Is it Time to Go to Rehab?
By Tom Horvath, PhD
Thanksgiving is a few days away. The day after Thanksgiving (or Christmas, New Year’s Day, the Super Bowl, etc.), we often get calls about a substance binge the day before. The binge was so bad, is it time to go to rehab (residential treatment)?
Below are some issues to consider when making that decision. I typically recommend AGAINST going to rehab, as I will explain. Every case is unique. In addition to the following considerations there may be many others. For many substances you need to taper off or get medical assistance (a detox). A brief admission lasting several days (up to a week or two) for detox is not the same as rehab, and it may be worthwhile.
Would going to rehab please your family, rather than going because you need it? Do you have a family member who, despite not being a health care professional, is convinced rehab is the only solution? Family pressure may nevertheless be a sufficient reason in your situation (although that situation might be an unfortunate one). Of course, if your problems have been ongoing and tumultuous, they may just be looking for a good night’s sleep and not worrying about what is happening with you.
Ideally you will discuss the option of rehab with one or more suitable professionals, not affiliated with a rehab. If you were going to surgery, you would get a second or third opinion and think little of it.
Depending on how you get to a facility, you might have been referred by someone who is getting a kickback for sending you, and choosing the facility based on the size of the kickback rather than your specific needs. The individuals who work directly for the facility may indeed be responsible professionals. However, they are in a conflict-of-interest situation. They are highly encouraged to facilitate admissions, rather than recommend what might be most useful for you.
You might do an internet search on this question: “Is US addiction treatment corrupt?” There are entire documentaries on this subject, including The Shuffle and The Business of Recovery. A book about the problems with quality of care is Inside Rehab, by Anne Fletcher.
If you are concerned that you cannot maintain a period of abstinence on your own (“I don’t have enough willpower”), perhaps some outpatient treatment to build and maintain your motivation would be a better use of your time and money. You and your will get discouraged if you hope to build and maintain motivation IN rehab, only to lose it shortly thereafter.
If alcohol is your primary concern, then disulfiram (Antabuse), is worth considering. While on it (and many days afterward), if you drink you will get VERY sick. There are other medications to consider for other concerns. When you get your second or third opinions, these meds are important to discuss if they did not come up in your first opinion.
Disulfiram is often a way to assure family members you are serious about change. Other options include ongoing drug testing, a sober companion for high-risk situations, or a sober living home (where you have a bed but can be free to engage in your life).
Treatment is more likely to be helpful when it reinforces a plan you have already made (at least in a general way), rather than when you hope treatment will make your plan. The fundamental issue, in most cases of addictive problems, is that you believe you need the addictive behavior to (cope with depression, anxiety, or trauma; have fun; cope with stress, etc.). If this belief is strong, and you are not willing to build up an alternative way of thinking and coping, and not willing to build up a new life that you do not want to lose, rehab may not help.
Further, the primary work of change with addictive problems is at home. Nearly everyone is successful in rehab itself (of course!). If you do go to rehab, start preparing for discharge immediately. Think ahead to all the situations, places, and people you will need to cope with in a new way and start talking about them immediately.
Being away from your life for 30+ days, especially if you are cut off from your phone and laptop, can be difficult to devastating. Ideally you would enter a rehab that does not completely disconnect you from the rest of the world (and there are exceptions to this idea, but perhaps not as many as overzealous family members might think).
Although rehab is often considered the essential beginning of change, it’s hard to see how that idea could be true. In most cases, the treatment is not individualized. You may be lucky to get one individual session per week. Otherwise, you’re sitting in lectures followed by a discussion period. If the topics selected are useful to you, you might get something from them. But many people report that they get too much of what they already know, not enough of what they need to learn, and almost no time to discuss their specific personal issues (in either the groups or individual sessions).
Furthermore, at least in California, the facility is required to provide only 20 hours per week of “treatment,” and what qualifies as treatment is broadly defined. The rest of your time could be doing many activities that might be enjoyable in themselves, but are they worth being out of the house for weeks? An intensive outpatient program (IOP), or multiple individual sessions per week (if that is in your price range), could be just as effective, without the life disruption.
Related to this issue is the quality of the staff that you will usually spend time with. Although there may be impressive credentials for the various directors, most of your time may be spent with drug and alcohol counselors, who might be excellent, but might also be relatively new, inexperienced, and under educated.
Many treatment facilities are intent on pushing their “program” onto you, whether you like it or not. Most of those programs are 12 step and disease model oriented. If that’s your orientation, that could work. If it’s not, you might spend more of your time being annoyed with the facility than working on yourself.
Many rehabs isolate you from your partner and family, even though working on these relationships could be central to the changes that you need to make. It is often better to start on improving these relationships almost immediately.
Ironically, the rush to rehab is often an attempt at a quick fix, when a better long-term solution may be available. That’s just like substance use, which offers a quick fix for the problems you are facing but passes over the better but longer-term solutions. Perhaps it’s time for you to entirely switch from a shorter term to a longer term orientation to problem solving?
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