So I started to seriously consider the idea that living in long term treatment might be the answer for me (it was).
If you leave rehab and fail to stay sober, ask yourself: “What can I do differently the next time?”
For me, the answer involved seeking out MORE treatment.
Overcoming complacency and finding a path of personal growth
One of the biggest problems with people who leave rehab is something known as “complacency.”
This can happen to the best of us even if we try to immerse ourselves in recovery and support groups. The problem is that we can get too comfortable, too lazy in our recovery.
And this is not a problem that you can normally diagnose yourself. There are really only two ways to recognize complacency:
1) Relapse first, then realize that you had been complacent.
2) Have your peers in recovery tell you that you are becoming complacent.
I guess a third option would be to just assume that you are always in danger of complacency. Because it is normally too close to you for you to ever diagnose it yourself.
The solution, in my opinion, is to assume that you are always complacent. This seems to work well for me in my own life, as it causes me to push myself to keep growing in recovery.
The way to overcome complacency is to push yourself to make more positive changes in your life.
If you stop making positive changes then you invite complacency back in.
If you refuse to stagnate and you push yourself to improve your life then you are actively overcoming the threat of complacency.
What better way to live your life in recovery then to always be pushing yourself for more growth?
This is relapse prevention in action.