Residential rehabilitation - rehab for short - is a term used to describe a drug and/or alcohol treatment program that is provided in a residential setting. Rehab facilities provide a structured program of support and care aimed at people who have difficulty becoming substance-free on their own. The length of stay at a rehabilitation facility depends on a number of factors, including the type of substance being abused, prior drug use, medical history, and cost.
Comprehensive intervention services and prevention programs are available to help combat such views and assumptions. These start with education. Shock tactics should not be used to educate communities. Instead, it's best to help people understand that drug addiction is a mental illness and people should be comfortable and supported while seeking help.
Other prevention or drug abuse interventions include syringe service programs that provide HIV and hepatitis testing, vaccinations, and clean needle exchange. Not everyone has the means to attend rehab, so any alternative opportunity to receive services is crucial. This can also include referrals to mental health services and/or access to housing or employment.
Addiction is first and foremost a mental illness, one that can affect anyone and which often exists alongside other mental disorders. Not everyone who takes illicit drugs or prescription medication will become an addict; in fact, most people do not. However, those who are at a higher risk of developing addiction tend to be more vulnerable to it (i.e. those already struggling with illnesses like depression or PTSD, or who do not have access to proper medical care).
As a diagnosis, addiction is when someone's brain tricks them into thinking they need the drug to function. Many times, this is achieved through chemical feedback loops in the brain, which bombard it with signals to release more dopamine. Other times, receptors are damaged and the brain signals that more drugs are needed to get the same "high." Addiction should not be confused with dependence, which is when the body physiologically needs to drug for daily functioning. Detoxification from dependence is painful and requires close medical monitoring, while addiction by itself does not necessarily have such effects. The two can also overlap.
All substance abuse can be treated successfully, given the right help. The process of getting and staying clean is not achieved through sheer willpower, but requires behavioral changes in both the addict him/herself, as well as support in their surrounding community. Substance abuse treatment is a long-term investment that can take months or even years. The most important thing is one's commitment and desire to be drug-free. All treatment is voluntary, since no one can be forced in a facility without their consent. Again, the goal is to stop relapse, which means it's imperative that the person is willing to change their lifestyle, relationships, and sometimes even living environment.
Take Care of Work and Family Obligations
Before beginning the process of choosing a rehab facility, you will need to take care of your obligations at home. This will not only ensure that your life is ready and waiting for you when you have completed rehab, but will also allow you to relax and focus on your recovery, instead of worrying about things back home.
If you're uncomfortable telling your employer about your upcoming stay in a rehab facility, remember that it's likely that anyone who has invested time into you as an employee and wants to continue to do so will likely appreciate your honesty. If you're not healthy, you're more than likely not going to be a good employee, either.
According to the Family and Medical Leave Act, you are entitled to up to 12 weeks of medical leave, so your job will be protected during your stay in rehab. Employee eligibility should be consulted individually with each employer.
If you have children, elderly parents or pets, you'll need to take all the appropriate steps to ensure they are well taken care of during your stay. Appoint someone as their guardian and make sure everything is prepared financially for them while you're away.
Tie Up Any Financial or Legal Loose Ends
Signing up for automatic payments of your bills or asking someone close to you to take over the care of your finances while you're in rehab is a very good idea. If you have legal obligations, be sure to notify the proper parties that you will be partaking in a rehabilitation program and will tend to your obligations upon your return. Putting this conversation in writing is a good idea.
It can be tempting to bring everything that reminds you of home, but taking only the things that you need will be crucial to your recovery. By sticking to things you absolutely need, you will also minimize any outside distractions that could halt or mitigate your sobriety. In rehab, your focus should be mostly on yourself and getting the best treatment you can, so leave anything unnecessary behind.
Choosing the Right Rehab:
When a person makes the decision to enter rehab, the first choice they need to make is what type of facility they should choose. This depends on, but is not limited to, the factors mentioned above. Most rehab stays are for 30 days, but can be extended for up to 12 months, with the added choice of being in either inpatient or outpatient care. Generally, people with debilitating mental illnesses (those that render a person unable to fully perform daily functions/tasks) choose inpatient facilities. Some rehab centers also cater to specific demographics, such as adolescents or women.
Outpatient facilities are more effective for individuals who have already attended inpatient treatment.
Shorter or outpatient options are also more suitable for those who have jobs or need a flexible schedule. Most people do not have the luxury of taking time off to focus solely on treatment. Furthermore, rehab can be expensive; the price per day can range from $500 to thousands of dollars.
Private rehab facilities usually have no wait times. This is important, since waiting to enter a rehab treatment program could be life-threatening. Public rehab facilities can have wait times up to six months and this, in some cases, could be far too long. If a person is waiting to go to rehab for other reasons or if they're not willing to go voluntarily, their probability of success may decrease dramatically.
Out-of-state rehabs are typically very effective. Because these facilities are away from family, friends and distractions, they take a patient out of the typical environment that could be a potential threat to their rehabilitation process.
On the first day at a new rehab facility, a representative will go through the patient's personal and medical history, also known as an intake evaluation. General questions include age, gender, previous history of treatment, any current and prior medications, known health problems or diagnosis, and the severity of the substance abuse. Questions may include all prior and current drug use, frequency of consumption, methods of consumption, and which symptoms are associated with the drugs. Honesty is crucial, as the answers determine what the treatment plan will include; medical professionals are not there to judge or penalize.
Once a person is enrolled, they almost always undergo detox. This helps to establish a clear and stable mind, maximizing success in recovery and building toward the long-term goal of sustained sobriety. It is also not uncommon for patients to relapse, and that is OK. It's not a failure, but rather a learning experience where patients determine what went wrong and how to avoid it in the future.
Because stays at rehab centers are not intended to be lifelong commitments, any and all therapies will become less frequent towards the end of the program. This allows patients to become self-sufficient when it comes to dealing with cravings or urges. Of course post-rehab communities exist to further support patients when they leave, but they may not provide direct medical services.
Different Types of Support
Rehab centers will provide individual counseling and group therapy to help patients work through their behaviors and thoughts around drugs. While group therapy is not mandatory, it is a great option that can lead to immense progress. Only those who have gone through the same thing can truly empathize with each other and give advice; medical professionals are present to coordinate and assist those sessions.
During individual therapy, where patients meet with medical providers, the aim is to figure out what situations make the patient want/crave drugs. Often called "triggers," these discoveries are crucial to building successful coping skills. For example, one might drink alcohol when they are under stress. The counselor or medical staff will help a patient figure out the triggers and signs of high-stress situations (i.e. constant sweating, headaches) and come up with more beneficial ways to deal with them.
Other topics include what to do when presented with the opportunity to relapse. Avoiding places with the abused substances is a good start, but many times, those places are also the same places where patients seek social support. For example, bars and nightclubs are where people relax after work and go on dates, so abstinence by itself is not always a realistic approach.
Through behavioral therapies like cognitive behavioral therapy (CBT) and motivational enhancement therapy, healthcare providers can tailor solutions to help minimize peer pressure and temptations. Tailoring solutions to the individual allows therapy to be customized, providing the individual the best chance for success in the program. In addition, by focusing on the patient's specific reasons to stay drug-free, therapists can personalize the recovery process and set clear goals. Many times these solutions are achieved through trial and error, and only through critiquing of the process can the best recovery be found. This is especially important for outpatient facilities where patients do not stay overnight and can go test out their coping skills.
A holistic approach, which is an alternative approach and not available in most inpatient facilities, is most often for more severe patients. By being in a new environment where there are minimum distractions, patients can focus on their recovery. This is especially true for people with other mental or physical illnesses like depression, anxiety, or PTSD. Some of these other illnesses may be the reason drugs were consumed in the first place and addressing those needs will also be a part of therapy.
To address other social issues, family therapy may also be a part of the process, especially with adolescents and young adults. This is when family members and sometimes friends go through therapy sessions with the patient and discuss how to deal with drug addiction. Being in a supervised environment (with a medical professional) means young patients can feel comfortable expressing their struggles and anger without being dismissed by their parents. It also serves as an educational tool for families to understand what drug addiction/dependency truly entails, and where it stems from.
In rehab, another main component of support is medication. Not everyone is prescribed medication, but it is frequently given to patients who have used highly addictive chemicals like nicotine or opioids. By targeting the same brain chemical pathways as the drugs, medications like methadone can block receptors, thus giving the brain fewer signals about feeling the 'high' and cutting short the desire feedback loop that leads to seeking more drugs.
Despite the overwhelming evidence-based research done on using such drugs to treat drug addiction, some facilities don't offer this type of treatment, as it can be seen as another form of drug addiction. Medication like methadone is not meant to replace an illicit substance with another addiction – it is meant to provide a safe platform from which the body and mind can heal. This is especially true in the case of patients who have become dependent on drugs, since they cannot function normally without them. Additional help is needed to stabilize the body and ensure it doesn't respond by going into overdrive. For example, if a person has heavily abused painkillers like oxycodone (which is given to post-operation patients), their body could associate severe pain with the total absence of the painkillers. Thus going 'cold turkey' could bombard the brain with pain messages, as it still thinks the body is in extreme pain.
The most common type of therapy is individual therapy. This is when a patient and medical provider have one-on-one sessions to discuss ways to prevent relapse. This involves exploring questions about how the drugs affects the patient and what the symptoms of drug craving are. Through changes in behavior and cognition (thought processes), problems are resolved and goals made and worked towards.
A more specific kind of psychotherapy is cognitive-behavioral therapy (CBT). This is a behavioral approach through which patients work to change their behaviors and thoughts. By identifying their own triggers for cravings, patients, alongside medical providers, can create goal-focused exercises to fight those urges. "Homework" is given at the end of sessions so patients can see if those exercises are helpful outside the doctor's office.
Dialectical behavioral therapy (DBT) is a specific form of CBT that focuses on a patient's relationships with other people in different environments -- especially intimate relationships (romantic, family, close friends). This form of therapy was formed when a scientist found that some people have more intense emotional highs and lows than normal. By focusing on interpersonal skills and how to interpret other people's emotions as well as their own, a person can start to find better solutions to their problems. DBT also differs from CBT as it also includes group therapy sessions.
Patients can expect to get the following out of one-on-one therapy:
- Guidance on how to work on and process the initial causes of drug and alcohol abuse, including history of trauma
- Strategies for identifying and interrupting alcoholism and drug abuse triggers (i.e. reaching out for support or engaging in self-care instead of drinking or taking a hit)
- Learning more structured ways of dealing with challenging thoughts and emotions, to help build up resourceful thinking patterns and behaviors
- Help establishing plans for tempting situations (such as seeing certain people or going to certain places). The more you have a system for handling triggering situations, the more likely you are to stay strong and avoid relapse
- Support in creating a new, healthy, and fulfilling life – the best way to stay sober is to thrive
Group therapy focuses on shared experiences between multiple patients and supporting each other. This may include shared learning experiences and team building exercises, all moderated by a healthcare provider. This type of therapy can include family and friends therapy, where loved ones are invited into therapy sessions with the patient. Group and family therapy can help alleviate strain in relationships, and help others understand the struggles of the patient.
A number of drug and alcohol rehab programs have recovering addicts actually invite family members to therapy at the rehab facility. Family therapy is important not only for the recovering addict, but for the loved ones themselves. Many times, they're deeply impacted by the addiction and don't have the resources to address it in a healthy way. Family therapy can help everyone involved move forward with love and grace. It's also one of the best ways to ensure that the family home is a safe and supportive place for the recovering addict once they graduate from the rehabilitation program.
In a more physical approach to therapy, experiential therapy helps recall emotional responses through movement and action. This ranges anything from sports to role-play to wilderness activities (hiking, mountain biking, etc.). Having a healthier outlet for excessive anger, depression or restlessness helps establish an alternate way of dealing with the original issue substance abuse was trying to cure. It is also a way to process emotions associated with past experiences, especially through drama and reenactments.
Outside the parameters typical treatment facilities, equine-assisted therapy is a branch of animal therapy that helps patients process their emotions with horses. Horses are known to be very receptive to people by picking up on non-verbal cues, a form of communication that may suit some patients more than talking. By expressing fear or frustration in new ways, patients can see their thoughts in a new light. Furthermore, though taking care of a horse, patients can have a specific focus and learn how to take responsibility for the care of another.
As one can see, there is a plethora of treatment and therapeutic options for drug addiction and substance abuse. It's important to figure out what kind best suits your personal needs and desires. All treatment programs will have multiple therapies, spanning anywhere from a few weeks to over a year. The best way to prepare is to do your research and check out facilities before enrolling. Ideally, find someone who can come with you and will have your back; no one should have to do this alone.
Leaving a drug and alcohol rehab center is not the "end" of recovery. Like many things in life, sobriety is an ongoing process that takes energy and commitment.
Before graduating from a drug and alcohol rehab center, patients normally meet with rehab experts to make a plan for aftercare. This can involve living in a sober living environment such as a halfway house. Sometimes, it includes the ability to return to the rehab facility on certain weekends when the person feels extra support is in order.
After the rehab program is complete, there are additional services that patients can use. This includes support groups, 12-step programs, and vocational services that provide long-term assistance. Some facilities also offer network alumni for post-rehab support, relapse prevention programs, aftercare programs and outpatient programs for relapse prevention. Often, the medical staff will do a rehab evaluation session where referrals or extension of stay are discussed.
12-step programs are frequently used because it helps people consistently reflect on their actions and show them the consequences of them. They are also available practically everywhere (for free), and give patients something to work on with the support of sponsors and loved ones. There are branches of 12-step programs for any number of addictions, including:
- Cocaine Anonymous (CA)
- Crystal Meth Anonymous (CMA)
- Overeaters Anonymous (OA)
- Pills Anonymous (PA)
- Gamblers Anonymous (GA)
- Sex Addicts Anonymous (SAA)
All follow-up programs aim to prevent relapse and require more than just dealing with the drugs. This is why some experts recommend doing outpatient programs after inpatient treatment. Follow-up programs are also there to acknowledge that substance abuse may last a lifetime, and no one has to do it alone. Most people have the urge to relapse, and it takes energy and renewed commitment to stay sober. Thus a variety of interventions exist that cater to geographic, demographic, and addiction-specific needs.
What happens after rehab?
Sober living facilities cater to people who want a fresh start. Also called halfway houses, people can enroll in these homes while they find new jobs or adjust to a new environment. These are often subsidized housing that community-based organizations have access to where all residents are recovering substance abusers. They still have rules but are designed to encourage people to be self-sufficient, complete certain household chores, go to work or school, or buy their own groceries.
Choosing to go to rehab is brave. It's a declaration that you want to live. It's also the beginning of a new phase of life – one based on self-awareness, a greater understanding of both your strengths and limitations, and an expanded sense of support.
Addiction is not a life sentence. Circumstances change and growth is always possible. Rehabilitation and recovery is a series of learning opportunities taken, and healthy choices made, over and over. You can make it through and emerge with dignity and strength, ready to live a life of joy and purpose.