To be perfectly honest, modern day addiction treatment has not really changed much. In fact, the experience that you get at rehab today is going to be pretty much identical to what you would have experienced a generation ago. This is not for lack of progress though, as many different people (and companies) are actively trying to “solve” the problem of alcoholism and drug addiction. For example, drug companies put lots of money into researching new drugs that may help to control cravings for people in early recovery (nevertheless, medication still plays a fairly small role in addiction recovery, mostly because they have yet to find a “miracle pill” that actually makes a significant difference).
So in effect, treatment hasn’t changed much. But you still may be wondering exactly what you can expect from alcoholism treatment these days.
Let me give you a brief overview of what to expect if you considering attending rehab. Note that this will be much the same if you are attending rehab for drugs other than alcohol as well.
The modern day alcoholism treatment model
Essentially what happens at treatment is this:
You check in, go through a medical detox, hang out in a residential facility for a few weeks, and learn about the recovery process. Normally you will be exposed to 12 step meetings or perhaps a religious based approach to recovery while you are in treatment as well. Counselors and therapists run various groups and meetings throughout the day, and you are expected to go to these groups and try to learn about how to overcome an addiction.
Near the end of your stay in treatment they will assign you some tasks to do after you leave rehab. Then they tell you goodbye and you are out the door. This is rehab in a nutshell. You dry out, stay in a drug and alcohol-free facility for a few weeks, and learn tips about how to avoid relapse. Then you go back into the world and try your best not to drink or use drugs.
It’s not a perfect system, but it’s the best we have right now.
Unfortunately it doesn’t work all that well. I think part of the problem with modern day treatment is that it is focusing on tactics rather than strategy.
A better approach would be for rehabs to teach you the overall strategy of recovery (which is to embrace personal growth).
Instead, what they tend to do is to overwhelm you with this barrage of information, trying to cram as many tactics as they possibly can down your throat in the short time that you are there. For example, they may try to teach you what to do if you get a trigger to use your drug of choice. How will you react? They will tell you to go to a meeting, to call your sponsor, to pick up the phone and call someone in recovery, and so on. These are tactics. They are actions you can take when you are facing a certain problem or challenge.
But you don’t get a chance to practice this stuff while you are in rehab. You are stuck there, completely shielded from the real world, and they just keep feeding you more and more information, hoping that you can remember it all later and then implement it when you are facing a dangerous situation. I don’t think this is very realistic. When I had one week sober and I was listening to all of this information in rehab groups it was absolutely overwhelming. There was so much to try to remember.
I am not sure if it is really possible to teach a recovery strategy in a short term residential setting. And I am not sure if it would actually be more effective or not than what is currently offered. But I can’t help but think that it would be. Later on in my own journey I went to long term rehab and was able to actually put some ideas into practice while I also had the support of rehab. I went out into the world each day and practiced what I was learning, but I still lived in a rehab center. This was a nice opportunity but it is definitely not “the answer” as far as bringing up modern treatment success rates or anything. Most all of my peers relapsed while living in long term rehab with me.
At most rehabs, the detox unit resembles a hospital. There are nurses. There are medical beds. They try to get you to sleep through most of your withdrawal process. This is safer than having you up and walking around anyway. I was in rehab once and a guy fell over backwards while he was in detox and cracked his head open. He was OK but they rushed him to the ER because he was bleeding quite badly. So the idea is to lay low and be safe while you are in detox. They try to keep you as safe as possible.
While you are going through detox you may be uncomfortable. Modern day treatment attempts to medicate this problem and get you through it as painlessly as possible. So if you are coming off of opiates they may give you a synthetic partial opiate to help with your withdrawal symptoms. If you are coming off of alcohol they may give you medication to help reduce tremors and things. The idea is to keep you safe but also to give you a bit of comfort.
At the same time, no one should expect to be over medicated while they are going through detox. It does not have to be completely pain and discomfort-free. I can tell you from experience working in a detox for 5+ years that many people expect this, however. They want to be completely taken care of with absolutely no discomfort.
Now I am not saying that people should suffer, but I have noticed a problem with people who tend to relapse. If you do not remember any negative consequences from your past actions then you are much more likely to repeat them. In other words, if your detox process is a breeze and there is no discomfort then what is to prevent you from going through it again in the future? Why not relapse if it is so easy and painless to get clean and sober again? I am not saying we should make people in detox suffer, but I am wondering just how hard we should be trying to mitigate every little bit of pain and discomfort. I watched a whole lot of people relapse.
So you should not expect detox to be very painful, or uncomfortable. They tend to take care of you quite well–maybe even too well.
Detox is easy. There is nothing to be afraid of if you are in a medical rehab setting.
After you leave detox you transfer to a different part of the treatment center. This is the part where you are in a residential setting. The idea is that you are now seeing clearly, out of the foggy mind that you had in detox, and you can now learn and be taught. So they make you start going to groups and lectures and meetings at this point. A popular tactic of people in rehab is to avoid these groups or sleep through them. If you are trying to do that then you might ask yourself: “What is the point of being in rehab if you are not going to attend the groups?” It really doesn’t make much sense to try to avoid the meetings. Therefore most treatment centers will give you a choice: Attend the groups each day or pack your bags. I don’t blame them for this. If you are not participating then there is no point in being in rehab. If you just want to rest you can do that at home.
If it has been a long time since you went to school then you are in a for a surprise, as the groups and meetings run all day long and they keep you quite busy. For the uneducated this will be completely overwhelming. Of course if you are familiar with modern education then it should be no real surprise, you just sit there all day and listen politely and try to participate as best you can.
If medical costs were more under control then they could stretch the time of treatment out and slow down the rate at which they try to teach you about recovery. In other words, treatment stays keep getting shorter and shorter as medical costs continue to skyrocket. No one can afford (or will pay) for 28 days in residential treatment any more. It is too expensive in today’s world. So they keep shortening the amount of time that you can be in rehab. In many places it is down to two weeks or even ten days.
But the therapists and the counselors who run the rehabs are still trying to help people. So what do you do? If you normally take 28 days to try to teach people how to live a sober life, and now you only have ten days in which to do so, what can you do? You shorten the program, of course. You take that 28 days of information and you cram it into ten days.
This is unfortunate for the people who are trying to get clean and sober. Here they are, still foggy from their addiction, just out of detox, and now they are being force-fed the principles of recovery in a condensed version. They are expected to learn and absorb recovery principles at roughly 4 times the rate that they had to in the past (when health care was cheap!). You can imagine what this does to success rates.
If you picture the ideal treatment, it is long. It is safe. So you take a bunch of alcoholics and drug addicts and you medically detox them, then you lock them away for as long as possible. You slowly teach them the strategy that they need in order to overcome addiction.
If you are really good then you will slowly reintroduce them to the real world, in bits and pieces, so that they can practice their recovery knowledge a tiny bit at a time and gain confidence. This is how long term treatment and sober living homes are supposed to work. Give the alcoholic a tiny bit of freedom back, bit by bit, and give them the support that they need in order to remain clean and sober while they learn how to build a new life. This is the ideal. It is expensive. It takes a long time. It start with a 28 day program rather than a ten day program.
And this is not even a cure, or a sure thing. It is just an ideal–better than the modern day, shortened alternative.
What aftercare typically consists of
Rehab is trying to help you avoid relapse in the long run. Of course you can’t stay in treatment forever and at some point you have to leave and go back into the real world. What you do at that point will determine whether or not you relapse. Therefore, “aftercare” is extremely important.
They have done all sorts of studies about aftercare and collected as much data as they can. Unfortunately it is difficult to get good data when it comes to aftercare, because people who drink and relapse do not typically respond to follow up surveys. Why not? Because of shame. You go to rehab, you get sober, you leave rehab, you drink, and then they send you a letter asking how you are doing with your new found sobriety. How would that make you feel? I can tell you what it feels like–it feels shameful. It feels awful. So most people ignore the survey out of shame.
But they have tried to collect good data over the years anyway, and what they have learned is this:
Aftercare participation is a very strong indicator of long term sobriety.
In other words, if you skip the aftercare stuff, you are going to relapse. If you engage in aftercare, then you have a chance at sobriety.
So what exactly is aftercare?
The rehab will typically assign you one or more of the following for your aftercare:
1) Outpatient treatment (you go to rehab several days each week but you go home each night rather than sleep there).
2) Counseling or therapy.
3) AA or NA meetings, sponsorship, etc.
4) Living in long term treatment, sober living homes, etc.
Those are your typical aftercare options. So everyone who leaves rehab is normally suggested to do some (or all!) of that stuff on that list. When I left rehab 12 years ago I was sent to long term rehab, and I was essentially doing all 4 of those things as my aftercare. This is not a magic solution though as nearly all of my peers relapsed (who were doing the same things that I was).
So if there is a lesson to be learned here it is that you should embrace aftercare. You need to dive into it and embrace it with the desperation of a drowning man. If you ignore parts of your aftercare recommendation then you are playing with fire and will likely relapse.
The rehab “cure” versus helping yourself
What about skipping rehab and simply helping yourself? Is that a viable option?
Yes and no. In my opinion everyone can benefit from treatment.
At the same time, I am a big “do it yourself” guy when it comes to recovery.
But I like to segment the problem, and I have to be honest when it comes to my own experience.
I got a great deal of help by attending treatment in the beginning. And I lived in a long term rehab for 20 months.
After that, I stopped depending on others for my success in recovery. In fact, I have lived the last ten years of recovery and sobriety without depending on meetings, fellowship, sponsorship, or any of that stuff really. I have shifted my recovery to one that is driven by personal growth and positive action.
But I am also realistic about what it really took for me to get clean and sober. I could not do it alone. I had to have help. I needed a lot of help to get through that first two years.
So I can only speak based on my own experience, and based on what I have observed in others. I don’t believe that anyone should try to overcome addiction without any help at all. There is no point in doing so. (There is definitely a point in developing your own personal program of recovery in long term sobriety, and reducing dependency on others). But in early recovery and when you are first trying to get sober, you need all the help you can get.
Is this hypocritical? I don’t think so.
We need help in early recovery. We don’t need as much help after ten years sober. Why should that be an issue, or a problem?
If you cannot sober up on your own then you need to seek out help in order to do so.
Modern day treatment is not perfect but it is better than nothing when it comes to finding sobriety. It is worth a shot for anyone who is struggling.
How modern treatment may be evolving
Health care costs are changing the face of modern day treatment for addiction. I believe the fact that we are measuring more and more is also starting to create change (why keep doing something if it is not really working, and is expensive?).
There is one movement for example known as “Oxford houses.” These are sober living homes that people rent and then live in while recovering from addiction and alcoholism. They are self sustaining and do not rely on outside money to exist. In a world of rising health care costs, such a self sustaining solution is very enticing and promising.
In a world where health care is expensive and alcoholics and addicts are broke, who will help such people get the treatment they need? Expensive medical treatment is not going to be the long term trend in my opinion. Instead it will be more grassroots style movements where struggling alcoholics and addicts come together to help each other “on the cheap.” Modern day economic conditions will drive this change.