There are actually not a whole lot of different options for the struggling alcoholic.
You can either surrender and ask for help, or you can stay stuck in denial and try to stick it out on your own.
There is practically no in between.
But sometimes the alcoholic can get stuck in a pattern. This is a pattern where they continue to relapse, drink for a while, then eventually they go back to rehab. Of course when they do this they go through detox and then they go through a short term residential program. Maybe they get out and they start attending AA meetings. But ultimately they stay stuck in this pattern because eventually they relapse, and the cycle starts all over again.
I have met people that are stuck in this exact sort of cycle who have been to rehab many times. Some of them have been to treatment a few times, others have been over a dozen times. In every case, the person is obviously missing something. They are not committing to recovery on a deep enough level. And so they continue to relapse.
It is in these sort of situations when I believe that long term rehab starts to make more sense.
When nothing else has worked, what more can you try in recovery?
Most treatment centers are pretty much the same. You check in and they make sure that you are not bringing in any drugs or alcohol with you so that they can keep the environment safe. Then they put you in a medical detox area so that you can get through your physical withdrawal safely. Finally they send you to groups, therapy, lectures, and meetings all day long so that you can learn how to overcome your addiction. This is the basic script for treatment and it is pretty much standard no matter where you go. There are some slight variations of course, such as religious based treatment rather than treatment based on the 12 step model, but ultimately even these two options are very similar to each other. They are basically alike.
So what other variables can you look at? Time is the big one. How long are you attending treatment for? Are you going for 28 days? Have you tried going for six months instead? How about a year or two? This is the main idea behind long term rehab. If you can stay in rehab for a really long time, then living sober will feel more and more normal to you.
There is a second concept here other than the time factor. That would be the learning and “societal integration” factor. Let me explain.
When you go to a traditional 28 day program, you stay in a protected environment the entire time. There is no chance for relapse because you are in a controlled facility. People are essentially “locked down” and they cannot just come and go freely, as this would compromise the safety of everyone. So staying clean and sober is actually very easy when you are in short term rehab. It’s controlled 100 percent.
On the other hand, when you go to a long term rehab, you are no longer being controlled 100 percent of the time. You may be held accountable for much of the time and you may even be in a controlled environment for much of the time, but you will also have a bit more freedom and the ability to come and go from the rehab as you please. In other words, you can leave rehab and then come back. You can get a job and go to work each day, even though you still live in long term treatment. This gives you more responsibility and it also gives you more freedom….enough freedom to hang yourself and relapse if you so desire.
So this is the other thing that you “get” from long term rehab that you cannot get from short term, 28 day programs. You get to “practice” recovery out in the real world. You get to start blending back in with society and the real world while you are still living in rehab. You get to practice recovery “on the outside” while you still have a supportive environment to go back to.
Short term residential programs cannot offer this. You just are not there long enough to experience this effect. It only happens in long term rehab, where you have the opportunity to slowly reintegrate with the real world while you are learning how to recover.
For many struggling alcoholics, this may be the thing that they are lacking from short term programs. They may be missing out on this “real world experience” when it comes to applying the program of recovery. They may need to test their ideas in early recovery and then be able to evaluate them with a group of peers, all while being held accountable. When you leave a 28 day program you are no longer being held accountable. Long term rehab generally comes along with a very simple rule:
If you relapse, you are kicked out immediately.
Pretty simple, and usually effective. Now you are being held accountable. So you can leave the treatment center and venture out into the real world, but you know that they are going to be drug testing you and giving you breath tests periodically and if you get caught drinking or using drugs then you are instantly kicked out. Is this enough to hold everyone accountable and keep them sober?
Surprisingly, the answer is no. Many of the peers that I lived with in long term treatment ended up relapsing anyway. Many of them doing so while they were still living there. It did not make a lot of sense to me because I was in a different point in my recovery–I had surrendered completely. The people who relapse while living in rehab have obviously not reached their bottom yet. And ultimately, this is what it always comes back to in recovery. Have you surrendered fully yet? This determines your success in sobriety.
Total surrender and a complete commitment to recovery
The perceptual mistake that I made in early recovery was this:
I believed that if a person made the decision to enter long term rehab and could commit to living there for 6 months or longer, then they must certainly be in a state of total and complete surrender. I mean, long term treatment and the six month commitment–to me–felt like a very serious and grave commitment. It felt like you were surrendering to prison almost. It was a very serious and heavy decision. It even felt like a grave decision. To me the decision was just filled with surrender. I mean here you are, agreeing to check out of life almost entirely, to go live in a rehab center for at least half of a year. It was serious. Or at least it was to me.
So when I made the decision to attend long term rehab I happened to be in a state of total and complete surrender. I had argued against long term rehab in the past, as counselors and therapists had been trying to convince me to attend it for a long time. I did not want to go and I equated the idea with prison. So when I finally agreed that long term rehab was probably what I needed, this represented a new breakthrough in my process of denial. You know that you have hit bottom when you agree to do the things that you said that you would never do in order to get help. I was in total surrender and I was willing to do anything to escape from the pain and misery of addiction.
For me, this total surrender also translated into a total commitment to recovery. I was not about to waste six months of my life without being totally serious about getting something out of it. I was serious. If I was serious enough to live in rehab for half a year, then I was serious enough to pay attention and really try to learn something. This is how I looked at it anyway.
I have to admit that I was baffled by my peers in long term rehab. Not everyone had reached a point of total surrender and in fact, many of them relapsed while living there. The vast majority of people that I met in long term rehab went on to relapse eventually. I could not understand why people would relapse who had every opportunity available to them to stay sober.
If you are living in long term rehab then you really get a chance to see where your commitment is. Because you have no excuse any more. You have 100 percent support when you are living in long term treatment. You are living, eating, breathing, and sleeping recovery all of the time. There is absolutely no reason that you should relapse if you actually want recovery.
Therefore when someone who is living in long term treatment relapses, you can be sure that they did not really want recovery. You can be sure that they were not in a state of total surrender. They had every opportunity to stay sober and they had every resource at their disposal. They just didn’t want recovery. They wanted to drink. It really is that simple.
If the person had just gone to short term treatment and then left and started attending meetings, then they have a million and one excuses as to whey they may have relapsed. They may not have had any support. Maybe they don’t have enough meetings close their home. There are a million excuses. But if you are living in a treatment center then you have no excuse. You are surrounded by peers who are all trying to help you recover. You have access to professional help at the rehab 24/7. There is no excuse other than you wanted to drink, so you went and drank.
Long term rehab takes away your excuses. You can still relapse while living in long term treatment, and many people do. But it is not for lack of support. It is because they don’t want to be sober. They don’t want recovery.
So if you truly want recovery and nothing else has worked for you, then you need to seriously consider living in rehab for a few months (or years). It’s not actually that bad. And it just may save your life.
Failing to find recovery is a miserable outcome. Nearly any means is justified to find sobriety
Some people object to the idea of long term rehab because they think it is going to be miserable.
I have two points to make regarding this objection. Keep in mind that I had this exact objection myself, and I believed that going to long term treatment would be the equivalent of going to prison. Eventually I lived in long term treatment for 20 months and it was the best decision I ever made.
First of all, long term rehab is not miserable. The idea is to give you freedom while you live there so that you can “practice” recovery while you still have a lot of support. Many long term rehabs are structured so that you get an increasing amount of freedom the longer you have stayed there. So when you first move in you may not have much freedom at all, and this is a good thing. Then after a few weeks they start to give you more freedom back. If you have been there for several months then you may have nearly total freedom to come and go as you please. Thus they are helping the alcoholic to ease back into the real world very slowly over time, bit by bit.
So living in rehab is not the miserable experience that you believe it will be. It is not bad at all. I lived there for 20 months and it was a great time, actually. I had fun. I would do it again if I had to, without any hesitation. Trust me, it is nothing like jail or prison. You have freedom, you have peers and friends that you will meet there, and you will have plenty of good times. It is not miserable at all.
Second of all, even if it was miserable, why would that stop you? Look through your denial and realize that nothing can justify your continued existence in alcoholism. If you are stuck in a cycle of relapse then you are completely miserable anyway. Nothing can justify the continued roller coaster of addiction. It is miserable and it kills you in the end. Who would sign up for that?
Maybe you are 40 years old and alcoholic. You are looking at roughly 30 more years of miserable drinking, or you can sober up and get 40-50 more years of good health and enjoyment. Seriously, those are your options. Now what if someone told you that in order to get the 40-50 more years of health and enjoyment, you had to go live in long term rehab for a year or two. Would you do it?
The smart choice is obviously to go trade a year of your life in rehab for a happier, healthier, and longer life. But of course most alcoholics cannot see the problem with this much perspective. They may not even believe that they could be happy without their alcohol. So they don’t even believe that this scenario applies to them at all.
If you are facing a choice between continued alcoholism or long term treatment, I can tell you which one you should pick. Perhaps that is because I had the same choice in front of me for several years and then I finally agreed to give long term rehab a chance. So I know what the outcomes of both choices are and I can tell you which one will lead to a happier and healthier life.
Excuses against long term rehab all seem silly after an alcoholic dies from drinking
I lived in treatment for 20 months and during that time I met about 35 other peers in recovery who tried to sober up by living there with me. A tiny few of these people remain sober to this day and the rest of all relapsed. About five of them have since died.
There are many excuses as to why you do not want to go live in rehab but none of the excuses hold up to the fact that five of my friends in recovery have died from the disease. All of the excuses against treatment sound pretty silly when the alcoholic struggles and then dies from their addiction. My best friend in recovery relapsed and died. What excuse can possibly justify that?
Most people who are even considering long term rehabilitation are in much the same situation. They have likely tried short term rehab a few times and failed at it. Their life is probably out of control to be considering this option. And therefore they are really choosing between life or death. They may not realize it at the time and it may take a few years for their alcoholism to kill them, but most people who are considering long term need to realize what level of consequences they are dealing with.
If you get caught stealing a beer from your day when you are 14 then the consequences at that point are relatively minor. But if counselors and therapists are telling you that you should go live in a long term rehabilitation center then you need to think carefully about the consequences here. They are not just pushing you into long term for the fun of it–they are afraid you are going to die! Really, this is the point at which they recommend that people go live in treatment. They don’t make the recommendation lightly. They don’t try to get everyone to go to long term. Just the hard cases who have failed repeatedly and are looking at heavy consequences if they continue to drink. They are trying to save your life when they push you into long term.
Out of the 35 or so that I lived with in rehab, five of them are dead and gone now. And those are just the ones that I know about. For all I know, more have perished since. This is a common occurrence among hard core alcoholics. They either sober up or they die. Don’t become a statistic if you have the opportunity to go to rehab.
How many times are you willing to do the same thing, only to relapse again?
At least ask yourself this much:
How many times have you tried to get sober, only to fail?
There is no certain number here, no right or wrong answer. I had been to treatment 3 times in my life and I tell that I needed something more in order to make the leap to sobriety. Whatever I had tried in the past was not working for me. I needed something more. And that “something more” meant that I should live in rehab for a while.
After working in a treatment center I have met so many people who continue to struggle with alcoholism, going in and out of residential treatment centers for decades up on decades. How many of those people could have stopped the cycle by living in long term rehab instead? Maybe not all of them but I can bet you that some people could (and should) break out of their relapse cycle by committing to longer term treatment.
If 28 days is not doing it for you then you have to consider your alternatives. One of the only things that you can try different is to increase the treatment duration. Sure you can try a different treatment approach (or model) but they are basically all the same concept. Therefore you should consider the length of time in treatment as one of the key things that could increase your chances at success.
Long term treatment worked for me when nothing else did.