What Doesn’t Work at Rehab for Alcohol Addiction
Going to addiction treatment is a bit of a crap shoot.
There is no guarantee that anyone is going to stay sober forever. This is unfortunate because this is really what the majority of people would like to buy with their trip to rehab.
We want sobriety to be sold as a product. So that we can simply buy it up or use our health insurance and make it all better without any real effort.
After the madness of addiction or alcoholism we want for the solution to be easy to implement. Just pay the fee and get cured, right?
Wouldn’t it be nice if it really worked that way?
Unfortunately for alcoholics, it most definitely does not work that way.
Some people get angry when they learn that this is the case. They get upset that rehab centers cannot work miracles or magically change people overnight.
It’s tough work. And there are a whole lot of things that rehab centers do right. But there are also places where they fall short, and these are areas that will perhaps never change. In spite of all of our efforts, there is no way to cure addiction outright. No magic wand. It’s unfortunate too, because that is something that people are definitely willing to pay for. People are also more motivated to gravitate towards an easy solution. The current solutions are anything but easy.
This is not a criticism of the treatment industry. Rather, it is an observation on the nature of addiction. If we could cure it, we would.
Drug rehab and alcohol addiction centers do the best they can
Rehabs do a lot of things right.
Here is what they can basically do for the alcoholic at our current state of treatment:
1) Disruption. The addict or alcoholic agrees to get help and they check into rehab. It is a controlled environment so that person is protected from the threat of immediate relapse. You can’t drink or use drugs if there are none available. So this is step one: disrupt the pattern of using. Remove the addictive substances.
2) Detox. Put the alcoholic through a medical detox center where they are kept safe. Monitor them. Nurse them back to health. Use medications to control extreme withdrawal symptoms. This is a 3 to 5 day process for most people.
3) Teaching. Rehabs then put the recovering alcoholic into groups each day and try to teach them how to recover. They use group therapy, videos, discussions, lectures, and so on.
4) Support. Rehabs usually stress the importance of peer support in recovery. Use your peers in recovery to help you maintain sobriety. Leave rehab and go to AA meetings and find more support. Go get yourself a sponsor after you leave rehab. More support. Find support! This is a directive. They cannot do it for you.
5) Aftercare. The rehab will design a plan for you. What are you going to do to stay sober after you leave rehab? The therapists and counselors at the rehab will try to lay out a plan that fits your circumstances. Go to this appointment, go to that meeting, follow up in this way. Again these are all directives. Suggestions really. Take them or leave them, to the detriment of your own sobriety.
So that is the basic process. Detox, teaching, support, and aftercare. (The individual really has to surrender first and agree to have some sort of disruption occur in their life, i.e., going to rehab to begin with).
This is what treatment centers do. They detox, they teach, they offer (and encourage support), and they prescribe aftercare.
Is it enough?
If the individual follows through with each and every suggestion that they are given, then they will probably remain clean and sober.
The problem is that most people don’t do this. Or can’t. Or won’t. Or it is just plain overwhelming to them.
Many tactics and strategies fall short of really helping people
So why do people fail in rehab?
Why do people go to treatment but then later relapse? How does this happen?
Is it just that they refuse to follow the simple instructions that they are given?
First of all, I don’t like it when people say things like “Anyone can get sober. All you have to do is follow this simple set of instructions that you are given. It is dead simple. Anyone can do this stuff.”
I don’t like that angle because I think it is a blatant lie. Recovery is not simple. The recovery program that they offered me was not simple at all. In fact it was horribly complicated and downright overwhelming.
Do you realize that a 12 step program actually has……twelve steps? How many steps do you think the average alcoholic can wrap their heads around when they have 4 days sober? I am not a stupid person but to be honest I found the idea of having a 12 step program to be overwhelming.
Two more things about that particular detail:
1) The 12 steps are not even the whole story. For example, none of the steps say “don’t drink no matter what.” But obviously that is one of the “steps” that you must follow. So there are also some implied steps that are not explicitly stated. Such as the abstinence directive that I just mentioned.
2) Treatment centers do not only teach the 12 steps. In fact, they teach a whole lot more other than that, and sometimes just leave the 12 step program to be explained to you via the meetings. In other words, they assume that you will learn the steps on your own in the meetings, so they focus on teaching you other stuff. Again, this is overwhelming. Also, if the 12 step program is so darn great, why in the heck would the rehab need to focus on all of this other information? If it really works, why not dedicate the entire rehab programming to teaching you about the 12 steps? But they don’t do that. Instead they have a group about meditation, then another about balanced lifestyle, then another about relapse prevention, and so on. They leave the 12 step program to take care of itself because they assume you are going to be attending AA meetings. So then they throw this barrage of other information at you instead. Of course they are only trying to help, and I realize that. But it’s overwhelming to the average Joe.
Another criticism I have of the treatment process has to do with aftercare. There is something called “IOP” that stands for “intensive outpatient.” I believe this to be a truly worthless form of treatment that most people should avoid. The concept is that you are in rehab but you still go home and sleep each night. Then you come back the next day. Oh and you will usually get your weekends off as well.
This may sound like a decent theory of how to help people but I think it is truly useless. One reason for that is because you don’t get the “disruption.” Your life is not disrupted at all because you are not living in treatment, you just go there once each day. But then you go back home. So your life is not truly disrupted.
This is a big issue. In fact, I think that most of the success of inpatient rehab is based on the idea of disruption. That’s the whole ticket. All of the groups and the lectures and the stuff that they try to teach you is mostly overwhelming anyway. There is no way that the average person can absorb and retain most of the information anyway. And even if you can absorb all of that information, it is useless unless it becomes applied knowledge. The stuff that they are teaching you in rehab has to be practiced. It must be implemented.
Outpatient rehab doesn’t make much sense to me. When I have glanced at success rate data I have never been impressed either. Clearly inpatient treatment is the better choice for most people, if not all people. If you go to outpatient rehab then you don’t get any disruption in your life. It is like saying: OK go to rehab now, but let’s increase the difficulty of staying sober by a factor of 10 by making you go home each day. Why would anyone want to do that?
IOP is a tough path to success. Avoid it if you can in favor of inpatient rehab.
Individual surrender is the whole key to success. This is beyond the control of rehabs
The biggest problem by far is that rehabs do not have control over your level of surrender.
This is not really a criticism. I don’t think our society would be happy with rehabs having this ability, to force people to surrender. That is not how we operate in our free country.
And yet that is what we ultimately want when we talk about “curing alcoholism” or addiction.
We want to be able to force people to change.
We expect for a rehab to be able to get a person to change their mind.
If you catch your kid using drugs and they won’t stop doing it and they are addicted, you want to send them into treatment to get the problem “fixed.” In that case we have a parent who probably does not really understand the nature of addiction, and they are hoping that the rehab can somehow convince the kid to want to become sober on their own. This is how you fix the problem, right? Convince the kid that drugs are no good.
Of course we all know that it doesn’t work that way. That it can’t work that way. And yet this is what we hope for. We expect that if we pay a million dollars to the best rehab in the world that they should be able to work this sort of magic on our kid. That they can produce a miracle, simply because we paid extra money for it.
It doesn’t work that way. Sorry. Believe me, I wish that it did.
Unfortunately rehabs have no control over the individual’s level of surrender.
The person comes into treatment and they are either at a point of total surrender, or they are not.
If they are in a state of total and complete surrender, then it almost doesn’t matter what the rehab suggests, the person will stay clean and sober.
If they are NOT in a state of total and complete surrender, then it definitely doesn’t matter what the rehab suggests, as the person is destined to drink or use drugs again. They are not finished drinking yet. Nothing can stop them.
And so it is not fair for us to expect or demand that a rehab center can perform this magic trick. The trick is impossible, to get someone to want to be sober. No one can convince someone who is not ready yet.
They must reach that conclusion on their own. And you cannot get there through logic.
This is an important truth and I wish that I had known it myself all those years ago.
You cannot convince someone to sober up through logic. Using logic is the completely wrong approach. It simply will have no effect at all. The alcoholic cannot see your logic. They have their own truth and you are missing out on that completely. Your logical argument as to why they should get sober completely ignores their truth.
And what is their truth?
That they are miserable, and the only way that they can get a tiny shred of happiness is by drinking or drugging. That they are different, they are unique, and for some reason they have to get drunk or high in order to be happy. That is their truth, and when we scream at them to go to rehab or get help we are ignoring their truth.
Now I grant to you that they are in denial. That the alcoholic is, in fact, wrong. Their truth is a lie. They believe that they can use their drug of choice to be happy, and yet they remain miserable. Of course they would be happier if they embraced recovery and got the help that they needed. But they can’t see that because they are stuck in denial.
So what is the solution?
It is not based on logic. You can’t tell them “Look, just read this article here, it proves that if you went and got help that you would then be happier.” That is a logical argument. It won’t work.
Instead, you have to let the alcoholic get their fill of pain and misery.
That is what they are doing, they are wallowing in a world full of misery. And they have to keep doing it until they realize that they are no longer getting what they want out of alcohol.
You see, in the beginning their drug of choice worked really well for them. Since then it has stopped working so great. Now it lets them down and makes them miserable. They are only happy for a few minutes each week, maybe an hour or so. But they can’t see this. They cannot see that the tables have turned, and that their drug of choice is no longer as effective as it once was. Instead, they blame others, they blame the outside world, they say “well if only I had a million dollars then I could drink and be truly happy.” They blame anything and everything except for the alcohol. And they hang on to the fact that they can become happy at any moment just by using their drug of choice.
At some point they will realize that this is no longer true. That their magic happiness machine no longer works like it once did. Instead of becoming happy when they get drunk or high they just stay miserable for 99 percent of the time. And so at some point they will realize that this is a bad deal, and that it is never going to get any better.
But you cannot convince them of this using logic. They must see it for themselves. They must drown in their own misery first. Sometimes it takes months, years, even decades.
Have they finally had enough misery? When they ask for help, when they ask how to live, you know they are ready to change. But until that point they are probably just hanging on to denial, hanging on to the idea that their drug of choice can make them happy whenever they want (even though it no longer works that well).
How to focus on what actually helps you remain sober
So how do you focus on what actually works?
If early recovery is a barrage of overwhelming information, how do you focus on the stuff that is truly helpful?
Is it possible to filter it down to that point anyway? If so, why not just eliminate a bunch of the useless stuff?
I think the problem is that we are still in the early stages of treating addiction and alcoholism. The science of doing so is very, very young compared to most branches of medicine. We know only a little and we just started about a hundred years ago. We are still stumbling around in the dark and have not even found the main light switch yet.
As such, there is currently a whole lot of information and not all of it is super targeted and helpful.
For example, I currently exercise every day in my recovery. Part of my exercise involves distance running. This is very meditative. I credit this with being a huge part of my success in my recovery. I don’t know if I would still be sober if it were not for my running habit.
The traditional recovery wisdom is to tell people to pray and to meditate. That’s it. They don’t mention the possibility of exercise. They don’t mention the possibility that exercise may include meditation, as it does for me. They just tell people to pray and to meditate.
What a shame this is! Not only that, but 12 step programs and most rehabs do not suggest or specifically talk about exercise at all. It is not even a visible part of any discussion.
So how does the individual find what really works for them, if the programs are leaving out potentially helpful information such as this?
My suggestion is this:
* Go through traditional recovery channels in early recovery, even though they are not perfect. Surrender and go to detox. Go to residential treatment.
* Take suggestions from people. They will most likely steer you into 12 step programs. Go with the flow. Take suggestions. Follow through. Get a sponsor. Do all of that stuff. Dive into it head first.
* Find the “winners” in recovery and ask them questions. What do they do in their day to day life? Don’t ask them what they do to stay sober because some of them (even though their intentions are good) will just regurgitate the same old AA dogma. They are trying to be helpful and they think that this message is the solution, when really you want to know what their daily actions are that keep them sober. Ask them what they do OUTSIDE of AA. This is where the real solution lies. Of course you aren’t going to drink while you are in an AA meeting. But how do you work your recovery the other 23 hours of the day? Don’t tell me about the steps. Tell me what actions you actually take.
* Seek feedback and suggestions from other people in recovery as to what actions you can take. Say things like “I want to work on personal growth, what do you suggest I do next in my life?” This is the central question that should drive all of your efforts in recovery. Take action.
* You have plenty of time in recovery so you should try lots of things. Some of them will help and some of them will not. For example, I tried sitting in the lotus position and meditating for a few weeks. This did not help me. But distance running was another form of meditation that worked well for me. So I had to be willing to experiment in order to find what worked.