There are many advantages to going to a long term alcohol rehab center over a short term residential program.
That said, the numbers are surprisingly similar. If you look at the success rates of long term rehab and you compare them to short term residential treatment, they are usually pretty close.
Why is that?
I am not sure exactly what supports this data, but I know what my own experience was. I lived in a long term rehab center for 20 months when I was recovering from alcoholism and drug addiction. While I was there I lived with eleven other peers in recovery. I probably saw a total of about 30 struggling alcoholics come in and leave during that 20 months. To this day, I know of maybe 2 or 3 of those guys who are still sober. Five of them have died. And all the rest have since relapsed.
So why are the numbers so depressingly bad? I’m not sure exactly, but I remember to stay grateful for the sobriety that I have in my life today. No one seems to get a free ride in recovery. You have to work for it, plain and simple. And it is a lot more work than most people realize at first.
Even though the data would seem to indicate that the success rates in long term rehab are not that much better than short term, I still believe in the model because it helped me so much. And there are a few select people that I watched it work for as well. Had these few people only attended short term treatment (including myself), I am not sure that they would still be sober today. That alone makes it worthwhile in my opinion. At least the option of long term treatment is there for people who need it.
Why disrupting the cycle is never enough
Short term rehab is disruption. Detox is disruption.
If you go to a regular short term rehab then what you are doing is simply disrupting the cycle of addiction. You are arresting it. This is powerful in the short term because you can isolate yourself away from the threat of relapse. So there is pretty much zero chance of relapse while you are in short term rehab. It is a controlled environment. They search everything that comes in and they make sure that no drugs or alcohol are available.
So you go to a 28 day program (or less) and you arrest your disease. You have achieved disruption. This works very well in the short run and it gives you a chance to at least decide where you want to go from here. You are sober now and you have your bearings again. The crazy chaos of addiction or alcoholism has been slowed to a halt while you are in rehab. The room stops spinning for you, at least for the moment.
Of course while you in short term rehab their goal is to teach you everything that they can about how to go out there into the real world and NOT pick up a drink or a drug. That is the whole point. If you just leave rehab without any real plan then your addiction will take over and you will relapse.
If you had the luxury of working in a rehab center for a few years (like I did, a very eye-opening experience) then you would realize just how much of a revolving door rehab can be. Many, many people who come to rehab are trapped in a cycle of relapse. They go in, they come out, they relapse, they go back in again, and so on. They just keep coming back to rehab and they continue to relapse. Now if this happened with, say, 2 out of every 10 alcoholics then you would think that is pretty normal, right?
That is why everyone should have to work at rehab. This happens with over half of all treatment prospects! It is really overwhelming to see it with your own eyes. I never realized just how many people are going in and out of treatment centers, over and over again, and failing to grasp recovery.
I guess this should come as no surprise to me though because I myself went to 3 treatment centers and attended at least 3 different counselors before I “got it.”
I think if there is a key takeaway from all of this then it is:
Disruption is not enough.
And I think we all know this intuitively. If you go to rehab for 28 days then you have disrupted the disease. You broke the cycle. But did you really fix the addiction? Did you address any of the underlying causes?
The same thing happens when an alcoholic lands in jail. So what, they experience disruption. They stop drinking for a while. Does this cure them? Of course not!
Disruption is not enough. It will never be enough on its own. We need more than just disruption to recover.
How much more?
We need to learn and we need to grow. That is why rehab is set up as a bunch of groups and lectures. They are trying to teach you what you need to learn in order to stay sober.
But how can you learn AND grow in recovery while you are in a 28 day program? You can make some growth while in rehab, but not very much really.
In order to make real personal growth, you need to get out into the real world and start practicing recovery.
Sometimes long term treatment is referred to as “transitional housing.”
This is because you are transitioning the alcoholic from rehab back into normal, everyday living. The long term rehab is creating a bridge between the two.
When I was in long term treatment I went back to school at a community college. Then I started working a part time job as well. While I was there I also had a car. So I was definitely in transition. I had many of the same responsibilities that you would have in the real world, but I still came home each night to a treatment center. And they continued to hold me accountable, giving me drug tests and breathalyzer tests at least once a week (randomly).
When you are in a 28 day short term rehab the amount of growth that you can experience is limited. You cannot go out into the real world and interact with people and deal with outside relationships and then learn from that.
But in long term rehab you can do all of these things. There is no cap on the growth you can achieve in long term because you have access to the outside world. This introduces risk as well because many people relapse while trying to achieve that “real growth” in the outside world. But the alternative is to just leave short term treatment and try to do it all on your own, without the support of living in transitional housing. So even though there is risk in achieving this sort of growth while in treatment, it is less risky than the alternative of not being in treatment at all.
My stance on long term facilities is that they will work for you if you want it to work. This is not the attitude that most people have going into it though. They have the attitude of “hey, I am checking into this long term facility for 6 months or more, and therefore I should not have to put forth any sort of extra effort in order to achieve and maintain sobriety. Just by virtue of the length of treatment I should have no problem staying sober. This longer treatment should, in effect, cure me.”
This is the attitude that people have. They think that because long term treatment is so extreme that it should fix them or cure them with almost no additional work on their part. They believe that the treatment itself can change their conviction and motivation.
This is not the case. This is one of the fundamental truths of recovery. You cannot force someone to change. When you put yourself in rehab, being in rehab does not force you to want to be sober. It does not do anything to motivate you. There is no treatment program or rehab available out there that is effective at actually reprogramming anyone’s motivations and desires. All rehab can do is give you the tools. It can help you, guide you. But it cannot do the work for you. It cannot create the desire for sobriety for you.
Going to short term or 28 day programs do not have the ability to cure anyone. Nor can they motivate anyone to want to change. Long term rehabs are no different. They have the same basic tools with which to help alcoholics and addicts, they just have a longer span of time with which to work with people. But there is no magic in any of these programs that can create desire for sobriety or motivation for people.
That desire has to come from within. So if you check into long term with the hopes that it will change you, then you have the wrong attitude. You have to say instead: “I want to change my life more than anything in the world. Therefore I will go to treatment in order to get the support while I do that.”
Exploring the root of your disease and uncovering defects
If you are in long term rehab then you have a huge opportunity.
Most people do not really start to dig and take advantage of this opportunity. What you can do is to start to do some of the hard work internally while you have the support of being in rehab.
There is not enough time for this in short term or residential treatment. But in long term rehab you have an opportunity to start doing this sort of work. Most people will do it through AA with a sponsor, even while being in long term.
In my own life I did exactly this. I realized in very early recovery (while I was in transitional housing) that I was prone to self pity. This was how my brain arranged for me to drink alcohol. My mind had to justify my drinking, and it was doing it with self pity.
After I went through detox and found myself living in rehab, I noticed that my brain was still doing this little game. It was still running through the self pity thing on a daily basis. It had trained itself to do that, and now that I was sober, it was continuing to do so.
I had to stop it.
But before I could stop it, I had to realize that it was a problem. Luckily I was in rehab at the time and so we talked about this sort of thing all of the time. What are our defects? What sort of games do we play in our minds? What are we feeling today? What is underneath those feelings? And so on.
So I had the chance to do this work because I first became aware of the problem.
Second of all I had to decide that I really wanted to fix this. I had to realize that if I did not fix it that eventually my self pity problem would lead me back to relapse. So I had to make a decision. I had to want to change.
Third, I had to actually implement the change. I did this at the level of my daily practice. So what I had to do was to increase my awareness. I had to “watch” my mind. And this took practice. In the beginning I would still “catch” my mind doing the self pity thing. When that happened, I simply made the decision to cut it off and redirect myself. It was a simple decision. But it had to come along with the decision that 1) I was going to fix this problem, and 2) That I was going to pay attention enough to my mind in order to catch it happening.
So I had to be vigilant. I had to pay attention. And in doing this for maybe two weeks, I was able to completely eliminate my self pity.
I don’t know if I could have done this as effectively if I was not living in rehab at the time. I was able to do so because I had the help and the support for each of those steps. You notice that it required more than one step to succeed, right? I had to become aware of the problem, decide to fix it, increase daily awareness, and then follow through and actually do it. Quite a lot to accomplish if you don’t have the extra knowledge and support of being in rehab.
A chance to establish new habits and a daily practice
Living in transitional housing gives you a chance to establish your daily practice.
What is the daily practice? It is what you do each day in order to take care of yourself. If you are an alcoholic or a drug addict then you probably will benefit a great deal by turning your healthy actions into habits. That way you don’t screw things up in the future. The daily practice are your daily habits and healthy routines that keep you moving in a positive direction.
When I was living in long term rehab the therapist was pushing me to do 2 things in particular:
1) Start meditating.
2) Start exercising.
To be honest I did not see the value in either one at the time.
I took both suggestions though and I found myself experimenting with both meditation and exercise. Eventually I settled into a routine where I was exercising every single day, and this exercise also included a form of meditation.
Looking back now I can see the benefits of these things. I have been doing them for about ten years now. And the daily exercise is a big part of why I am sober today. It keeps me grounded. It gives me a ton of benefits that are hard to describe or put into words.
And the key is that this is part of the daily practice. I don’t have to wonder if I am going to do it. I just do it. Because I have decided that it is beneficial to my recovery and to my overall health and so therefore it becomes automatic. It is my daily practice.
There are other parts to the daily practice. It is about taking care of yourself. Your whole self. Your spiritual self. Your relationships. Your mental faculties. And so on.
When you are in short term rehab (28 days or less) you don’t really have time to explore this sort of thing. You can get a small start on it, but you cannot really establish or explore what works for you as far as the daily practice is concerned. Short term rehabs don’t necessarily even do a good job of explaining how or why this might be important. It is very difficult for anyone to describe or explain, actually. Here, I’ll take a stab at it now:
You need to establish a daily practice that you use to take care of yourself. Take positive action every day of your life and continue to improve your life and your health in recovery. Find the habits and routines that work best for you through experimentation and feedback from others.
That is a pretty good summation of the process. Talk to others in recovery, get ideas about what works for them, and then try those ideas in your own life. Give the ideas a chance to really work for you. For example, I had to exercise for over a month (maybe over 2 months) before I really felt like it was benefiting me. If I had given up after a few weeks then I would have missed out on a huge key to my recovery. This is why it is so important to get feedback and advice from others. Enough people in my life kept telling me that exercise was of critical importance. I had dabbled in it before and did not really see it for myself (because I could not get past the pain and discomfort of when you first start to exercise) and so I had to keep hearing this over and over again. Finally I decided “You know what? Enough people are telling me that exercise is an important key that I just need to put my head down and do it. And get through it. And keep doing it until it is easy for me.”
And so that is what happened. I had finally heard it enough that I was willing to take action and really see it through. And that is how I have had to learn in my recovery. I keep hearing a message over and over again until I am willing to really explore it and implement it. This happened with quitting smoking, too. I did not just up and quit because it was the right thing to do. I struggled with it for a while and had to keep talking to people and finding my own path. But I stuck to it and eventually I figured it out and I was able to do the work. And I got results and my life got better and better.
The daily practice are the habits that you engage in every day that help you to take care of yourself. You don’t really have time to dive into this or explore it in a short term setting. If you are in long term rehab then you should definitely be exploring how to take better care of yourself in many different ways. This is the whole point of recovery–healthy living!
Continuous feedback and adjustments
One of the biggest advantages in long term facilities is the opportunity for constant feedback.
This is gift. If you don’t use it then you probably won’t stay sober.
If you are living in treatment and you are transitioning to the “real world” then you have this huge opportunity. You have the luxury of being able to get feedback as you go along.
When someone leaves short term rehab they don’t get this (unless they go out and find huge amounts of support).
So you can go out into the real world, deal with life, and then report back to your peers in recovery. You can talk with each other and see how things are going. You can advise each other and give feedback. You can help each other to make adjustments as you go along.
This is huge. If you are living in long term rehab then you should definitely take advantage of this.
I was living in a facility and we had two groups each week. We sat down with all 12 of us who lived there and we went around and found out how each person was doing. If someone was struggling with something then we would address it. If someone was having problems we would seek solutions. We helped each other through discussion and feedback.
There are many advantages to long term rehab but most people do not really take advantage of them. Instead they are hoping that the increased time in treatment will somehow do the hard work for them. If you have the opportunity to live in long term rehab, I suggest that you take full advantage of it. But be prepared to do the work in order to build a new life in recovery. It doesn’t create itself!