The Problem with Alcoholism Rehab Treatment – and How to Fix it

The Problem with Alcoholism Rehab Treatment – and How to Fix it

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If you have ever heard the success rates for alcoholism rehab treatment then you probably know that it is not exactly a magic bullet.

Typical success rates vary wildly when reported because there is no exact method for measuring what “success” really is.

For example, say that you have an individual who comes into rehab for their alcoholism. They complete the program and then they leave treatment. Two weeks later the rehab calls the person up for a follow up phone interview and asks them if they are still clean and sober.

Note that the rehab might wait two weeks or they might wait two years before following up. Just because someone stays sober for two weeks, does that really make them a success?

Second of all let us imagine for a moment that you are the struggling alcoholic who has just left rehab. You invested a great deal of time and effort and money into treatment. It was a really big deal and a big event in your life. Nevertheless you end up relapsing almost immediately upon leaving. So when the rehab center calls for a survey and asks you if you are still sober, what do you tell them?

- Approved Treatment Center -

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You would be amazed at how many people would not tell the truth in this situation, simply based on their level of shame. They don’t want to admit to themselves that they have failed so quickly. They may be embarrassed as well.

So you can see that the data that rehabs collect may be a bit skewed to begin with.

But even with these inherent problems with getting good data about success rates, you will still probably not be very impressed if you do the research. Most figures pin the success rate after one year somewhere between 3 and 20 percent. In other words, at least 8 out of 10 people have relapsed after one year of leaving rehab.

I know that this is a very difficult problem to address but those figures do not really sound like a success to me. Now it would be easy to point the finger at the rehab industry in this case but I don’t really believe that you can do that. They are not the problem as they are doing everything that they can in order to help people.

People who are not familiar with the treatment industry may believe that there is a magic cure out there somewhere. There is not. Believe me, if someone had cornered the market on treating addiction, that is not a secret that would be kept. If such a secret existed it would spread quickly and the treatment industry would adapt. But no one has found this magic cure because at the current time it does not exist. Recovery is hard work no matter how you slice it. Period.

So the problem with rehab is that it is expensive, it is a huge ordeal, and it only works roughly 20 percent of the time or so.

How can that be fixed? Especially when the treatment industry is already doing everything that they can in order to help people?

Why rehab is not a magic cure for alcoholism

I do not believe that short term residential treatment is every going to become a magic bullet or a cure. No matter what techniques or therapies are developed, there are always going to be major hurdles for alcoholics to face.

The problem lies with the individual. What can you do if someone wants to self destruct? Not much. The most that any rehab can do is to offer the hand of help and be ready to give assistance when the person is ready to get clean and sober.

This may be the entire problem in itself: A lack of surrender. People go into treatment long before they have hit their true bottom. How do I know this?

Two ways. One, I have been to treatment 3 times in my life. Obviously the first two times I went I was not at a real bottom. I wanted a change in my life and I was willing to go to rehab but I was not willing to do anything in order to get that change. I was not at my real bottom. I may have thought that I had hit bottom but there was still a part of me that wanted to drink and self medicate. So I know that it is possible to fool yourself, to go into treatment and not really be ready to make serious changes.

Second of all I worked in a rehab for 5+ years. While I was working there I witnessed thousands of alcoholics who came into treatment to try to turn their lives around. Over time I was able to see much more clearly who was serious and who was not quite ready yet. The vast majority were not ready. They thought they were ready but something was holding them back. They had some sort of reservation. They had not had enough pain in their addiction yet.

If you want to increase the success rate of your treatment center then one way to do it would be to screen the alcoholics that you allow to come into it. Only accept people who are at their true bottom and who are willing to do just about anything in order to get clean and sober. How exactly would you screen for that? I’m not sure exactly, as no one has ever done it yet (as far as I know). But a treatment center might try some things like:

1) Interviewing applicants to make sure they are serious and want help for themselves (i.e., they are not coming for their spouse or for their family who is pushing them to get help).
2) Demand a big up front commitment in some way. For example, have people commit to a longer stay in treatment if they want to come in to rehab. Make it a binding contract, almost like going voluntarily into jail. Sounds like a scary concept but then you filter out the people who are not so serious, etc.
3) Accept referrals from hospitals or jails. People who have just experienced consequences may be more likely to see positive results in treatment and be more motivated to take it serious.

Those are just ideas on what might produce better success rates. Unfortunately it does not really do anything to help people who do not fit into those narrow categories. So while a rehab might try something like this just to make their success rate look better on paper, they are not really reaching out to all alcoholics and their true success rate has not changed at all.

Long term rehab is not a magic cure either as relapse rates are relatively high

My own experience is biased because I finally got clean and sober by going to a long term rehab. I lived there for 20 months.

This was the best decision I ever made. Ever.

So for a long time I was convinced that long term treatment was the “cure” for addiction and alcoholism. I walked around and saw people who had relapsed and I thought to myself “What is wrong with these people? Don’t they realize that if they just go live in rehab for a few months (or years) that they would overcome their addiction?”

I thought this way for a while but eventually I started to see the cracks in my theory. Long term rehab was not, in fact, the magic bullet that I thought it was. It worked for me but it definitely did not work for everyone. I slowly realized this as:

1) Many of my peers who lived with me in long term rehab ended up relapsing. This is did not always happen quickly but after a few years time I realized that nearly everyone had relapsed. Many stayed clean and sober while in the long term rehab but months or years later nearly everyone had relapsed.

2) I looked at statistics and rehab data (mostly from the NIDA, a government website) and realized that the success rates for long term treatment do not really differ that much from short term residential. My assumption was that they would have very different success rates, and that long term rehab would win hands down. This was not the case though when I looked at the numbers. Very little difference, in fact.

My assumption was not that long term rehab was a magic cure, but that people who were willing to live in rehab and commit to longer treatment would obviously be more serious than someone who is only willing to go into a 28 day program.

In other words, why were so many of my peers in long term rehab relapsing? I thought they were seriously committed to recovery. Otherwise, why did they sign up to live in rehab for 6 months to two years? It did not make much sense.

And therein lies the problem. Long term rehab is no magic bullet. Just because it requires a much bigger commitment than short term treatment does not seem to affect the success rate of it very much.

Baffling.

And, I think it proves an important point:

You can’t just force people to become sober by forcing them through longer treatment programs.

Nor can you fix them just by using a “better” treatment program.

There is no such thing, really, as a “better treatment program.” I think that we all have this secret hope in our hearts that perhaps there is a magic rehab out there with a significantly higher success rate than all the other rehabs. That we sent johnny to the rehab down the street and he relapsed, but if we only could have sent him to “the best rehab in the world” then surely he would have stayed sober.

Not true. There is no “better treatment” out there. That is a myth, it is a lie. Sure, rehab centers will vary. They are different. Some are probably better than others in some ways. But ultimately this line of thinking misses the entire point, which is that it all comes down to surrender.

My second rehab center (out of 3 total) was to a very prestigious and world renowned rehab center. They had an outstanding reputation. And yet I relapsed immediately.

My third rehab center was a local place that was struggling to get by. In fact they went bankrupt while I was living in their long term rehab center, but another company stepped in and bought them out to keep it alive. They were not prestigious and well known. And yet that is where I finally found sobriety.

So if you think that we can “fix rehab” or that we can “fix the treatment industry” I think that we would be focusing our energy on the wrong place. You can’t fix rehab. You can’t make it better. I mean sure, you can improve a rehab center a little bit, and you can play around with new treatment methods and methodologies, but there is really no magic cure out there. You can’t change your rehab program and suddenly hit a home run and have a 90 percent success rate. That isn’t going to happen because the success rate does not depend on how nice your therapists are or what type of meetings you have the clients attend.

It is all up to the individual. And that is the problem.

The only way to “fix” the problem is on an individual basis

The only way that you can really fix the lousy success rates of treatment are on an individual basis.

This is sort of a cop out. Essentially we are saying here that you can’t really do much better, and that the treatment industry is already doing everything that it can to help people.

I have studied the field for 12 years now. I lived in rehab for 20 months. I went to 3 different treatment centers in 3 different cities. And I worked in a rehab for 5 plus years.

After all of that, I am convinced that there is no magic cure out there. It all comes down to individual surrender.

It is up to the individual alcoholic to seek help, to want to get sober, to want it more than anything else in the world.

If you take an alcoholic who is in a state of total surrender and you try to help him, it does not even matter that much what you do.

Let’s say you spin him dry in a medical detox and then send him to a 28 day program.

Or let’s say you give him to a very active group of AA people and they take him to meetings every day for 90 days.

Or let’s say that you have him live in long term rehab for a year.

Maybe you have him go to counseling and therapy every day and also get a sponsor in AA.

None of these things are necessarily the answer. None of them rise above the others as being the perfect solution.

What is important is the individual’s state of surrender. Have they surrendered fully and completely? If so then they will do well with any of the above setups. So long as they can detox safely and then get help and support, things should turn out well for them. It is all up to their level of commitment and surrender.

If such a person goes to short term rehab and then they leave and relapse, then you should not say “well, if he would have taken our advice and gone to long term rehab instead, he would still be sober today….such a shame.” This is not how it really works. He could not have “just taken your advice and gone to long term” and things would not have just worked out well as you are predicting. It was not the treatment choice that screwed him up, it was the lack of surrender.

If you surrender fully then any treatment will help you. If you have not surrendered fully then nothing can help you.

The problem is that there is no such thing as a rehab center or a treatment method that can make people surrender.

There is no place that you can go where they will beat true surrender into you. It doesn’t work like that.

If it did then the success rates would be 100 percent, or very close to it. If rehab centers could force people to surrender then you would see amazingly high success rates.

Obviously this is not the case. If any treatment method can figure out how to force people to surrender then suddenly we could cure all alcoholics and drug addicts. But you have to stop and think about that for a moment. Would our society even allow that sort of “cure?” Where an institution is allowed to force people to do something? Where we somehow beat people into submission? I sort of doubt that our society would allow such a cure.

And this is why the problem of alcoholism will always be difficult. It will always be a personal battle. And we will always blame rehab centers instead of pointing at the real culprit, which is lack of surrender. People fail because they are not yet ready to change. And yet our secret hope is that some rehab out there might be able to convince them to change.

Of course rehabs cannot convince people to change. We would not even allow such a place to exist. It goes against the freedoms of our society.

If you want sobriety badly enough then you will do whatever it takes to get it

The bottom line is that it all comes down to individual surrender. If the alcoholic wants to change badly enough then they will do whatever it takes in order to change.

Willingness is the key. You have to be willing to get out of your own way and let others tell you how to live.

This is hard. No one wants to be told how to live. No one wants to go through that level of humility if they can possibly avoid it. We don’t like being wrong. We don’t like admitting that we need help in order to live.

Asking for help can be the single biggest hurdle to recovery. Most alcoholics are too proud to ask for help. They want to figure it all out for themselves. It is only after much chaos and misery that they are willing to admit that they cannot beat the problem on their own, and that they need outside information. For some people it takes years or decades of pain and misery before they surrender.

Why you should still consider rehab as the best starting point for recovery

Rehab is not a magic bullet and I do not believe that it ever will be.

If someone wants to drink and self medicate then there is nothing we can do that will change their mind.

You can’t send someone to rehab and have them magically change their level of willingness.

You can’t send someone to rehab and then the treatment somehow forces them to surrender.

I don’t see this as ever being realistic. I do not believe that any rehab will ever be able to “cure” people who are not at total rock bottom.

Instead, I think it is always going to be up to the individual.

Those who are willing will recover. Those who just want a quick fix to their pain are not going to make it.

The only way to “fix” the treatment industry is to fix the individual. Total surrender leads to willingness. And willingness leads to follow through.

And the follow through is what keeps people clean and sober.

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