Drug and alcohol residential or outpatient rehab treatment is a place to go when an addiction has become a problem in your life, and you find yourself unable to stop. Whether the addiction is centered around alcohol and drug abuse or gambling, video gaming, Internet, sex and porn, etc. then perhaps residential or outpatient treatment is for you.
We can use a model to help conceptualize the process of recognizing there is a alcohol and or drug abuse problem or any other forms of addiction and how to take action to do something about it. This model is called the, “Stages of Change” model, which describes common stages or phases individuals go through in changing behavior: Pre-contemplation, Contemplation, Preparation, Action, Maintenance. It is an important and necessary part of psychotherapy addiction assessment.
This is the first stage where a person doesn’t see that they have a problem, and therefore, are not yet thinking about changing their behavior. The person is in ‘denial’ about their problem, and isn’t aware that change is needed. In fact they do not see themselves as having a problem. It is everyone else in their life that views them as having a 'problem' or the people in their life are the 'problem.' Sound familiar? At this stage, the person needs help in seeing that they have ongoing drug or alcohol abuse/dependence or other forms of addictive behavior such as gambling, sex, or the Internet to name just a few of the common seen addictions in life. This is where I begin my non judgmental and non confrontational style of psychotherapy.
My approach utilizes Motivational Interviewing skills, which is a process whereby I create an alliance with my patients by working with them in a non-judgmental, non shaming therapeutic style. The goal is for the patient to create their own insight by helping them to see the discrepancies between the reality of their situation - the negative consequences caused by their addiction and their statements of denial. The idea is for the patient to gain insight by considering the possibility that perhaps a problem does exist – all change is intrinsic – meaning we change from within. We do not change by someone telling us that we have to change because we have a problem. Or that we have to change or else…….Few people like to be told what to do - no matter what the issue and pushback is the norm.
While a ‘confrontational’ style of intervention is commonly known to the public, thanks to the promotion of reality television shows, research shows that this approach in the long term is rarely successful. Instead, I prefer an alternative style of intervention using positive reinforcement a style referred to as Systemic Intervention. In a Systemic Intervention the focus is not just helping the identified patient (IP) into recovery but helping the entire family or system enter into recovery. I have often conducted ‘interventions’ regardless whether the ‘IP’ decides to come in with their family. The family suffers from the consequences of addiction just as much as the person who is struggling with their addiction. The family is often overlooked in the process of getting treatment for the abuser.
This is the stage where a person understands that they have a problem, and considers doing something about it. Still, at this stage, the person hasn’t yet made a commitment to change. They may not know what steps to take and need help in formulating a reasonable, doable plan that fits their situation. I help them in coming up with a plan by collaborating with the patient. It has to be a plan that they can buy into - that fits their needs. At this stage, I also help the patient and their family members to support the person by helping them to deepen their understanding of the pros of leading a clean and sober life - alice free from their addiction, the consequences of their addiction and that help is available to them if they chose to accept help.
At this stage the person has made a decision to change their behavior and face their addiction. Regardless whether the addiction is centered around abusing drugs and alcohol or any other forms of addiction including, sex and love addiction, porn, Internet, video gaming or gambling. This is a stage where people often need help in deciding what to do. Every person struggling with some form of addiction is different and ‘one size’ treatment does not fit all. This is a stage where I work closely with the individual and the family and help them to choose what is the best course of action for them to take. What may work for one person may not necessarily be the right course of action for another. At this stage we begin the process of preparing and planning what to do. Because there is the real possibility of not following through with intentions and plans, this is the stage where a person needs a lot of encouragement and support to help them follow through with their intention to seek help. There is always the risk of falling back to an earlier stage in the model.
The person now has made a commitment to make a substantial change and follows through with their plan. Plans from the Preparation stage are put into action, e.g., attending a 12 step group, going into residential or intensive outpatient treatment and or meeting with a therapist who specializes in addiction. The best approach to successful treatment is to include all of the above.
This is the stage where it is acknowledged that the person has truly committed to maintaining the change in their behavior and is living clean and sober - a life free from their addition (s). What we call maintaining ones recovery. This takes work, dedication, commitment and constant vigilance. Applying relapse preventions skills are necessary until the person has had some years under their belt living free from their addition the risk of relapse remains high. Maintenance is an ongoing stage and usually the risk of relapse has diminished substantially after the first year and especially if the patient has been taught relapse prevention skills. Often, over the years due to the positive experiences of living clean and sober the risk of relapse can diminish greatly. However, even after years of sobriety, the risk for relapse can always be there. Support from family and clean and sober friends is always helpful. If relapse occurs at any time after being free from their addiction - for any length of time, taking the necessary steps to get back into recovery should happen as quickly as possible. Relapse should not be looked at as a failure. For some it’s part of the journey of recovery and living clean and sober. If relapse is treated quickly and without shame, the relapse process can be studied and used to strengthen an individuals recovery program.
Inpatient or Outpatient Treatment?
Once having made a decision to get treatment, where to go needs to be decided, including whether to go to an inpatient facility or an outpatient facility—the two main settings for treatment.
Inpatient Residential Treatment.
Inpatient rehabs are also referred to as residential treatment centers. This choice may be best for persons who are moderately to severely affected by their addiction. This type of treatment costs more compared to the outpatient treatment because residential costs and other expenses are included. Inpatient rehab provides an environment away from many triggers, e.g., people, places, and things, and an environment of continuous care.
In looking at substance abuse several questions to consider:
Are you using alcohol or drugs on a daily basis or are active in your addictive behavior and are not able to remain addiction free for 24 hours? If the answer is “Yes,” then inpatient treatment is most likely indicated.
Do you experience severe withdrawal symptoms if you try to abstain and stop drinking or using drugs, e.g., convulsions, seizures, blackouts, delirium tremens (DTs) (body tremors, confusion, disorientation, stupor, hallucinations)? If “Yes,” then a medical detoxification facility is required prior to entering residential treatment. These days many high-end residential treatment centers operate their own medical detox centers. Alcohol and some drug withdrawal can be fatal is not managed medically. One of the main reasons people continue in their addiction is the fear of withdrawal and the physical and emotional pain that accompanies the withdrawal stage.
Intensive Outpatient Treatment (IOP)
With an outpatient program, people visit the treatment center on a weekly basis for counseling and treatment (for example, 3 -4 x / week for 12 weeks). This type of treatment is less costly compared to the inpatient treatment because the client does not incur residential costs. There are several new studies out that indicate IOP is just as effective as inpatient treatment depending on the severity of the addiction.
One last word on rehab. There are many studies that show rehab does not work for many people especially if they enter into a residential treatment center for the minimum 30 days. There are several reasons for why people relapse after a 30 day stay. One reason is that 30 days is often not enough time but due to the expense of rehab and the time it takes out of ones life, 30 days is all people can afford. Ideally 90 days is preferred. If you end up choosing a 30 day program then there should be a thorough aftercare plan provided before discharging. A thoughtful and well planned aftercare plan should include outpatient treatment, membership in a 12 step group and a sponsor. A significant cause for relapse is the transition back into the 'real' world, which can be overwhelming to most people. The reality is anyone can stay clean and sober in a residential system where you are in an environment, which is highly structured from the time you wake up in the morning until you go to bed at night. That coupled with the fact that it difficult to obtain drugs and alcohol or gamble or engage in any other risky addictive behaviors in a confined, monitored environment. Difficult but not impossible.
Because I also specialize in relapse prevention, I work closely with patients that recently have completed residential treatment and people who are currently in an outpatient setting, helping them to understand the risks of relapse and how to avoid situations that can lead to relapse.
Rehab is an expensive investment. As in any investment it is important to take great care in protecting your investment. Which is why treatment does not end after one completes a residential or outpatient program. Weekly and daily maintenance is a must to minimize relapse. The first year is the most difficult year in the maintenance stage. Again, many studies have shown that the first year is the most important year. Once a person successfully maintains their recovery from their addiction for one year, the odds greatly improve in maintaining their recovery and the risk of relapse drops significantly. I have helped many of my clients successfully navigate their first year of recovery by teaching them relapse prevention skills, cognitive behavior skills and treating their underlying cause of addiction. Many people who suffer from an addiction are merely attempting to self medicate their depression, anxiety, trauma and their core belief issues that they are not good enough. If these issues are not successfully addressed in therapy with a psychotherapist who understands and has been trained in co-occurring disorders the likelihood of relapse remains high. However, this does not have to be the case.
Thom Kessler, LMFT, RAS
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Marriage & Family Therapist and Registered Addiction Specialist