What happens to your recovery if you relapse while attending outpatient alcohol treatment?
There are basically two kinds of alcoholism treatment, with maybe a few variations on the basic themes:
* Inpatient treatment.
* Outpatient treatment.
The difference here is pretty obvious. With inpatient rehab, you stay overnight in a rehab center as if you were staying in the hospital. You sleep there. They have their own recovery program that they try to teach you.
With outpatient rehab, you go home each day. You sleep at home.
The variation on this is that you might be doing something like counseling or therapy, in which case this is also done an outpatient basis.
I have always been a big fan of inpatient rehab, because for me (in my own experience), my environment played a really big part in my addiction. This was not because I was in a bad environment, per se, but more because I had created an environment that was conducive to using drugs and getting drunk. So my job revolved around using drugs, my friends were all into drugs or drinking, and I spent all of my free time either getting high, drunk, or planning ways to do so in the future. My life revolved around my addiction, and that was part of a deliberate design. I grew into that lifestyle, and the signposts of addiction were all around me. I lived to get drunk and high. It became my life.
This may not be the case with you. I have no idea really. Maybe some people get addicted to drugs or alcohol and it doesn’t really change their entire life. Maybe you really just use your drug of choice but the rest of your life remains unchanged somehow. I don’t honestly know. For me, everything changed eventually. For example, I found myself working at a job where everyone else used drugs or alcohol. How did this happen? Did I do that deliberately? The correct answer is: “Sort of.”
If you use drugs and alcohol for long enough, then your life will start to rearrange itself to support this behavior. You are obviously going to be attracted to other people in your life who are doing the same sort of things that you are doing. This is how all of my friends turned into people who abused drugs or alcohol. This did not happen overnight of course. It took years of alcoholism before I woke up one day and realized that I never really spend time with anyone anymore unless that person drinks or uses drugs. This is a process that evolved. I did not plan it consciously and it did not happen quickly. But it does happen over time, simply as a result of your addiction.
As such, my bet is always on inpatient rehab. I never liked the idea behind outpatient treatment. I don’t think it is a strong enough disruption.
The philosophy behind outpatient treatment
The idea behind outpatient treatment is essentially this:
1) The alcoholic or addict surrenders and they want to get help.
2) They do not need medical detox, they are past that or simply do not need it.
3) Therefore they do not need inpatient rehab, they can do treatment on an outpatient basis.
4) Going to rehab each day via outpatient, they can learn about how to live a new life in recovery. So they are there to learn about recovery.
5) Second of all the person in outpatient treatment is using it as a form of support. They will probably also be encouraged to attend AA meetings outside of the rehab. In this way, the outpatient treatment is not only about learning a new way of life, but it is also about having support.
The only way that this technically differs from inpatient rehab is:
1) You don’t sleep in the rehab center overnight.
2) You don’t get to socialize as much with your peers (after all the groups and lectures are done, for example).
In my opinion these are both major issues. They don’t seem like that big of a deal when you first think about them, but if you have actually lived through early recovery, I think they are both pretty crucial.
First of all, staying at an inpatient rehab and sleeping there overnight is like a giant wake up call. It is part of the critical process of disruption.
I believe that “disruption” is an important concept in early recovery. In order to break free from your addiction, you need to disrupt your pattern of abuse.
You can do a minor disruption or you can do a major disruption.
Minor would be like going to one AA meeting per week, and doing absolutely nothing else for your recovery. That is minor.
Major disruption would be like what I did in early recovery, which was to live in a long term treatment center for almost two years straight. Of course while I was living in long term rehab, I also went to meetings every day, had therapy, group discussions twice a week, one on one counseling, and so on. It was a total package, but the foundation of that package was that I was actually staying in a long term rehab and sleeping there each night. This is highly disruptive. The “old life” is completely gone.
When you go to inpatient rehab, your old life is completely replaced for a while. Nothing is the same. You are around different people, you are sleeping under a different roof, everything changes. This is complete disruption. The main question then becomes: How long does this disruption last for? 28 days is a popular time frame and if you go to long term treatment then you may be looking at anywhere from a few months to a few years. In my opinion, the longer you can stay in this “disruptive stage” the better your foundation is in terms of learning a new way of life.
The corollary to this is: The quicker you go back to your old environment, the greater the chance is that you will return to your old lifestyle.
This is why 28 days in rehab will produce (slightly) better results than 2 weeks in rehab. It is also why I finally stayed clean and sober after attending long term treatment, having failed in short term rehab twice before and also failing in several outpatient attempts (which were actually counseling, but you get the idea).
Treatment for alcoholism can be plotted along a continuum. At the one end you have “less intense” treatment and at the other end of the spectrum you have “most intense” treatment.
Most intense would be living in long term rehab for two years. This is what finally worked for me. Of course, many people can get sober with less help than that. It depends on the person and their situation.
Less intense treatment would be going to counseling for one hour each week. That is not very intense. That is not nearly as disruptive as living in rehab, or even going to inpatient for a week. Staying in rehab for a full week is very disruptive to your life (and to your addiction) compared to just doing anything on an outpatient basis.
I am an alcoholic. If you put me in an outpatient program, my mind will figure out pretty quickly that I can still drink or use drugs while I am doing it. But when you stick me in an inpatient environment, that option of “cheating” disappears. You can still walk out of rehab and go get wasted, sure. But if you stick around at an inpatient setting then you are automatically building up sobriety. It is a controlled environment, which is the whole point. You are protecting yourself from yourself by agreeing to stay in an inpatient setting. This is powerful, and often necessary. It certainly was for me.
The idea behind outpatient treatment is that you can cut down on the amount of disruption (and costs!) but still get the help that you need.
I suppose that this actually works for some people who are highly disciplined and self motivated. I am fairly motivated myself but I was never disciplined enough to overcome my addiction on an outpatient basis. It was just too tough for me. I needed inpatient rehab to do it. There are certain things that I needed to learn about recovery that I could not learn without staying in a rehab center.
Why a relapse during outpatient treatment is such a setback
If you happen to relapse while doing outpatient treatment, this is a huge setback. In fact, it pretty much ruins the whole thing.
This is because relapse erases all of your current progress. Any progress that you have made since you got clean and sober is instantly erased when you take a drink or a drug. It all goes down the drain, instantly.
In my opinion, when this happens, you need a hard reset. If you try to pick up the pieces from there then it is a battle of willpower. You have to do much of the legwork on your own, without any help. Sure, you are still going to treatment most days (maybe 4 days a week or so) but how does this help you to break out of the new pattern that you just fell into?
When you relapse you are reverting back to your old pattern. It takes so much effort to turn that around and start living sober. To do this on your own without any help is almost impossible. In fact, many people define addiction in this way. In other words, if you can just quit on your own without any problems, then you were not even alcoholic to begin with. The alcoholic is thus defined by their need for outside help in order to quit. I am not really sure if I agree with this definition 100 percent, but it certainly makes a lot of sense when you apply it to the real world. I worked in an alcohol detox center for over 5 years and I would say that such a definition makes sense. People who don’t need help in quitting their drug of choice don’t tend to self identify as “alcoholics” or “addicts.” People who do need help eventually accept the label. Whether this is right or wrong is sort of besides the point, because if you are drinking or using drugs and it is ruining your life, then you would benefit greatly by asking for help.
The question then becomes: How much help do you really need?
I used to like the idea of outpatient rehab. It sounded a lot better to me than the idea of staying overnight in treatment. This was before I had ever tried to sober up, of course. Who wants to disrupt their life so deeply and lock themselves up voluntarily? It sounds so bad. The idea of outpatient rehab sounds so much nicer. Like you are more in control of yourself.
So here is the real test, if this is your line of thinking:
Go to outpatient rehab. Start there. If it works for you, then great. Go live your life sober and free and be happy. You have made it work. As they say in AA, “our hats are off to you!”
On the other hand, you might relapse. This is possible. Be prepared for this possibility and promise yourself that you will be, first and foremost, honest with yourself.
This is easy to agree to now but it is hard to do in the future. The reason it is hard is because you will have so many convenient excuses. Relapse can happen for any number of reasons, and you can likely justify many of them. Right when you seem to be making a tiny bit of progress in quitting drinking, the drama will hit your life and you will see a need to self medicate.
Therefore you must be honest with yourself. If you can’t quit using outpatient rehab, you should force yourself to consider inpatient.
If that sounds terrible to you, don’t worry. It used to sound terrible to me too–the mere thought of attending inpatient rehab.
So here is what you do:
Get honest with yourself, make a decision to stop drinking, and then start taking action in terms of asking for help.
Start with the least intense option and proceed to the most intense treatment option.
Therefore you can start with casual counseling or an AA meeting. But if you fail, you must promise yourself that you will try a more intense treatment option. Right up to and including going to a 28 day rehab program or even long term treatment.
Once you make this commitment to yourself, that you will stop at nothing in order to overcome your addiction, then that is when you will start making progress. Once you commit, your life will turn around. But you must really be prepared to go to any length, to do whatever it takes. Consider this guide to recovery and see how much effort you might be willing (or not willing) to make at this time.
Considering inpatient treatment
If you relapse during outpatient treatment, my best advice for you is to go to inpatient rehab.
Many people have lots of excuse as to why they cannot, or will not do this.
If you let yourself be stopped by these excuses then this is very self defeating. I have been there before myself, where I made all sorts of excuses as to why I should not go to inpatient rehab. For example, after I had been there once before, I had the excuse of “I know what they will tell me, I know what they are going to teach me, and it did not work the first time, so what the heck.”
Before I ever attended rehab I was stuck in denial, plain and simple. I kept saying that I did not need rehab, because I was not really addicted, because I did not want to stop drinking. How silly is that? I argued that I was not truly addicted because I really did not want to stop drinking. If I wanted to stop, then surely I would be able to do so (I reasoned), but I just did not want to stop….yet. That was my lame argument. I could not even see the denial and the fact that alcoholism had me trapped to the point that…..of course I did not want to stop! I was addicted. But I could not see this simple truth when I was stuck in denial.
And I was afraid of inpatient rehab (before I had ever gone). I was terrified of what they might do there. Obviously it was some sort of torture to the alcoholic because they were withholding alcohol and other drugs, right? I mean, what could honestly be worse than that? I could not imagine what it would be like other than the fact that they would be trying to change me.
I was afraid that rehab would be like brainwashing. I mean, I still wanted to drink and use drugs, so what could they possibly do at rehab that would fix me? Other than brainwashing me? So I had that horror.
And ultimately this was correct. Not that they brainwash you in treatment, because obviously they do not. They can’t. They don’t know how to do that yet, if they did then they could cure addiction. But this is not accurate.
Instead, the alcoholic decides that they want to get help, that they want to stop drinking. Then, they go to rehab, and the rehab gives them suggestions as to how to go about living a new life. That’s all. There is no brainwashing. There is no torture chamber. You either want to stop drinking, or you do not. And if you do not want to stop, then there is no rehab in the world that can help you. There is no rehab that has a torture chamber that forces people to NOT want drugs or alcohol. That doesn’t exist. Yet some part of my brain imagined that this is how it must work.
Overcoming excuses for inpatient treatment
There are many excuses as to why you can’t go to inpatient rehab.
All of them are garbage. I don’t care what you say, they are all garbage excuses.
Let me tell you why.
1) I had excuses myself, such as “I don’t want to lose my job” and also “My family can’t function without me there” and also “who will pay the bills while I am in rehab, and we can’t afford rehab anyway because it is expensive.” I lived with these excuses for many years, then one day I looked past them all and went to rehab, resulting in:
* Having better finances in my life than ever before due to sobriety.
* Having better relationships with my family and friends than ever before.
* My family did not disintegrate while I was in rehab.
* My job offered to let me come back after rehab, plus I had new opportunities for much better jobs in recovery, with doors opening up left and right for me.
This is the first reason. All of my excuses were just based on the fear of getting sober. EVERYTHING got better in sobriety. Everything. My job, my finances, my relationships, all of it. Going to rehab was not fatal. Yet I told myself it was fatal, or that “I can’t go to rehab because….”
All my excuses were flat out wrong.
2) I know alcoholics and drug addicts who have used these excuses, then they died a week later. Sometimes a month later. Sometimes a year later. Ask me how many alcoholics and drug addicts I know who have died. I worked in a rehab for 5+ years and I lived in long term rehab for 2 years before that. I have watched a great deal of this recovery stuff. I have met thousands (literally) of people in recovery and people struggling to get sober.
And I can tell you, many of these people who have excuses end up DEAD.
Think about that. Really pause and consider this. You could go to rehab for 28 days, and the whole world will stop and all of your excuses might turn into big problems and headaches.
Or, you could die from your addiction.
It happens. Alcoholics and drug addicts die every day from this disease.
And how many of them don’t have to?
How many of them could have made a decision, walked into detox, and turned their life around?
But they have excuses. They have families that depend on them, they have a job they can’t lose, they can’t afford to go to rehab, and so on.
Hogwash. All of it. Your excuses don’t wash, because the alternative is DEATH.
This is just what I have learned, and experienced over the years. Don’t let your excuses hold you back from getting the help that you need. It isn’t worth it.
What about you, what has your experience been with outpatient rehab? Was it positive? Was it helpful? Let us know in the discussion forums. It only takes a second to register!