A Realistic (and Practical!) Approach to Addiction Treatment and Recovery
The statistic Practical Recovery would most like to publicize is how many of our clients return here after a relapse. When some treatment centers are publicizing “cure rates,” publicizing “return rates” would not appear to be good marketing! However, the reality of addiction treatment is that after any particular episode the most likely outcome is a slip or relapse. The slip or relapse does not necessarily mean that more treatment is needed, but in some cases it does. We have had clients who were previously in treatment at many of the “brand-name” treatment centers in the country. When they relapsed they elected to come to Practical Recovery, perhaps because if they returned (to most treatment centers) they would have gone through the same “program” they experienced previously. Every treatment episode at Practical Recovery, even for the same client, is unique. When they return here they pick up where they left off, rather than re-traversing old ground. One of our clients had been to so many treatment centers she stated she was ready to open one of her own—as soon as she got sober.
For some clients we establish conditions of treatment, but only when the client has a parent or other person paying for treatment. In these cases we often get advance agreement to have regular drug testing (one to three times per week) by an independent facility, with the results released to the payor. Depending on the level of supervision of the client, we are not surprised by slips, but attempt to turn them into learning opportunities. Although we have needed to discharge clients from our sober home, we do not discharge clients from our outpatient treatment center (with the exception of violence). In some cases we require certain types of services or a certain frequency of services. We have placed some clients on reward (contingency management) plans.
For the client who needs a break from the regular work in order to achieve initial abstinence, we offer alcohol and drug rehab at Reunion San Diego. Because some individuals often relapse when substances are nearby, initially they need to stay in a secluded residential facility. With luck an initial period of abstinence will acquaint them with why life might be better sober. Or perhaps, as the Big Book suggests, these individuals need more time to make a decision. Such individuals may have a very long history of use, or may be young but intent on punishing their parents (or others) by destroying themselves.
The Practical Recovery approach appears to be suitable for most clients with addiction problems. Because we also see individuals with mild to moderate problems, who are most suitable for moderation plans, we can cover almost the full range of addiction treatment. For most clients, having freedom of movement in the real world during treatment (in our treatment-in-residence or outpatient programs) means they can bring real-world situations to treatment for discussion. When they discharge they will not feel as if they have been thrown from safety into total temptation. This connection between treatment and the real world may be the reason why at long-term follow-up outpatient treatment works as well as residential (or better, considering the price difference). Of course, for some, a period of time in residential treatment appears necessary to clear their brains (by abstaining), allowing them to make some better decisions.