I personally lived in a long term rehab center for drug and alcohol addiction for 20 months.
During that time I probably watched about 30 to 40 of my peers come into and go out of that treatment center.
The place housed 12 guys total. There was one therapist who was in charge of us all. The therapist worked regular full time hours but did not actually live there with us.
If you relapsed while you were living there you were kicked out instantly. This was sort of the point, really. You had to have some accountability. I mean if it is just a flophouse then what would be the incentive to stay sober? There has to be some consequences. So the rules were that if you relapsed while living there you got the boot. I thought this was more than fair.
When I first got accepted to the program I was obviously low man on the totem pole. I was the newest member of the group and had the least amount of sobriety. But eventually I stayed there long enough and I was the “senior member,” having accumulated the longest stay and the most time sober. The new members looked at me in awe because I had over 18 months sober. To the newcomer this can seem like an impossible task.
While I was living in long term rehab I noticed a disturbing trend that I never would have guessed before. The trend is this: Long term treatment doesn’t necessarily work much better than short term rehab. I guess what I mean by that is that the success rates are not that far apart. If you look at the studies and the data it will give a slight edge to long term rehab, but sometimes (depending on the study) the success rates are the same. And while I was living there I watched this truth unfold before my eyes. Even though I was lucky enough to remain sober (was it luck?) I watched dozens of my peers relapse. It was frighteningly frequent for being a long term rehab.
That said, even though dozens of my peers relapsed in long term treatment, I still believe it is a powerful method for recovery. After all, it worked for me when other methods failed. For example, I had been to two previous residential treatment centers (one of two weeks duration and the other of 28 days), plus I had been to counseling and therapy for years. None of that stuff worked and so eventually I was close to giving up all hope when I finally caved in and agreed to go to long term treatment.
What is the secret to sobriety? What is the key to making long term rehab work for you? I think I have some scattered answers to those questions based on my experiences. Unfortunately it is not clear cut and unfortunately long term rehab is not a magic bullet. But if you want recovery bad enough then I believe it is still a really good path to take. It worked for me.
What your attitude should be upon entering any treatment center
It could be said that your attitude upon entering a treatment determines your outcome. This is at least partially true but there is more to the story than that.
When I worked in a residential treatment facility I got into the habit of predicting who was going to stay sober and who was going to relapse. This same treatment center that I worked at was also connected to a long term rehab, of which I had some limited interaction with as well. So I got to know most all of the people who came into treatment and also the people who came into long term rehab. In fact, this was the same long term rehab that I used to live at myself when I was sobering up years before.
And as you know, people talk. They can’t help themselves. So if someone leaves treatment and relapses, the crew back in treatment finds out. They can’t help it, they are wired to care. They have to know. So it is not like people who leave just disappear into thin air and are never heard from again. The old peers and friends from long term rehab tend to follow up, to keep tabs, to hold people accountable.
So what I learned in all of this (while I was both living in long term rehab and working there) is that I could not necessarily predict who was going to remain sober. It was much harder than you would think.
Now don’t get me wrong, it was still fairly easy to predict a failing attitude. Someone comes into rehab and you just know they are never going to make it because their attitude is so bad. This is obvious, and you should definitely take note of this. A bad attitude sets you up for relapse. Period. So it was fairly easy to predict this side of things.
But there was also the struggling alcoholic who would come into treatment and your heart would absolutely bleed for this person. They had the best attitude in the world. They were full of hope without being cocky. They were warm and friendly and nice. They had hopes and dreams and they really wanted to do the right thing and to find the right path.
Many of these people relapsed. Many of the people who had a fantastic attitude towards recovery relapsed. How do I know? Because number one, people talk….and number two, many of these people who relapsed came back at a later time for more treatment. That makes it sort of obvious when they come back to detox a year or two later. I worked at a rehab for 5 years and if you count the time that I also lived there it was more like 7 years. So you get to know and watch a lot of individual stories during that time. Thousands rather than hundreds.
So what I am saying is this:
If you have a bad attitude when you check into rehab (short or long term, doesn’t matter) then you are almost certainly headed for relapse. And if you have the perfect attitude then you may or may not be headed for relapse as well. Having just the right attitude does not insure success.
So what does insure your success?
I would say that “depth of surrender” is at least as important as having the right attitude, and probably is even more important.
Remember those people that I mentioned who had the right attitude upon entering rehab, but they still managed to relapse anyway?
Why did they relapse? What was the problem, if they had the right attitude?
The problem was that they had failed to surrender fully to their disease.
They were not done self medicating yet. They were not done drinking. They were still having fun with drugs or alcohol. They were not yet desperate for change.
It is possible to be in this state of “non-surrender,” and yet still be eager to learn, humble, and pleasant with others. Just because you are humble and eager to learn does not mean that you are in a state of total and complete surrender. We are talking about that state of desperation where you are willing to do anything in order to escape the pain and misery and chaos of what you have been living through.
There is difference. True willingness comes from total surrender and real desperation. You have to be miserable. Totally sick and tired.
How long term rehab is different from short term treatment and what sort of strategy you should use
Long term rehab is quite different from short term residential programs.
It is more about living when you are in long term, whereas short term treatment is more about learning. They are pushing you out the door in 28 days or less and so they have to cram you full of as much information as possible in that short amount of time.
With long term it is different. You have time. You have time to go through different experiences on the outside and then use the support that you have living in long term to help you make it through those new experiences.
For example, going out and getting a new job while you are in long term rehab. What is that like as a sober person? Maybe you have never had to deal with an annoying boss before without being able to drink your frustrations away. So how do you deal with those frustrations? If you went to short term treatment then you have to figure it all out on your own, after you leave rehab. But if you are living in long term treatment then you have the opportunity to go back to the group and say “hey, I got this new job last week and I think the boss is going to drive me crazy. What can I do about this?” And the group can give you feedback and you can make adjustments right as you go along, with the support of treatment behind you.
This is the whole point of long term rehab. That you have a ton of extra support as you try to manage your life without drugs or booze. So you can actually learn as you do things.
In short term rehab you can only make theories and learn about the potential future. So they might tell you in short term rehab “hey, you might get angry at your boss some day, and if you do then here is how you deal with it. Use these tools, call your sponsor, go to a meeting, call your peers in recovery, etc.” And so you are told what you must do in that situation but you don’t get to practice it. You just have to leave rehab and then you are on your own and you have to sink or swim.
But when you are living in long term rehab you have a chance to adjust and learn as you interact with the world. You get to leave the rehab and go get a job, or go to school, or whatever. You get to go out into the world and interact and then come back to the rehab and say “this is how it went, and this is how I dealt with it. Help me adjust.”
So the right attitude to have in long term treatment is one of humility, of learning, of being willing to take advantage of the support you have. If you are living in a long term facility then you likely have peers there will and probably some form of counsel. Take advantage of that support, that is the whole point! Use it to your advantage. Use it to learn. Then by the time you are ready to leave the long term facility you will probably be much wiser and your experience will be incredibly valuable to others. The newer people in the long term rehab will be benefiting greatly from your experience. They will be sad to see you go because you will actually help them a lot.
But in order to get to that point you have to be willing to learn. You have to be willing to experiment and try new things and learn from them.
Why most people fail to remain sober even when having the advantage of living in long term rehab
As I said earlier, I was honestly shocked at the poor success rate that I observed while living in long term rehab. This continued after I left the treatment center but then later worked there for 5+ years. I watched many people go through long term treatment but I was always discouraged by the poor success rates.
So what was the deal? Why did so many people fail to remain clean and sober, even though they had all of the advantages of living in a rehab center? How did they fail with all of that support behind them?
It always comes back to surrender. Everything in recovery boils down to surrender. This is a fundamental concept of recovery, and it is the entry ticket to a new life in recovery. If you fail to surrender then you cannot succeed in recovery, period.
So many people that I knew were fooling themselves. They were entering treatment for the wrong reasons. I know this too because I did it myself twice.
For example, a long term treatment center is usually a pretty sweet deal in terms of living itself. Of course there are different models set up out there but the one that I stayed at was set up to house homeless (or semi-homeless) alcoholics. This meant that you could apply to go there and if you were accepted then you basically got a free ride. They fed you, they housed you, and they asked for nothing in return unless you started working while you lived there (then you had to pay a percentage of your gross pay to them).
This is both good and bad. It is good because then such a treatment center is able to help those people who really need it the most. People who have no other place to turn too, no other options. But it is bad because it sort of sets itself up to be a “flophouse,” where struggling alcoholics know that they can get a free ride on easy street. It’s nice to have a roof over your head and 3 square meals per day. In fact, if you have been out on the streets drinking for a while then this sounds like a slice of heaven. Most alcoholics would give up their friend alcohol for a while in order to enjoy such easy comfort. The sad thing is that people who might do this have no intention of quitting alcohol in the long run. They are just using it as a temporary “break” in their life.
If you have a bad attitude then you will relapse. If you have a good attitude then you are likely to relapse as well. The only people who “make it” in recovery are those who have reached a point of total and complete surrender. People who are willing to do anything and go to any length in order to remain sober.
You would think that this would include nearly anyone who is going to long term treatment. However, as pointed out above, this is not always the case. Many people who check into a long term facility have no intention of quitting alcohol in the long run. They are just there for temporary relief.
So how do you know if someone has reached a point of true surrender?
You never really know for sure until you see the outcome. The problem is that we can even fool ourselves. I know this to be true because I went to treatment a total of 3 times. And every time I went I had some amount of hope that I might be able to change and make it work in sobriety. But the last time that I went to rehab things were different. I was totally and completely miserable. I was thoroughly miserable. And I was just so sick and tired that I was willing to do anything to end the pain. This is what made all the difference. But the first two rehabs that I attended, I had no way of knowing that I had NOT yet reached that point of total surrender. You will know it when you reach it, but you will not know it if you are not quite there yet. This is subtle but very important, as your entire success or failure in recovery hinges on it.
What your recovery strategy should be post-treatment
The entire time that you are in treatment you should be planning.
You should be forming a plan for when you leave. Everything that you learn and everything that you are planning for should be in answer to the question:
“What am I going to do to stay sober when I leave out of this treatment facility?”
The answer to that question may vary depending on your situation. For example, when I was in short term rehab, the answer to that was “I am going to check into a long term facility and live there for a long time.”
But then I was living in long term. And so it was critical that I ask myself that same question regarding the day in the future when I was to leave rehab altogether. What was my plan at that time? To go to meetings every day? To see a counselor or therapist every week? To work closely with a sponsor in recovery? To do all of the above? To do something else entirely?
If you don’t have a plan then guess what will happen? The default will take over. And you should be able to guess what the default is. If you have the label “alcoholic” or “drug addict” applied to yourself then you know what your default choice is. It is to self medicate.
Everyone relapses unless they take action to overcome this default action. We should never be shocked when an alcoholic drinks. We should never be shocked when a drug addict uses drugs. We should be amazed when they stay clean, because this goes against their nature. It takes energy, effort, change. So realize that you are going to have to put forth a tremendous effort in order to overcome your “default mode.”
What to do if you relapse
If you relapse then your goal should be clear:
Get professional help immediately.
The alternative to this is to be overwhelmed with shame and guilt. If you let yourself wallow in this shame then it will only fuel you deeper and deeper into addiction.
You feel bad because you relapsed, so you medicate by drinking more. A vicious cycle.
You must cut this off instantly before it ruins you. Relapse can be deadly. In fact it can be much worse than the addiction itself because the disease progresses.
The disease progresses while you are sober. Most people do not believe that or understand it. But just listen to people who come back to AA meetings after a relapse. In every single case such people say “It got worse.” They always talk about how their addiction or drinking was much worse following a relapse than it ever was before.
So if you relapse you must take immediate action, and seek professional help. Don’t let the shame and guilt keep you from going back to treatment. Almost no one gets it perfect on their first try anyway.