What are some of the key concepts that alcoholics rehabilitation centers use to try to help people?
Let’s break some of the concepts down so that you can understand what you are getting when you go to rehab.
Disruption, education, and support
There are 3 main concepts that nearly every treatment center will employ. Those are disruption, education, and support.
Disruption is actually part of the surrender process. When you surrender and agree to go to rehab, you are disrupting your pattern of abuse.
But more than that, the rehab center does everything that they can in order to further disrupt your pattern of alcoholism. For example, they will generally try to encourage you to stay in treatment for as long as possible (or as long as your funding will provide for) because they know that this is even more disruptive to your addiction.
When you are addicted to alcohol then you are stuck in a pattern. You drink every day, over and over again. If you can disrupt that pattern by being in treatment for two weeks then that is a good thing. If you can disrupt the pattern even further by being in treatment for 28 days then that is even better. I actually went to rehab and stayed for 20 months, which was probably just about the most disruptive thing that I could do in terms of overcoming my addiction. Now this is not to say that just going to rehab for a longer period of time will solve all your problems–it doesn’t necessarily work that way. In order for the disruption to lead to long term sobriety, an awful lot of things have to happen in addition to just the initial disruption. That said, the concept of disruption is still very important. This is one of the biggest selling points of going to rehab. If you actually commit to rehab and stay there for 28 days then you have an automatic jump start on your recovery. Even though you are in a controlled environment, getting 28 days sober under your belt is certainly worth something. It is a huge part of what gives you a fighting chance against your alcoholism.
Now the next major concept is education. What this really means is that the alcoholic must learn a new way of life in treatment. Typically this involves the 12 step program but it may also involve religious based recovery or even a behavioral approach instead. Regardless of what the methodology is, the basic idea is always the same: The alcoholic does not know how to live their life without drinking, and they need to learn an alternative way to live.
In fact, this is a big point that many people get tripped up on. They believe that if they just find the one true solution to recovery then all of their problems will be solved. Or people who have achieved recovery in some cases become extremely biased because they tried so many different ways to quit drinking and then they finally got sober after going to program X (maybe AA, maybe religious recovery, whatever). And so then the recovering alcoholic believes that because program X finally worked for them, that it must be the one true answer for every alcoholic on the planet. Nothing else works, right? This sort of bias is incredibly common in recovery, and it is almost impossible to talk anyone out of it. They just cannot see how any other viewpoint would be valid. And they feel justified in being obnoxious about it because they are saving lives, right? Or at least they think they are.
In reality, the actual program that you learn in order to remain sober matters very little. That will sound like blasphemy to some people in recovery, but again, those are likely the people who are suffering from that particular bias. The bias where they believe that they way that they finally got sober is the only way that could ever work for anyone else.
What matters much more than that is how you work the program that you learn. In other words, it is not so much WHAT you are taught in rehab, it is more about how you implement it. Do you follow through? Do you apply the strategies and tactics that they give you? It is all about taking action.
Most recovery programs give lots and lots of suggestions. Some of the people follow through on these suggestions and most people do not. And, most people relapse. What does this tell us?
Then those same people who relapse will blame the program that they had learned. They will say “that program was not right for me,” or “that program is junk and it doesn’t really work for anyone.” Then they find some other program and believe that it will solve all their problems. And they are actually correct–that new program will solve all of their problems, if they are willing to actually follow through and take suggestions. But the real truth is deeper than that–the first program that “failed them” would have worked just fine as well, if only they had surrendered fully to their disease the first time. No surrender, no recovery. What you actually learn in terms of a recovery program is largely beside the point.
For the record, most rehabs use the 12 step program of recovery that is based on AA. This is not necessarily good or bad, it just is. If you work that program and follow through then it can (and will) work for you. There are other ways to get clean and sober though and many of the people who are in 12 step programs are terrified to explore those avenues (if it ain’t broke, don’t fix it–they will argue). So if the 12 step program works for you then this should work out fine. Go to your meetings, work the steps, get a sponsor and join the fellowship. Dive in head first and do not resent any of it. If that doesn’t work for you, there are other ways of maintaining sobriety (though you will mostly have to figure that out for yourself, with a little direction and suggestions from Spiritual River of course).
Why aftercare is at least as important as the actual residential treatment
Recovery is process. Everything is process.
You don’t go to rehab and become cured. That is a myth. Maybe you already knew that but many people do not realize that simple fact. Recovery is not a one off event. It is not a cure.
Recovery is a process.
If there is one thing that my sponsor taught me it is that recovery is a process. I realize that more than ever now because I also have watched him grow and evolve and change a great deal since I met him over 12 years ago.
When you are in rehab for 28 days you may come to resent the fact that they are telling you what you must do when you leave treatment. You have to go to outpatient therapy, or counseling, or AA meetings, or all of the above. And you have to do it a lot, nearly every day or even every single day, and you have to keep doing it for a long time.
When I first realized that the first time I went to rehab I said “forget it.” It was all too much for me and I was still stuck in denial anyway. But the idea of recovery as a lifelong process was just overwhelming to me at the time. I was nowhere near desperate enough for change. I went back out and drank more and lived through a whole lot more pain before I was willing to finally surrender.
If short term rehab (28 days or less) is the disruption phase, then your aftercare program is the follow through phase. This is where you make or break your recovery. Anyone can go to short term rehab, get spun dry in detox, and then get slapped on the back and sent back out into the big, bad world. But it is very few people who manage to stay clean and sober for an entire year after that, and even less who will stay sober for 5 years, 10 years, and beyond.
Who makes it?
If you look at the data enough you will realize a definite trend: Those who dive into recovery and go all out are generally the ones who make it. People who go to every single meeting, who keep every appointment for counseling after they leave 28 day rehab, and so on. The people who live through long term rehab and then get heavily involved in support structures like AA and sponsorship groups and so on. If you want to stay sober then you should follow through. The data doesn’t lie. People who relapse are the ones who fall by the wayside, they stop going to their outpatient meetings, they stop going to 12 step meetings, they disconnect from everything in recovery and slowly drift back into relapse. They don’t necessarily want this to happen, they are not trying to relapse when this happens, but it is a lack of action that gets them in the end. It is a failure to follow through.
This is aftercare. This is what you are supposed to do when you leave the 28 day program. If you just go home and you don’t follow through with anything or go to any therapy or meetings or anything then you will just fall right on your face.
Addiction carries a momentum with it. It is hard to stop drinking. It is really hard to establish your momentum in a new direction. You can’t just do 28 days and then expect your whole life to simply rearrange itself. This is not a single decision that then automatically ripples through your life. It takes work. It takes sustained effort. And this is why it takes a serious commitment that must come out of full surrender. No surrender, no recovery.
So those are the 3 basic concepts. Disrupt your pattern of addiction, educate yourself on how to live a different sort of life, and then follow through with aftercare. These are the basics that most rehabs try to teach you.
Of course, people can go through all of these motions without ever having truly surrendered first. I have done so myself at least twice when I was not yet ready to fully commit. But in retrospect all I did in those two cases was to go through the disruption and learning phase, but I never implemented anything in the follow up. I never followed through and went to aftercare.
This is why perhaps the strongest predictor of your long term success in recovery has to do with aftercare. If you go to all of your aftercare post-treatment then your odds of achieving long term sobriety go up a huge amount. If you skip all of your aftercare or ignore it completely then your odds of being sober in the long run are seriously diminished. Process, and follow through.
What you can learn from watching people in treatment centers
I lived in a rehab center for 20 months and then later on I worked at a rehab for over 5 years.
You can learn a lot by watching people in rehab. You start to learn what does and does not really work. There are a few ways that this happens and unfolds.
One, people who leave rehab and then relapse very often come back later. I was astounded at how much of a “revolving door” treatment was when I worked there for 5 years. I watched some individuals come back into treatment several times in one year. And this happened with a startling number of alcoholics and addicts.
Second of all, I was very bad in the beginning at predicting who was going to “make it” and who was going to relapse. This was very deceptive and tricky at first because normally the people who were the most positive and the most vocal ended up relapsing. But at a glance those people really seemed like they had the best odds of making it.
I had to think back to my own demeanor in rehab to see what sort of person is actually in a decent position to stay sober. It is not the person who seems confident and has it all going on right off the bat. No, it is the person who is quiet. Not quiet because they don’t care, but quiet because they have truly surrendered.
This is the greatest predictor of future sobriety–the depth of your surrender.
If you show up to detox and you are confident and happy and talking about how great recovery is then you are probably going to relapse. This is not the image of a person in deep surrender.
You have to show up to rehab and be at rock bottom. You have to be in a position to stay to other people “I am devastated and I don’t know how to live. Please show me how. I will listen.”
If you are confident or cocky or manipulative in any way (or even trying to control things in the slightest) then that is not a good sign. You must be in a state of full surrender.
The alcoholic who is in a state of surrender has lost the ability to care. They no longer care. They have stopped caring. If they still cared, they would go get drunk again! So it is a fine line. At the same time, they still have that tiny sliver of hope that maybe things will turn out different this time if they actually shut up and listen. That might sound harsh, but it was definitely true for me. I had to learn how to get out of my own way, even though I normally liked to think that I was pretty smart, and that I generally knew what was best for myself. The truth was that I was screwed up in my life and I had no idea how to live anymore and I needed help.
How to work your recovery perfectly and not relapse
So what I learned by watching people in recovery is that there is a right way to go about it and a wrong way.
I also had one more piece of evidence that fed into this, and that was my own personal experience. Having “made it” to over 12 years sober I, at some point, starting counting my own journey through early recovery as a success. When does early recovery actually end and long term sobriety begin? That is up for debate but I am going to stay that I definitely no longer in early recovery at over 12 years sober now. Therefore I have one more (strong) data point in my own experience, not to mention all of the alcoholics that I observed while working in rehab for 5+ years.
What I learned is that the people who gave up total control in early recovery fared better than those who struggled to control things.
Again, my own experience was huge in pointing this out as well.
I had been down the road before, and I had struggled to control things, and it never worked. So I had to figure out how to get out of my own way and let others tell me how to live.
To do this I made a secret pact with myself: No decision allowed.
What I mean by that is that I was not going to allow myself to make any decisions on my own. If I was going to do anything other than brush my teeth then I was going to get feedback from other people first before I did it. I was so afraid that I would sabotage myself and relapse that I did not trust myself with my own ideas.
This worked. It worked quickly, too. Try it for just two week and see what happens. Truly, do not let yourself make any decisions, but instead rely on the input and feedback of others. Commit to doing this for just two weeks and watch what happens. You will be amazed.
I was amazed. I am not sure how long it took, but I was amazed at how much better my life was suddenly getting. I realized that I was still in control of my life, and I was still the final decision maker, but I was sort of “cheating” by getting all of this advice and input from others. It was like I was getting free advisers in my life who wanted to help me succeed. And that is exactly what happened. I asked for input from my sponsor, from my peers, and from my therapist. Everyone gave me suggestions and told me what to do. Then I did it, and followed through with their suggestions, and most of what they suggested was stuff that I kept and continued doing. Very few things I discarded and forgot about as being useless to me.
And then I repeated the process. I sought out more suggestions. And so I continued to grow and to learn in my recovery. And I found out that by trusting other people my life could get better. A lot better. And really quickly too. This tactic works extremely quickly if you completely surrender to the concept and really get out of your own way. Trust me, you have to try it to get the full effects. Just talking about the theory or thinking about it will not help you. You must seek out advice and feedback and then act on it.
Teaching people how to engage with personal growth in long term recovery
One of the biggest challenges for treatment centers is to teach the newly recovering alcoholic what they must do in order to stay sober in long term sobriety.
Believe it or not, this is a bit different than what you might do to stay sober at 30 days into it.
We learn and grow and change in recovery. As such, our recovery strategy will change in long term sobriety.
This is as good thing and not to be feared. But it is a difficult thing to teach someone in early recovery how this transition will occur.
In the long run, complacency is overcome through personal growth. But in early recovery, a greater emphasis is put on support structures and disruption.
In the end, the recovering alcoholic must find their own path to overcoming complacency.