But I recently got a question about how long term is usually set up, so I wanted to provide a bit more detail for people who might be thinking about going to long term rehab. The following is based on my experience in a single long term treatment center, so I’m sure there is quite a bit of variation out there. But also, I’m sure a lot of rehabs are fairly similar as well.
Obviously when you are living in a long term treatment center, there are a number of rules that have to be followed. There is no way around this as the nature of addiction is for people to break the rules and sabotage themselves and their recovery. So here are some of the highlights:
1) No drugs or alcohol allowed, and weekly (random) drug tests and breathalyzers to insure sobriety. Zero tolerance policy with this, if you screw it up you are instantly kicked out.
2) Mandatory program requirements, with severe penalties or discharge if people miss the groups or the meetings.
3) Zero tolerance policy on violence. No fist fights or weapons are tolerated. Immediate discharge.
4) Tendency towards an all-male or an all-female facility. Sneaking in a member of the opposite sex is prohibited, etc. Need to focus on self and not on outside relationships (at least not new relationships, at least for the early stages anyway).
The long term treatment center that I stayed at had a phase system. This was designed to restrict the newcomer when they first checked in so that they could be safer from the threat of relapse, and then slowly give the person back their freedom the longer they stayed sober. So the phases were set up like this:
1) First 2 weeks was complete restriction, could not leave the grounds at all for any reason, unless going to an outside 12 step meeting and accompanied by peers.
2) First 30 days was phase one, which gave the person 3 hours of “personal time” each day (must sign in and out when leaving and coming with a peer).
3) Phase two would last up until the first 90 days, and include more hours of personal time each day (5 hours I believe it was).
4) Phase three would last up until 6 months, and would include 4 overnight passes each month in which a person could sign out for the night and stay elsewhere. Also more personal time each day (6 hours).
5) Phase four would include 8 hours of personal time each day and up to 8 overnight passes each month. People could sort of come and go as they pleased at this phase, giving them the highest degree of freedom.
The place I stayed at had one therapist that looked over the whole place. This therapist watched over 12 men in this case and the following therapy schedule was set:
1) A one-on-one session with the therapist each week.
2) There were 2 mandatory therapy groups that met each week, once on Monday evening and once on Thursday evening. Group topics were fairly flexible and could be adapted to any existing problems or issues that clients were dealing with. Missing one of these groups meant instant discharge in most cases.
3) Mandatory 90 meetings in 90 days in a 12 step program. Also mandatory to get a sponsor in the fellowship as well. After the 90 in 90, required 3 meetings per week minimum.
These things might sound like a lot as you read it, but you should not be overwhelmed by it. Spaced out over the course of a whole week these demands are not unreasonable. It seemed to provide just the right amount of “program” and therapy in order to keep a person well grounded in early recovery.
I am convinced that any less structure would have produced lower success rates. A bit more structure might even have been beneficial, though it was probably not necessary. You have to give people freedom (or the transition towards freedom) so that they can learn how to live again.
The whole point of long term treatment is so that the addict or alcoholic can learn to live a sober life. If you coddle them and shelter them too much then you are setting them up for failure when they eventually move on. On the other hand, if you give them too much freedom in the beginning they will never be able to stick around long enough to see recovery start working in their life. Thus the need for balance and transition.