Walk into any treatment center, and you’ll hear the ravaging war stories. You’ll talk to the person who’s been to rehab three times, ten times, and twenty-six times. You’ll learn about the facilities that created miracles, and you’ll hear about the facilities where clients died on the immediate grounds. In other words, if you ask a hundred clients about their rehab experiences, you’ll probably hear a hundred different answers.
It’s no secret that rehab has become the epitome of the Wild, Wild West. You send yourself (or your loved one) to treatment in the hopes that it’s “for the best,” but it can be challenging to distinguish the truth from the photo-shopped images splashed across the fancy website.
Does Rehab Work?
Despite what any facility tells you, there isn’t a clear answer. I’m a therapist, and I’ve worked in rehab settings for the past five years. I’ve supported clients in all levels of care, from the first hour of detox to years after completing treatment.
Here’s what I’ve learned. Rehab can work, and such facilities have saved thousands of desperate lives. Rehab can work, but it’s hard to distinguish what’s responsible for making it work. Is it being secluded from the rest of society? Is it professional therapy or counseling? Is it being around like-minded individuals who understand the perils of addiction? Or, is it a combination of all of the above?
I can’t tell you what it is. A client might, but his or her answer will vary from the next person’s.
Furthermore, the type of rehab can make a profound difference. People struggling with a co-occurring disorder, such as depression, anxiety, or eating disorders, may not benefit from an approach that only focuses on substance abuse. Moreover, these people often leave treatment in worse condition than when they first arrived. Even if they are sober, if they haven’t addressed the underlying issues associated with addiction, the susceptibility to substance relapse or psychological decline remains high.
Most experts will agree that rehab alone does not “fix” addiction. If anything, these facilities create the initial path towards change. They offer a safe haven for acute stabilization, for individuals to learn the coping techniques and relapse prevention skills needed to flourish in “real life.”
That said, even the best rehab outcomes cannot necessarily predict long-term sobriety. That’s because sobriety is a daily commitment, an active choice that an individual makes each day. Completing a program only means there’s more work to do next.
What If Rehab Isn’t Working?
There are many reasons that rehab may not be working for you or your loved one. Although not an exhaustive list, these reasons may include:
- Unwillingness to comply with treatment rules
- Resistance or ambivalence about sobriety
- Continuous, unmet needs in rehab (medication, psychiatric support)
- Distracting, external factors (marital stress, financial worries, concerns about employment)
- Unfit level of care (i.e., the individual would do better in a residential facility- but is only receiving outpatient services)
- Coordination or communication problems with the treatment team
- Limited or no support for planning aftercare upon discharge
- Issues within the rehab community (bullying, stealing, peers relapsing)
It is recommended to reflect on the potential barriers influencing one’s rehab experience. If the same problem continues to manifest in every treatment setting, it’s time to look inward and identify whether you hold responsibility for the pattern.
Just like life, rehab isn’t meant to be ‘perfect.’ In fact, some reasonable stress can actually be a good thing, as it encourages clients to implement problem-solving and distress tolerance skills. That said, excessive or downright dangerous issues can certainly attribute to one’s inability to thrive.
What Other Alternatives Exist?
Rehab is not always a viable option for everyone. For one, it can be costly, even with insurance coverage. People with young children or other dependents may not be able to miss work or be away from their families. Furthermore, rehab may not always be the appropriate course of action for mild or moderate substance use disorders.
Other treatment options may include a combination of psychotherapy, life coaching, spiritual involvement, support groups, medication-assisted treatment, and holistic approaches that may include exercise, yoga, and nutrition.
Sometimes, the best treatment requires a trial-and-error approach. What works for one person may be disastrous for the next. Keeping an open mind is imperative. Staying informed and curious about the treatment process is also essential.
And remember, nothing really works if you don’t want to do the work.