What Exactly Goes on in a Drug Rehab Center?

What Exactly Goes on in a Drug Rehab Center?


Many people who are nervous about going to drug rehab or addiction treatment centers want to know: What exactly goes on in there?

It’s a fair question because one of the greatest fears that holds people back from recovery is the simple fear of the unknown. When we are diving into a new experience like sobriety we have no idea what to expect, and our expectations are all over the place. For example, many of us are worried that we will never be able to be happy or have any fun again if we leave our drug of choice behind forever. So there is a great deal of fear that goes into this pre-treatment phase.

The fear of the unknown

It is more than just the fear of what treatment might be like, however. This fear of the unknown runs much deeper than that because the addict or alcoholic is facing an entire new life in recovery, one in which they have no idea what it will be like or how they will spend their time.

If you have people who you drink or use drugs with then you probably have an idea that you are going to leave those relationships behind in early recovery. So you are told that you will “make new friends in recovery,” but who really wants to do that? Who wants to be told that they are going to have to meet new people? That is scary enough in itself for many people.

You may be told that you are going to have to do certain things in order to recover. For example, maybe you are told that you are going to have to attend AA meetings on a regular basis. Maybe you are intimidated by these meetings and are essentially afraid of them. Maybe you are nervous about speaking in front of other people.

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So there are all of these potential fears that go along with rehab that may not have anything to do (directly) with the treatment itself. Some of the fears are related to the fact that you are facing sobriety for the first time, or that you are going to be exposed to AA meetings, or whatever.

The fear of the unknown is not just a simple thing that is one dimensional. It can run very deep in many different directions, and this fear can paralyze people and stop them from taking action.

So my point here is to give you an idea of what treatment might be like so that you are not as afraid of it.

Keep in mind that thousands of people enter treatment centers and rehabs every single day around the world and none of these are fatal experiences. Life goes on and people manage. Nothing turns out to be as bad as these people feared that it would. Keep that in mind if you are facing the idea of getting help for yourself at some point in the future. It’s never as bad as you think it might be.

Fact: detox is not a horrible experience. Stop worrying!

I blame mainstream media for painting detox as being a painful experience.

I know that this is not the case because I worked in detox center for about seven years as a nurse aid. I gave medicine to struggling addicts and alcoholics who needed it (doctor ordered of course!). I have worked all shifts with these struggling addicts and alcoholics, including the overnights.

And I have been there myself at least 3 different times. I have been through the detox process myself and been on both ends of the equation. So I definitely know what to expect and what the experience is like. And I have experienced detox in 3 different rehabs around the country.

So what have I learned based on all of this experience? Detox is not so bad. It’s not bad at all in fact, and the people who work in the detox area just want you to be as comfortable as possible.

There are a variety of medications that can allow you to be comfortable while you are going through detox. Now I have heard several people who think that this is crazy to take any form of medication while they are detoxing, and I believe that such people simply lack the knowledge to know any better. When you walk out of detox after a few days you will not be taking any drugs or alcohol, including any medications. Having a doctor prescribe you medicine to help you get through the detox process (safely) just makes sense. Don’t be one of these people who thinks that they have to do it without any medications at all.

In fact that is the only thing I would caution you about if you are looking to find a treatment center: Avoid any of them that do a medication-free detox process. Instead, you want to see that they use medication. Now you might be asking “Why? I thought the point was to get off of drugs!” True enough, but there is a safety issue involved here. For example, many alcoholics would die if they detoxed without any medication. The withdrawal process can kill them if it is not properly medicated. So don’t get it in your mind that you need to detox without medication, as this is just foolish (IMO).

Second of all, realize that the goal of detox is not to be miserable. Everywhere that I have been in detox the people wanted me to be as comfortable and pain-free as possible. So do not think that you are going to be in for a miserable experience. This is not true at all. Trust me, the medical staff who work in detox centers do NOT want you to be uncomfortable. I have worked in detox as a nurse aid for several years, and I can vouch for this–we want our patients to be comfortable and not in any pain! Why would we want a patient to be suffering? That just creates problems for the staff and the other clients.

So do not worry about detox. It is not as bad as you might think it is, nor is it painful or uncomfortable.

Residential treatment and 12 step meetings

After you get through the detox process, which usually lasts about three to five days, they will probably move you over to the residential side of treatment. This is where you will attend meetings and groups and lectures all day.

I have a limited pool of knowledge here because I have only been to 3 different treatment centers (after that, I finally “got it!”). But all of those treatment centers shared some similarities.

One of those is that there was always a morning meeting where all of the residents got together and went through some general business. They would plan out the day, introduce new clients, say goodbye to people who might be leaving that day, and so on. Then they might do an inspirational reading or thought for the day. Sometimes this meeting was basically combined with breakfast. Usually it was not too heavy or serious of a meeting.

After that you would get a short break before attending your next group for the day. This is then what rehab would be like: A series of breaks in between scheduled groups and meetings. They basically keep you busy all the time so that you are learning about how to recover. Many people do not like this but you need to stop and think about it for a second: What is the point of going to rehab and then just sitting around or napping all day? What is that going to get you? What are you going to learn? Not much.

So you need to get active, you need to get involved, and so most treatment centers require this. They will basically expect you to attend all of the groups and participate, or they will basically force you to choose between leaving treatment or staying and participating. But there is almost no point in being in rehab and not participating. You may as well be home at that point, as you will learn nothing.

I have been on both sides of this issue and I can definitely say that this is a good policy for a rehab to have (forced participation). There is no point in being at rehab and sitting around, learning nothing.

So there will likely be groups, meetings, and lectures throughout the day. You may have a 12 step meeting such as AA or NA in the evenings. This is typical of most rehab centers to have one 12 step meeting each day, usually brought in from the outside by people who are in AA and NA themselves.

It is not uncommon for a treatment to have a weekly schedule of groups. So for example, every Friday at 2PM might be a group about relationships in recovery. Every Tuesday at 7PM might be an AA meeting. The schedule repeats each week and therefore you will know what groups and topics to expect if you are in treatment.

Therapists and counselors

It is also likely that you will have your own therapist or counselor while you are in treatment. This person will probably talk to you maybe twice a week or so for an hour or two, but probably not as frequently as you would like to see. Unfortunately they have to spend most of their time writing things down and documenting what has occurred. They could never do seven hours of therapy in an eight hour work day because of all of the documentation and red tape that is required of them.

In the old days everyone who went to rehab pretty much stayed for 28 days. This was when health care was much cheaper and insurance companies were willing to pay more. These days things have tightened up a great deal and it is very rare for an insurance company to pay for a full 28 days. Therefore you can expect to see treatment visits of much shorter time frames such as ten days, 14 days, and so on. Most people will not be in residential treatment for more than two weeks. The money is just not there any more and health care costs have skyrocketed.

As such, the primary role of your therapist or counselor is not to explore your issues or try to dig into your past in order to help you (there is not enough time for this), so instead they want to get you on a new treatment plan and get you lined up for aftercare. The driving question is: “What are you going to do when you walk out of rehab?” Because that moment comes much sooner than it used to in the past as treatment visits get shorter and shorter.

The entire point of treatment needs to revolve around this question, because everyone has to leave rehab at some point. When they do leave, are they prepared to face the world without resorting to their drug of choice in order to self medicate? If we have taught them well in treatment and given them plenty of resources and tools then they should be able to avoid relapse. This is the basic idea behind treatment of addiction. Give people support and alternatives. Set them up for success in avoiding their drug of choice.

An aftercare plan

Aftercare is basically code for: More treatment. The only question becomes: If you are going to have more treatment after you leave residential rehab, how intense and how long is that follow up care going to be?

If you leave rehab and make no effort at all for any sort of aftercare, then you can be assured that you are almost guaranteed to relapse. If nothing changes, nothing changes. If you just go back to your old life without doing anything different then you can expect to get the same results that you used to get (self medicating).

Therefore aftercare is important. What you do after leaving residential treatment can determine how long you stay clean and sober for.

It is suggested to most everyone in treatment that they follow up by attending AA meetings, getting a sponsor, and generally immersing themselves into the 12 step program. This may work for some people and not as well for others, so treatment centers also advise people to do more than this for aftercare. This usually falls into one of three categories:

1) Follow up counseling or therapy on a weekly basis.
2) Outpatient treatment on a daily basis.
3) Long term treatment (living in rehab or a halfway house).

You may note that these three forms of aftercare are increasingly more intensive. The first is just counseling and may only require one hour per week or so. The second may require several hours each day (outpatient). And the third option may have you living in rehab for several months or even years (I lived in long term rehab for 20 months myself).

The intensity of your aftercare plan should match the amount of help that you think you need in order to stay clean and sober. When I was leaving residential treatment over 12 years ago, I had no confidence that I could remain clean and sober without a LOT of extra help. This is why I elected to live in long term rehab.

Your peers that you meet in treatment

Of course if you go to rehab then you are going to meet new people in treatment who are trying to get clean and sober along with you. These are your “peers” and you have to realize that most of them are not going to be clean and sober for the long run (statistically most people relapse before they get to a year sober).

This is not to say that your peers are not important in early recovery, because they definitely are. No one recovers in a vacuum. But you also have to be realistic and realize that the odds are stacked against people. The whole group of people that you go through treatment with is not going to stay sober together forever. Most of them will relapse eventually and you want to protect your own sobriety first and foremost.

This is why they recommend that you go out to AA or NA and find established meetings in your area. The people in those meetings have significant sobriety already and will be much more stable than the peer group that you met in short term rehab.

I would urge you to do this in your early recovery. As soon as you leave residential treatment your goal should be to expand beyond the peer group that you met there and find people who have more clean time. Go find real meetings, AA and NA meetings that are not connected with treatment centers. This is important. Because it is in those meetings that you will find “real recovery” from people who are living it out in the real world.

What are you waiting for?

The fear of the unknown should not be an excuse to prevent you from taking action. I have outlined the basics of treatment that you will find in most every rehab around the world, so there is no need to be afraid of what you might experience in treatment. The people there only want to help you. Getting through detox is generally fairly painless. They keep you busy and try to teach you a new way to live so that you have a fighting chance when you finally leave rehab and face the “real world” of temptations.

If you have been on the fence about attending rehab then you should take the plunge and just go already. There is nothing to be afraid of and there are no challenges that you cannot overcome and deal with. Remember that if nothing changes then nothing changes. Your life is not suddenly going to get better without you first making a huge decision and taking massive action. Some addicts and alcoholics hold on to a false hope that perhaps their “luck will change” and that their life will magically get better on its own. This will never happen if you have alcoholism or drug addiction and the only solution is to face your disease head on and give sobriety a chance. Doing that requires a great deal of support and new information, which is where treatment comes into play. It is very, very unlikely that a person can recover without some form of treatment or outside help. Therefore at some point you may need to bite the bullet, face your fears, and go get the help that you need.

When you do so you will realize that you were worried about nothing all along, and should have sought help much sooner for your problem. Everyone who goes to treatment and remains clean and sober has nothing but gratitude for the decision that they made.

No one regrets getting professional help. So why should you avoid it? What is your excuse?

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