Foundations of Addiction Treatment 3: Follow through and Aftercare Recommendations

Foundations of Addiction Treatment 3: Follow through and Aftercare Recommendations


Yesterday we looked the importance of asking for help in early recovery. Today we are going to look at the idea of follow through, and how that will affect your chances of staying clean and sober.

What happens to 90 percent of people who attend rehab

I had the luxury of working in a drug and alcohol rehab for a period of about five years continuous. Before that, I lived in the rehab for about 20 months. So in that time period I got the chance to make lots and lots of observations.

One thing that is peculiar about the treatment industry is the amount of repeat customers. You would not necessarily think that this would be the case unless you got a chance to work at a rehab and could see it for yourself. It is difficult to pin down the numbers based on casual observation, but it seems like about half of the people who come to rehab end up coming back at least one more time.

So while I was working in a detox center for five years straight, I could not help but observe this incredible phenomenon. Most people not only relapsed, but they also came back to treatment for another go-round. Not only that, but I also deduced that if all of these people are coming back for more treatment, that surely there are others who relapse but either do not come back to rehab, or they go to a different rehab center.

Based on these observations over time it was pretty easy to deduce that nearly everyone relapses, and very few people actually “make it.”

When I first got into recovery I heard people in AA and NA meetings quote these crazy relapse statistics, saying things like “only 5 people out of 100 will be sober after the first year.” These statistics were meant to scare people into staying straight, and I never put much weight on them. But then later when I got a job in a rehab center I sort of absorbed that same data through my own observations, and the numbers seemed scarily accurate. Not many people actually made it. Most relapsed within the first year. I could see this was overwhelmingly the case just by how many people returned to rehab for more treatment after a relapse.

Now when these people come back to rehab after having a relapse, they try to analyze things and figure out where they went wrong and pick it all apart. Well I can boil it all down in a nutshell for you:

They did not follow directions.

Plain and simple. We have another term for this, and that would be “follow through.” The person who relapsed did not follow through and do what they were supposed to do in order to stay clean and sober.

If you listen to their story you will see that at some point they stop following through, they go off on their own and try to do their own thing (too soon), and they are no longer taking direction. They end up relapsing because they did not follow through on the instructions they were given at rehab. Plain and simple.

How to follow through perfectly

So how can you follow through perfectly?

The answer is pretty simple. You simply have to follow directions, right down to the letter.

Early recovery is not the right time to design your own recovery program. That comes later. But when you are first getting clean and sober you need to follow directions without trying to manipulate anything, without trying to change anything. You just need to do it. Do what they tell you to do.

If you go to rehab and the counselors and therapists there tell you that you need to do this, that, and the other thing, then you need to follow through perfectly and do those things. Many people will do only what is convenient or appealing to them, and therefore they will not follow the directions perfectly. They will pick and choose what they want to do. This is not the right way to work your early recovery program. You cannot pick and choose. You are not in a position to be able to pick and choose. After you have a few years of recovery under your belt, THEN you can pick and choose. But at this early stage of the game you need to follow directions.

The ultimate path to freedom in early recovery is a bit of a paradox. It will feel like a contradiction. In order to obtain the greatest amount of freedom, you must first surrender everything and give your life over to someone else’s advice. That means you ask someone for help, and then you do exactly what they suggest, without really questioning it. Sounds like a total loss of freedom, right? But therein lies the paradox. Because by following exactly what they tell you to do, you will gain the ultimate freedom in recovery by being able to enjoy your life without chemicals. By surrendering fully and giving up all of your control, you will gain the ultimate freedom. It is very counter-intuitive and most people have a death grip on their need to control things so they will generally not do this until they have fully hit bottom first. In other words, people need to be truly miserable before they become willing to give up total control of their life.

I struggled with this for years because people were trying to help me and they were pushing my towards more and more treatment, and I was stuck on the idea that I wanted to be free. I was not ready to surrender yet so when they suggested that I go live in long term rehab it sounded like a prison sentence to me. I would not hear of it. “How ridiculous,” I thought, “to spend six months to a year in a rehab facility. What a waste of life!” Or so I thought at the time.

But eventually I got miserable enough in my addiction that I finally realized that I had to try something drastic. Going to 28 day programs was not working for me. So I realized that I probably actually did need to go live in rehab for a year or two. Because I had hit bottom and surrendered, I became willing to follow instructions. I had put my pride on the shelf and became willing to do exactly what they suggested–to go live in rehab for the long term. It was then that my life really turned around.

The way to follow through is to first hit bottom and surrender. You have to stop fighting and struggling for control. Once you can let go of that need for control, then it becomes possible to follow directions. It is then that your life will get better. Infinitely better. But first you have to let go of your struggle for control, you must let go of everything, you must let go absolutely. This is how to follow through and take direction and advice. You have to put your trust in someone else other than yourself.

What should you do in regards to aftercare recommendations?

If you go to a treatment center or a drug rehab they will undoubtedly give you some aftercare recommendations. These are the suggestions that they are giving you for after you leave inpatient treatment.

My suggestion is that you follow them exactly, without question and without hesitation. These are professionals who are only trying to help you to stay clean and sober. This is their job–to help people recover–and it is all that they do. Why would you ignore their advice and go with your own ideas over what they suggest? That would just be crazy, unless you happen to be an expert on recovery (and you are almost certainly not, otherwise what are you doing in rehab, right?)

I am no expert on recovery either….I was just barely smart enough to figure out at some point that I had better start following directions. My way was not working so well. Therefore when I had finally surrendered and realized that I could not out-think my addiction, I realized that I had better start taking their recommendations seriously. All along, the professionals had suggested to me that I go live in long term treatment. I had resisted this idea so fiercely that I swore I would die before I ever went back to rehab at all. But addiction has a way of wearing you down. You get sick and tired, and then eventually you grow weary of being sick and tired. This is what broke me down to the point of becoming willing to go to long term rehab.

Now not everyone needs to go to long term treatment in order to get clean and sober. That was just what I had do in order to change my life. Your situation might be a lot different. Most people, in fact, do not need to go live in rehab in order to change their life. Most people can either go to short term rehab, or meetings, or both in order to change. Long term rehab is just what it took for me, given my history and my current situation.

If your aftercare recommendation does not give you enough support

There is a possibility that you need more support in your recovery than what you are getting. For example, say that you are going to one or two AA meetings each week, and that is pretty much it. Depending on your situation this may not be enough support to really help you to maintain sobriety. You might need more help than this.

If this is the case then you need to seek out more help and support. If you fear that you are about to relapse then you need to reach out and find more help. Talk to people. Tell them that the help that you are receiving is not enough. Tell them that you need more help in order to stay clean and sober. Maybe they can find you more meetings, maybe you can go to outpatient treatment, maybe you can get into group therapy, maybe you can go see a counselor each week. The point is that if you do feel that you have enough support in your recovery, then it is your responsibility to find more help. It is up to you. You have to seek out more help and support.

Another thing that you might need to do is to look at the big picture. In other words, what level of help and support have you had in the past, only to end up relapsing again? Chances are good that you actually need MORE help and support than what you had.

For example, say that you just casually went to a 12 step meeting here or there in the past, but you ended up relapsing. Now you are attempting to get clean and sober again. Would it make sense to just casually attend a 12 step meeting here or there? No, of course not. You obviously need more help than that!

So this next time around you might try to increase the amount of help and support that you receive. So you may bite the bullet and go to an inpatient treatment facility, even though you vowed at one time that you would never need to do that. Get over yourself and go get the help that you need!

Or maybe you have been to inpatient rehab a few times, but you always seem to relapse at some point after leaving. Maybe you need to get serious about the idea that you could really benefit from living in long term treatment. This is the hurdle that I was facing myself, after having been to short term residential twice before already. On my third trip to rehab I realized that I needed to try something different.

How to get it right the first time and avoid being part of the 90% who relapse

I cannot really speak with authority about how to “get it right the first time” because honestly I was on my third trip to rehab before I finally “got it.” I know of other people who were on their 20th trip to rehab and obviously they were still struggling with their addiction.

That said, it is theoretically possible to get clean and sober on the first try, though I am not sure how likely it is to do so. There is a learning barrier there that has to do with our expectations and perceived challenge. The problem is that we have been conditioned throughout our lives that if we want to get modest results from an endeavor that we only need to put forth a modest effort. This conditioning causes us to expect to be able to sort of “skate through recovery” much easier than what other people make of it.

In other words, we are smart and we know it. Therefore we expect that we will have a bit easier time of recovery once we get in the game and learn the ins and outs of it. We know that in other areas of our lives, we have been able to make a modest effort at things and usually get pretty good results from it.

What we are not counting on here is the fact that most addicts and alcoholics are smart too. Therefore, when we believe that we are “above average” in recovery and can just skate through, we are mistaken because we are NOT above average. Most addicts and alcoholics are darn smart and darn sharp people. And now realize that 90 percent of them relapse in the first year.

We want to think that we are smarter than the average bear, but those are daunting odds. Therefore we would do well to realize that if we are going to succeed in recovery, we have to make an extra special effort. In fact, we have to try harder at this recovery thing than we have ever tried at anything else in our entire life.

This is how to “get it right the first time.” I can only speak from experience here, and it took me three times in order to get it right, but on the third time around this is what I did differently:

1) I surrendered fully and let go of everything. Everything I was struggling to control in my life, I just let go of it. All of it. Totally and completely.
2) I became willing to do things that I had never been willing to do in the past (go to 12 step meetings, live in long term rehab, take advice from others, etc.).
3) Every suggestion that I was given by trusted professionals, I acted on it to the best of my ability, without any hesitation. I followed through.

If you were to interview a hundred people who had relapsed after leaving rehab, and you really dug into their answers and got them to give you the full story, you would realize that none of those people did a 100 percent job at following through on their aftercare recommendations. This is what makes or breaks your recovery efforts: the action. The follow through.

On the other hand, if you were to interview a bunch of people who had left rehab and stayed clean and sober for at least the first year, you would find that these people took tons of massive action. These are the people who were all about the follow through. These are the people who went to three meetings per day. These are the people who dove into recovery like their lives depended on it.

Really you have to dedicate your entire life to your recovery effort. That is the level of dedication and follow through that you need to embrace. Anything short of that and you are probably setting yourself up for failure.

Sponsorship in early recovery – more advice and direction

What about sponsorship in AA and NA?

In my opinion this is a decent opportunity in early recovery to receive more guidance and direction. It is amazing what we can accomplish when we get out of our own way. Sponsorship allows us to do exactly that.

When I first got clean and sober I had a sponsor who was giving me advice. I was a bit confused at the time because his advice was not directly related to recovery. For example, he wanted me to start exercising and also to go back to college. I did these things but to be honest I thought he was a flaky sponsor. Why was he not focusing on my spiritual experience, staying sober, etc? But looking back I can see that he was pushing me in just the right direction at the time, when I believed that I should have been focused on other things.

So instead of studying the Big Book, he had me finishing up my bachelor’s degree. Instead of attending non-stop NA meetings, he had me out running six miles per day. At the time I thought these were bad decisions, but looking back now I can see the wisdom behind it all.

We cannot always see what our next obvious move in personal growth should be. Others can see it more easily than we can. This is what makes sponsorship powerful and effective. Other people can tell us what they think we should be doing, and then we simply go and do it. This is how to “get out of your own way.” If you are in early recovery and you are trying to figure out what to do next, you are likely to screw it all up or at the very least you will be inefficient. Having someone else tell you what direction to head in can be most helpful.

Therefore sponsorship is like an extension of treatment. Of course all of this is contingent on your willingness to take advice and direction. The more willing you are to follow other’s advice, the more successful you are likely to be in early recovery.