Does rehab actually work for “curing” alcoholism, or is it basically a big scam? This is a serious question that I have heard many people ask in the past.
If you have ever been exposed to the success rates of the treatment industry in general then you should not feel guilty about asking such a question.
You see, the expectation of society is that we can send someone to treatment and simply “fix” them. That it should be like a medical cure. We have all of this technology and medical advancement in the world, so why should that not apply to addiction and recovery, right? That is the belief and the expectation that the modern world places on a disease such as alcoholism or drug addiction.
Yet the reality is very different from this. We are not much better off when it comes to treating addiction or alcoholism than we were, say, 50 years ago. Of course they are doing more research now and learning about the brain itself and how addiction is a disease of the brain. And they are still collecting lots of data about various treatments and how they are working for alcoholics (or not working). But on the whole we have not really had any serious breakthroughs. We have not had any major advancements. We still do not have a “cure.” There is no magic pill that can be given that will cause a person to WANT to get sober. And I think ultimately that is what people want.
They want to be able to send someone to treatment who is not even willing to get help, and somehow have that person become convinced that they need to change their life. They want addiction and alcoholism to be cured for someone who does not even want to change. And this is not anywhere near realistic. The success rate of treatment is not even 100 percent for people who actually want to change! Just think about that for a moment and realize just how tough it is to treat alcoholism or drug addiction. Even when the person wants help and they want to change their life you still may struggle to really help that person. We do the best that we can but many will still relapse. The numbers are not so great when you step back and look at the big picture.
This is not to say that treatment does not work at all. It most certainly does work in some cases, and for me that is enough. It just doesn’t work that often, or that consistently. I owe my own sobriety to a rehab center that was patient enough with me to house me for a very long time. Treatment works under the following conditions:
1) The person has a genuine desire to change their life.
2) The treatment center gives them skills and tools that they will need in order to remain sober in early recovery.
3) The person leaves rehab and finds a lot of support on the outside.
4) The person transitions from this support structure to a life of personal growth and learning.
5) Through it all, the person persists and/or follows through with positive action and willingness.
So there are a lot of hoops to jump through there and notice that actually attending rehab is really only one of those hoops. The rest of them are conditions that have to be met in order to maintain sobriety in the outside world. Sure, you have to go to rehab and listen to what they tell you to do. But you also have to be willing, and to follow through, and to explore a life of learning and growth. Complacency is a real risk in long term sobriety. Lack of support when leaving rehab is another huge risk. And of top of that, the alcoholic must have the drive and the willingness to take consistent action. It is a lot to expect from one individual.
It is a lot to expect because recovery is pass/fail. You cannot try to get sober and then earn a grade of a B minus. You either get an “A” or you fail the class. There is no in between. You either remain clean and sober and build a new life for yourself or you go back to your old life and you drink again. Those are the only two absolute outcomes. There is nothing in between for the real alcoholic. This is simply the nature of their disease. The whole point of addiction is that they cannot control their intake. So even a little bit will turn into a disaster and a seemingly innocent relapse will blow up into full blown chaos, given enough time. There is no in between. If there were an in between then they would not have a disease, they would not have a problem, their life would not turn into chaos based on their self medicating.
Recovery is pass/fail and that puts a tremendous amount of pressure on the recovering alcoholic. There are so many ways to screw up your recovery. There are so many different paths in life that will lead you back to the bottle. It can be difficult to find the path that leads to sobriety.
I really believe that the whole point of treatment is to get the alcoholic started on the right path. Start them on a path that leads to a life of sobriety. What the alcoholic must realize is that this is merely a starting point. When they leave rehab and have 2 weeks sober, they are just now starting out on a new journey. This is a beginning. They have not been “cured” by any means. They have a ton of work to do now. This is where the real work in recovery begins.
Treatment centers can never guarantee success because relapse is so tricky in early recovery
Unfortunately treatment centers can not really guarantee success. If they could then addiction would be cured and there would be no more problems or chaos in the world of recovery. Websites like Spiritual River would not exist because the problem would be simple and the solution would be nice and tidy. You could just go to rehab and be cured forever. The problem would disappear.
This is obviously not the case. The problem of addiction and alcoholism persists because ultimately it is all up to the individual if they are going to make recovery work or not. And it’s hard work. If it were easy work then, again, we would likely be very close to a “cure.” Look at the data though. Look at the success rates. Look at the 5 year success rate for post-treatment. Depending on where you look up your numbers (they tend to vary a bit) you will likely be depressed by what you see. Most people are not able to change.
One of the reasons for this is because treatment has become more widespread. Awareness about addiction and alcoholism has increased. Popular culture addresses the idea of addiction and encourages people to treat the problem, much more now than ever before. So we are at a point in time where more people will be diverted into rehab than in the past. There is more awareness now of addiction and the potential problem. So we have more people who are more willing to look at rehab as the solution.
This is actually sort of a problem. It is a problem because in the past (when stigma was greater) people were less likely to go to rehab unless they had really hit rock bottom and become desperate. Today they have fought so hard to remove the stigma of treatment and make it seem more acceptable to people. So the problem lies in the fact that you now have more and more people who are exposed to rehab who are not really ready to change. They have not hit bottom. They are not desperate. And so you see the success rates get even worse (they were already bad to begin with!).
Exposing people to rehab may be a step in the right direction. I am not sure about that. Most people that I know have gone to rehab more than once if they are sober today. So perhaps it takes more than one try for most people. If that is the case then so be it. We are just going to have to relapse a few times and keep pushing for more treatment.
What would be nice is if they could somehow separate every treatment center into two groups of people: Those who are seriously desperate and have hit rock bottom and will do whatever it takes to remain sober, and those who are really just dipping their big toe into recovery and they are not at their bottom and they are not seriously desperate for change. The problem of course is that there is no “cure” or even treatment for those who are not desperate. Our current treatment model does not know what to do with those people, other than to give them the same treatment that we give to the super desperate group.
AA and the rehab industry knows how to deal with the desperate folks who are eager for change. That is what their program is set up for. But how can you convince someone that they really need to change? How can you inspire someone to take action? How can you demand willingness from people? There is no way to do those things currently. We don’t really know what to do with someone unless they are already at rock bottom.
So for now, treatment centers will always be lacking because we don’t currently have a solution for everyone who comes to rehab. Part of the treatment population is truly desperate for change, and the other part is not. We don’t know what to do with those who are not at rock bottom yet. We don’t know how to help them. And maybe there is no good answer for that. Perhaps they just have to go back out there into the real world and take some lumps and get some more pain before they become ready to change.
Rehab is the perfect disruption, but it is a short term solution to a lifelong problem
Rehab is the perfect solution in the short run.
It is the ultimate form of disruption (other than jail).
The alcoholic enters a controlled environment. They are medically detoxed. They have no access to drugs or alcohol. So it is the perfect disruption. While they are in rehab there is no chance for relapse.
This is the perfect solution if you look at a short enough timeline.
The only issue comes in if you start to look at a longer timeline. What happens after 3 months? After 6 months? After 3 years?
Of course it depends on what you are measuring. Most people like to think of alcoholism being cured and that the alcoholic will never take another drink in their whole life. If this fails to happen then we might look back and blame the treatment for failing that person. At one point does that become unfair to the rehab? After a year? After ten years? Somewhere in between? How long should sobriety last?
Of course we all want for it to last forever. And this is obviously the goal of recovery (just a day at a time though!).
My solution to this part of the problem was simply this: longer treatment.
I had been to short term residential treatment and it worked really well while I was there. But right after I left I got into trouble again. So many therapists and counselors were pointing me towards long term rehab.
This is sort of a brute force solution. If you relapse after staying in a 28 day program, then find yourself a 1 year program instead. That way you will at least got a year of sobriety instead of a month, right?
Simple logic. It worked for me. I stayed in long term treatment for 20 months. I have been clean and sober ever since (12+ years). The time investment was well worth it for me.
Unfortunately this does not work for everyone. I watched many of my peers in long term treatment relapse. In fact, the numbers did not seem much better than short term rehab. But it worked for me because all of those other conditions had fell into place for me: I wanted to change, I was willing to do the work, I was following through, I was taking positive action, and so on. Everyone who relapsed while living with me in treatment was not doing all of those things. They had not checked off every single one of those boxes. They were always lacking in some area (willingness, follow through, etc.).
And in the long run, even a long term rehab center is just a drop in the bucket. It is still just a temporary disruption on the journey that is your life. You still have to leave treatment eventually and face the real world.
All treatment is merely a temporary disruption. It is up to the alcoholic to create a new life in recovery that can support their new habit of sobriety.
The best answer for most struggling alcoholics is to get into treatment. After that the solution is in their own hands though
Even though rehab does not work as a real “cure” it is still the best answer for most any alcoholic or drug addict. It is a natural starting point because it is the safest form of disruption. It is also a good place to start on the process of learning how to live in recovery.
That said, it is not always the perfect solution. But it is really the best thing that we have available today. Everyone expects for medical technology to have a “cure” for us, and this is the best that we have. But it is still better than nothing. By a long shot it is still better than not doing anything.
Most alcoholics and addicts will never try to change. Government data says roughly 4 out of 5 alcoholics will never seek treatment at all for their problem. So for those who do, we would hope that their chances would be good that they can make a positive change in their life. This is true only if they have all of those elements in place: Surrender, willingness, follow through, support, and so on.
After you leave rehab, the real challenge in recovery begins. That is when it is up to the individual alcoholic to take action and follow through on what they have learned. Most people have to try and fail a few times before they realize just how hard the challenge is that they are facing. It is not easy to change everything, yet this is what recovery demands of us. You must change your whole attitude and your entire life. It is no small task and so most people get overwhelmed with it before they even get started.
Why most people fail after leaving rehab
Why do most people fail to remain sober after treatment?
They don’t follow through. They were taught in treatment that they need to go out and build a support system. They were told to go to outside meetings, to get a sponsor, to work through the steps, and so on.
The question is: Did they do all of that?
Did they embrace recovery and take action? Are they following through every single day and taking real action in their life to make changes?
For most people post-treatment, the answer is “no.” They may start out strong but they quickly taper off in their efforts.
Sometimes I say that “I cheated” in recovery by living in long term rehab. Once I made the decision to live in long term treatment I did not really have a choice. I had to follow through. It was part of the programming. So I forced myself to follow through for almost 2 years straight. This did wonders for my recovery.
Obviously the key is in the follow through. If nothing changes, nothing changes. You gotta take action.
The solution is a philosophy of personal growth
Ultimately any treatment center is only a starting point. It is like setting a boat to sail out at sea. The rehab can point your boat in the right direction, but it is still entirely up to the alcoholic to do all of the sailing. Once you leave port, you are on your own. Recovery is a long road, and rehab is only the beginning. They can only hold your hand for so long. Eventually you gotta set sail and create your own path in life.
The biggest key for me in long term recovery has been that of personal growth. If you are taking positive action every day in order to change your life for the better then the chance of relapse is greatly diminished.
Rehab works great as a starting point in recovery. It is not a cure for alcoholism. But it is still the best starting point that we have at our disposal today.