What We Need to Develop in Alcoholism Treatment Facilities
The great challenge of alcoholism treatment facilities is how to improve their success rate.
There have been a few rehabs that have figured out how to have the appearance of achieving this. But in reality my belief is that all they have really done is to manipulate the numbers.
Let me give you two examples.
The first example is a program that was designed for medical professionals who got into trouble with drugs or alcohol in the workplace. The program attempted to rehabilitate the person and keep them working in the medical profession so long as they were able to complete a very intense program.
This program included mandatory counseling, mandatory 12 step involvement, and also mandatory drug testing. So they had to take regular drug tests and also alcohol breath tests on a very frequent basis.
The bottom line was that they got to keep their job, but if they screwed up again during the course of this program then it was all over.
This particular program has a very high rate of success. Something like 60 percent or so.
But as you can see, the program is structured around existing incentives. The participants are all medical professionals who have a vested interest in keeping their jobs! So there is a large amount of extra incentive right there. In addition, they likely have some working knowledge of recovery programs and what it takes to succeed. They have probably witnessed the dark side of addiction in their workplace already since they work in the health field.
The second example is a famous treatment center that has the reputation of being one of the best in the business. I am not even sure what success rate they currently claim to have but I know a little bit about how they arrive a that number. Here is what they do. When you go to rehab for 28 days you are in a controlled environment. While you are there it is easy to be clean and sober because you do not have access to your drug of choice. As soon as you leave the security of the rehab facility the real challenge begins. How many days clean and sober after leaving treatment would you need to have before you called that rehab visit a “success?” If the person stays clean and sober for a month? For a year? For 3 years? For 10 years? What length of sobriety determines the success rate? A treatment center that wants to put up impressive numbers just needs to shorten their timeline. Generally about half of people leaving rehab will stay sober for 30 days or so, whereas about 10 percent will stay clean and sober for a full year. Those are just general rates of success and they can be manipulated even further.
One way to manipulate that data further is to discard certain people who relapse from your pool of data. For example, your treatment center may be a 28 day program but then you would recommend a certain aftercare plan for people. Then what you would do is to check and see if the people followed through exactly with all of their aftercare recommendations. Did they go to every single outpatient meeting? Did they attend the recommended number of 12 step meetings after leaving rehab? Did they keep it up? If not, then you might say that they did not follow through with your treatment plan, and therefore the data does not apply to your success rates. Throw them out. They don’t count because they did not follow through. This then skews the results and makes it look like your rehab is more successful than it really is.
So what I am saying is that we need to focus more on the real success rate instead of focusing on how to make our treatment centers appear to be more successful.
How can we really help struggling alcoholics? It is a tough problem and there are certainly no easy answers. If there were easy answers we would have discovered them by now.
What we need to do is thoroughly explore the process and see if it can be fine tuned at all to better improve success rates.
Disruption is easy. How do you teach follow through?
Disruption is easy. You just check into any rehab and you have succeeded at disruption. You have disrupted your pattern of alcohol abuse. Suddenly you have no access to alcohol and you are stuck in a medical detox and residential rehab for a month. This is the easy way to get sober.
The problem is not getting sober, though. Any alcoholic can (eventually) muster up the courage to check into rehab. Believe it or not, this is the easy part! The hard part is what happens on the day that the alcoholic steps foot back out into the real world. What happens on day 29 after rehab is over? That is where the challenge lies.
So the job of the rehab center is to teach people how to follow through.
The first thing that they try to do is that they make all sorts of suggestions and recommendations. For example, they tell people that they need to:
* Go to meetings.
* Get a sponsor.
* Get phone numbers of their peers in recovery and actually call them on a daily basis.
* Get involved in AA.
* Call their sponsor regularly.
* Work through the steps with their sponsor.
* Go to various outside AA meetings and find the ones that click with you.
And so on.
I can tell you what the problem with this is.
The problem is not a lack of information. The rehab is teaching people what they need to do. They are giving people the keys as to how to remain sober.
The problem is that they are not teaching people how to actually follow through and take massive action. They are not teaching commitment. They are not teaching dedication.
And perhaps you can’t. I am not criticizing really, only trying to dig deeper into the problem and find solutions. I worked in a rehab center for 5+ years and watched a whole lot of people relapse. I watched many people relapse over and over again. They kept coming back for more treatment. What was the problem?
It was not lack of information. The rehab was teaching the right things. But what they were not teaching was follow through.
Why people relapse in the first place
The reason that people relapse is a lack of action. A lack of follow through.
They are told what they need to do in order to remain sober. But then when they leave rehab they fail to do it. They fall back into their old patterns. They don’t follow through and use the suggestions that they were taught in the first place. So they relapse and their life falls apart again and they are back into the cycle of madness and chaos.
I went to rehab three times in my life. The first two times I went I obviously failed and relapsed. The reason that I relapsed was due to a lack of action. I did not follow through and go to meetings, get a sponsor, or do any of the things that were suggested to me. I just did not want to take action because I had not yet surrendered to the disease. I wasn’t desperate enough yet to take action.
The third time that I went to rehab I was desperate for change. I was at a real bottom. I was completely sick and tired of existing. Every day was a chore. So I was ready for something different. I was open to the idea of massive change, of taking real action. This made all the difference in my recovery. I was willing to follow through this time. Instead of leaving treatment I transferred to a long term rehab center. I also got a sponsor this time and started working through the steps. I lived in rehab and went to groups and meetings every day. I got heavily involved in the recovery community. I followed through because I was desperate for things to be different.
At one time I believed that the answer must be “long term treatment.” After all, I had gone to short term treatment twice before and failed. My life finally turned around for the better when I went to long term rehab, so that must be the answer for everyone, right?
Long term rehab is not the solution based on available data
Even though long term treatment worked well for me, it does not work well for everyone.
First of all is my subjective data based on my own experience. I lived in a place that housed 12 recovering alcoholics total. I lived there for almost two years. In that time I probably lived with about 30 to 35 other alcoholics. At this time I know of 2 others who are still clean and sober today. I know of 5 who have died. And the rest have all relapsed.
Those aren’t very good results! So I did some searching around on the web and I found that the success rates of long term treatment are not all that much better than short term rehab. In most cases they are slightly higher but in the long run they are pretty darn close.
So those two pieces of evidence (both my subjective experience and the data I found online) do not really support the idea that longer treatment is the solution. It might help in some cases but it is certainly not a magic bullet. It works for some but then again, so does short term rehab. Longer rehab is not the answer that can solve the addiction problem.
What is the real solution for long term success in recovery?
The real answer for long term success in recovery is based on personal growth and taking massive action.
It has to do with this massive dedication and commitment that a person may or may not have in recovery.
You can see this in people if you spend enough time in recovery and go to a variety of meetings. Some people have this fire about them and they are excited about recovery and they are taking action on a regular basis. Other people just sort of show up and expect for this magic to somehow rub off on them through osmosis.
Some people are actively creating this awesome new life in recovery, while others are expecting it to be dropped into their lap just because they show up at a few meetings.
The outcomes of these two attitudes should be obvious. It may be cliche, but your success in recovery is going to be determined by your attitude and your commitment to taking action.
Another thing that you can do is to look at various programs and recovery philosophies and pick out the success stories. Actually talk to people who have successfully overcome addiction. Talk to lots of people like this. Keep seeking out the “winners” in recovery who have multiple years sober and find out what their story is. Find out what makes them tick. Find out how they actually work their recovery on a day to day basis.
Then, branch out and seek out the “winners” from various recovery philosophies. Maybe you start in AA and you find the winners in AA and talk to them. OK, that’s great. You have a baseline. Now go find the winners from a religious based recovery program. Talk to them. Find out what makes them successful in recovery.
Then go do the same thing with fitness based recovery programs (such as “Racing for Recovery”). Interview those people and find out what makes them successful.
If you actually do this and find successful case studies from at least 3 or 4 different recovery methods you are going to realize something.
Number one, you will realize that there is no one true path to recovery. You will realize that there is no single program that is one size fits all.
Number two, you will realize that there are some common factors in all of the “winners” that you talk with. There are some similarities that tie their success stories together.
These similarities are the details that alcoholism treatment centers need to focus on (combined with an emphasis on execution and follow through).
What are those similarities you will find?
* Surrender. Every person who is successful in overcoming their alcoholism will have gone through a process of surrender.
* Disruption. Every alcoholic who breaks free from addiction has been through some sort of disruptive phase (such as detox).
* Learning. Everyone has to learn how to live a life of sobriety without self medicating. They need new information in order to move forward. Their old ideas don’t work for them anymore.
* Action. They establish a new pattern of living. New habits. New actions to take each day.
* Growth. They develop a new daily practice. They push themselves to keep learning and to improve their life. They also push to improve their life situation.
* Personal growth. They push themselves to eliminate the negative aspects of their personality. They try to actively change who they are and how they react to the world.
Can these things be taught? Sure. But it may be even more important to teach people how to consistently follow through and take action to begin with.
This is why most treatment centers push the idea of doing 90 meetings in 90 days. If you can get people to establish a new positive habit like that and to follow through with it then you are definitely making progress.
But again, the problem is in teaching them to follow through. How can you motivate someone externally? For the most part it seems that you can’t. Creating incentives is too big a leap for the treatment industry perhaps. Therefore it always seems to rely on internal motivation from the individual. It is all up to them to motivate themselves enough to follow through with what they are taught. Unfortunately this produces a success rate that is rather poor in general.
Teaching the basics of personal growth
How can you teach people to learn and to grow after they leave treatment?
Most rehabs seem to outsource this task to their follow up programs. They reason that if someone goes to AA and gets heavily involved then that will take care of their personal growth.
The problem with that is that most people who go to AA do not really dig into the program with the right level of intensity.
You can certainly use AA as a platform for personal growth. But most people who go to the meetings are not doing so. They don’t have the right attitude. They are hoping to simply show up and maybe read the big book here and there and expect to have this awesome new life. It doesn’t work that way though. If you want this awesome new life in recovery then you have to build it with your own bare hands. You have to get involved and take action. And that means doing a lot of hard work. Most people do not have the drive or the dedication to do this. Even when their life is on the line.
People who actively work the steps in AA and do the work are the exception rather than the rule. But there are actually people who are doing the work in AA and who have found a path of lifelong growth in doing so. These are the “winners” that you find if you are willing to look and listen for them. They are walking the walk rather than just talking the talk. They are challenging themselves to keep improving every single day.
The thing is, you do not have to be in the AA program in order to experience the kind of personal growth that can keep you clean and sober. It is just one possible path out of many.
The key is that the recovering alcoholic has to embrace the philosophy of personal growth. They have to have the right attitude. They have to be eager to learn and to improve their life.
There must be an element of hope, that things are going to get better. Recovery doesn’t happen overnight. It takes time for the benefits of all of this positive action to really kick in. And so there must be an element of hope and possibly even an element of faith, that things will improve.
Then the work comes in. The individual has to put in the work to change their life for the better. Positive action, every single day. At first this will be a drag because you will not experience quick results. But over long periods of time the consistent action will start to add up. The alcoholic will transform without even knowing it. Then one day they will look back at their progress and realize that they have become a living miracle. They have learned to become happy without their drug of choice.
This is the end result of an ongoing process. That process is best described as “personal growth.” It is a path of self improvement. You can talk about it in groups (such as AA meetings) but the path is an individual one. You must walk it yourself. Some people never actually do the work even though they are heavily involved in groups such as AA. Such people eventually relapse due to a lack of action. They are all talk and no walk.
Others are like myself–I walked away from the groups and set out on my own path of personal growth. I talked with people who were successful in recovery and found the common thread. That thread was personal growth and positive action. Consistency was much more important than what program you chose to follow. So I started taking positive action and the results have been amazing. There is hope, you really can recover. But you have to put in the work.
The secret is not which program you choose. The secret is in taking action. Following through. Dedication to a new way of life. Those are the keys that can unlock a new life for the alcoholic.