If you have a struggling drug addict in your life then you may be thinking about trying to help that person.
You are probably aware that there is more than one form of treatment available to help addicts and alcoholics.
So there are options. And you might be confused about these options, or want to know more about each one, and you probably want to know–ultimately–which option is right for the addict in your life to get the help that they need.
So let’s take a closer look at the various treatment options, and hopefully zero in on a solution that will help the struggling addict in your life.
I have some bias of course, because I base this on my own experience, but I have also worked in the treatment industry for several years, and thus have observed several thousand treatment cases directly. I feel like I have a good grip on what works for most people and what does not, having watched thousands and thousands of addicts go through various stages of treatment.
A continuum of treatment options
There is a large range of treatment options, ranging in both price and intensity.
On the far end of the spectrum, you may start out with something like counseling or therapy.
So the addict might see a therapist once a month or once a week, usually for an hour or so, and talk about their problems.
This is probably the least intensive option for treatment. The addict is still spending 99 percent of their time in the same environment, and they are not really removed from their usual daily triggers. Many people who attend counseling or therapy do so when they are still using their drug of choice, and there is nothing that will really help them to achieve complete abstinence while they are going through counseling. They basically have to do everything on their own, with just verbal support once a week or once a month from the counselor.
The next step up might be casual 12 step meeting attendance. Many therapists or counselors who have a struggling addict is likely to encourage meeting attendance at 12 step groups like AA and NA. So the addict may start attending the meetings in order to try to solve their drug problem. Notice I say “casual” meeting attendance. Further down you will see that there is another intensity at which someone might attend the 12 step program.
The next rung on the recovery ladder might be outpatient treatment. So this is just like inpatient treatment except that the addict does not sleep at the rehab overnight, and instead comes home to sleep. But then the next day they go back to the treatment center and attend groups and lectures all day. So this is much more intense than counseling, therapy, or 12 step meetings, but the addict is still dealing with environmental challenges–i.e., they still have to go home each night and face the threat of relapse.
In my opinion, outpatient treatment is one of the worst options. First of all, it is somewhat intensive, but in my belief it is intensive in the wrong way. Instead of removing the addict from dangerous triggers, all it does is put them through lots of groups and lectures all day, attempting to educate them about addiction and recovery. In my opinion this is a very tough way to overcome an addiction. The easier path is to choose a more intensive treatment option in which you are actually living a clean and sober in a stable and safe environment. In other words, outpatient treatment is too dangerous because of the constant exposure to relapse and triggers. You are not protected like you are with inpatient rehab. The lectures and the groups attempt to “fix” you, but they do not teach you how to actually live clean and sober. Addicts tend to learn by doing, by living….not by being taught, preached at, or schooled. So I personally believe that outpatient treatment is one of the least helpful treatment options.
Stepping up from outpatient treatment you might have what I would call “hard core 12 step meeting attendance.” An example of this would be someone who is desperate to get clean and sober, cannot afford or arrange any professional treatment options, so they simply hang out at 12 step meetings all day long. Of course they are not in a protected environment either, and they have to go home each night, risking exposure to relapse and triggers. But in many ways this is more intensive than outpatient treatment, because:
1) The person is usually highly motivated, as there is nothing else mandating that they attend 12 step meetings all day long.
2) There is more community involvement and real-world support for the addict in this situation.
3) Sponsorship within the 12 step program can take this recovery approach to the next level, making it even more intensive and successful.
Not every person has an option of doing “hardcore 12 step meetings.” But most cities have enough meetings these days and many of them have a meeting hall where it is possible to stay in meetings and be surrounded by recovering addicts all day long.
It’s a very informal option, but it’s an option. And I’ve seen it work for some people.
Now we come to inpatient treatment. This is what most people think of when you say “drug rehab.” The traditional detox program followed by residential treatment, usually lasting 28 days.
Inpatient rehab has a lot of advantages over every option we have discussed thus far, including:
* Complete safety of the drug addict with a controlled environment in which they stay overnight for the duration of the visit. Pretty much guaranteed clean time for the duration of the visit. So a 28 day program gets you at least 28 days of clean time, and is a solid start on your recovery. Other options like outpatient can make it difficult or impossible in some cases to string together 28 days of continuous sobriety.
* Medical supervision of the recovering addict. This can be important in some cases depending on the severity of detox, or if there are other health factors complicating the recovery process. For example, someone with chronic pain issues who is addicted to opiates can get some help and guidance and alternative medications while in inpatient rehab, but they cannot really get that level of help and medical assistance while they are in counseling, or doing outpatient therapy, etc. So inpatient treatment offers more medical resources, which can–in some cases–make or break someone’s recovery.
* Aftercare recommendations. Inpatient rehab generally has the best continuation programs of all the treatment options. This means that it is the most “ongoing” of all the options. Of course it is always up to the individual addict to follow through with their aftercare recommendations, but inpatient treatment is the most likely option to set the stage for success in this way.
* Comprehensive solutions. If you go to therapy, that’s all you get. If you go to outpatient, same thing….you get outpatient therapy. But when you go to inpatient treatment, it becomes a hub for all of the other treatment options. Many people will leave inpatient and continue on with counseling or therapy. Some will follow up with outpatient groups. Many will start attending 12 step meetings. So inpatient rehab sort of “contains” all of the other treatment options.
Finally, long term treatment is an extension of the inpatient rehab idea, and generally deals with a longer treatment visit of more than 30 days. Most long term rehabs are from 90 days to a year, though some are even longer than that.
I personally lived in long term rehab for 20 months, and it was one of the best decisions I ever made.
You cannot really get more intensive than long term. Here, the addict is actually living in treatment, fully immersed in recovery on a 24/7 basis.
It normally has all of the same advantages as inpatient rehab, only for a much longer duration.
So those are pretty much the treatment options that most people are going to be considering:
1) Counseling or therapy.
2) Casual 12 step meetings.
3) Outpatient rehab.
4) Hard core 12 step meetings.
5) Inpatient rehab.
6) Long term rehab.
How intense is their addiction?
So the first question that you need to ask yourself is:
“How intense is the addiction?”
If it is not very intense then you might do well to choose one of the less intensive options.
For example, someone who is just experiencing a very minor drinking problem might simply do a few counseling sessions to talk about their problem and see if they can get it under control.
Who knows, there are people who actually do just have a simple drinking problem rather than full blown alcoholism. They might do well with a few therapy sessions, take some pointers, learn how to curb or reduce their drinking, and so on. (I have no idea about such things, to be honest, having always been a full blown addict and alcoholic!)
On the other hand, some people clearly have a more serious problem than this, and their addiction is much more intense. They might be using multiple substances. They might be suffering heavy consequences from their drug use, such as lost jobs, blackouts, family disruption, and so on.
The addict may have been building up their drug abuse for years, taking increasingly greater quantities, to the point that it has become physically dangerous.
In extreme cases, the more desperate an addict is, the more intense the treatment solution should be. If they are just a casual drug user then they might do well with therapy or meetings or whatever. But if their addiction is more intense, then they might do well to choose a more intensive treatment option.
Have they failed at treatment before?
The next question you need to ask is:
“Have they attended treatment before, and failed to stay clean?”
If so, then this points to the need for MORE intensive treatment options.
For example, perhaps they have been seeing a counselor or therapist to try to get their drug problem under control. When this fails, you might suggest inpatient treatment next. Nothing has worked so far, so try a more intensive solution.
It would be rare for someone who has been to inpatient rehab several times to suddenly get clean and sober after choosing to go to counseling once a month. This would not make logical sense and in my experience I have never really seen it happen.
What I am saying is that people who have tried some treatment options and then relapsed are generally going to need MORE intensive treatment options in the future, not less intensive ones.
This is also a sure sign of surrender, when an addict agrees to go to a treatment option that is more intensive than anything they have tried in the past. Such a step is almost always a good sign, because it shows that the person has surrendered to at least some degree and is willing to try something new (which may be fairly scary for them as well, though they will probably not admit to this).
So if the struggling addict has been to inpatient rehab twice before, it does not make much sense to encourage them to go to counseling, or 12 step meetings. Sure, those things might be helpful to them at some point in the future, but they are going to need detox and residential treatment first, before those less intensive options can really benefit them. Remember to match up their treatment with how intense their addiction is at the time. If they are struggling to get clean then it is likely that they would benefit from detox and residential treatment.
Where therapy, counseling, and meetings work best
As mentioned there is a time and a place for therapy, counseling, and casual meeting attendance. Actually there are at least two instances where this “less intensive” level of treatment may be appropriate.
One instance is when the addiction is not very intense, or the drug or alcohol abuse is very light and casual. This may also be true if the drug use is very recent and new, and has not been going on for very long at all. In such cases, less intensive treatment options may be a good fit.
The other example of when counseling, therapy, and light meeting attendance make sense is in long term recovery, after a person has established their sobriety and their recovery.
After someone is clean and sober and has a few months of clean time under their belt, it makes sense for them to make use of the less intensive treatment options. But early in their recovery they are going through a tough transitional phase, and these less intensive options are not so helpful.
It is the transition that is particularly difficult. Just ask someone who has 5 years clean and sober how hard it was to stay clean and sober for the last year of their recovery, as compared to their FIRST year of recovery. They are going to say that their first year of recovery was several times more difficult for them.
Why is that? Because the transition is the tough part. Moving from “full blown drug addict” to “happy and successful life in recovery” is quite a huge leap. It does not happen overnight and it does not happen without a great deal of struggle and effort.
The momentum needed to create positive change, at least in the beginning, is very difficult to achieve. This points to the idea that we need highly intensive treatment options in early recovery, followed by less intensive treatment options as we stay clean for longer periods of time. After several years in recovery, we no longer depend on treatment or counseling at all in most cases (though many people will attend 12 step meetings for life, although typically in a casual–and not hardcore–fashion).
What to try when nothing else works
If the addict has been to inpatient treatment already, I would suggest that they attend another inpatient rehab. I recently read a statistic that the average number of treatment episodes for people who have found successful recovery is approximately three. This statistic is backed up by my own experience, in which I attended three rehabs before I finally “got it” and made it work.
So the first thing that I would suggest is that every addict who is still struggling should attend inpatient rehab, and give it an honest effort. If they have been to treatment before and it failed for them, they need to ask themselves: “Did I really give treatment a chance, and follow through on what they were suggesting to me?” Most people who take an honest look at their past will realize that they had not truly surrendered, not fully surrendered, and that they could give it another shot if they were to get honest with themselves.
My next suggestion for people who have been down this road several times is to step it up and attend long term rehab. This was the decision that I finally made in my own recovery journey, and up until that point I was absolutely horrified at the idea of living in long term rehab. In my mind, I equated the idea with going to prison.
This, of course, was ridiculous. Living in long term rehab was an awesome experience, and I would gladly do it again without any problem or hesitation if I had to. It is nothing like prison or jail, and in fact you have almost total freedom. You get all of the advantages of inpatient rehab, while also slowly getting your personal freedom back so that you can start living sober in the real world. It is the perfect transitional environment.
In my particular case, I had a life that was structured around drug and alcohol use. I had a bunch of friends who all used drugs or drank with me. I had a job in which I was heavily involved with other people who also used drugs or drank with me. This was my entire life, and all of the people in it had been carefully chosen based on their drug or alcohol use. I did not really associate much with anyone who did not use drugs or alcohol with me.
Based on this situation, going to inpatient treatment was not working out well for me. I was coming back to the same life, the same environment, and I was terrified of attending 12 step meetings. So there was no way for me to get any kind of support when I left rehab. There was no way for me to break through my fear and start attending 12 step meetings in order to get support.
What I had to do, based on my unique situation, was to take the plunge and live in long term rehab. This will not be the solution for everyone, but it was what I had to do in order to break free from my addiction. Living in long term gave me the support that I needed to actually have a chance at staying clean. It forced me to attend meetings every day. I instantly made new friends in recovery who did not use drugs or alcohol. Long term did for me what I could not do for myself out in the real world. My particular problems could not be overcome with less intense treatment options, so I had to finally go with a more intensive solution.
The best choice in almost any situation is inpatient rehab
The fact is, I did not just walk into long term rehab. Instead, I transitioned into it from a regular short term inpatient facility.
Therefore, I still believe that the best choice for most people is to attend an inpatient facility. There are other ways to get clean, but none of them are as flexible, powerful, and comprehensive as going to a short term rehab program.
You may also be wondering when is the right time to take action and intervene for the struggling addict in your life. Find out what the perfect timing is to convince someone to attend rehab.