Rehab is sort of an old fashioned term for inpatient or residential substance abuse treatment.  It is an abbreviated word for rehabilitation.  Actually, the term substance abuse is also an old fashioned term, as this illness is now referred to as substance use disorders.  With regard to rehab, the goal is to help the patient identify and accept the illness, and then to learn how to manage it, rather than having it managing them.  The end goal is no longer using the substance and avoiding switching to any other substance or unhealthy behavior to replace it.

What happens in rehab? 

 Just as those diagnosed with diabetes are taught about their illness, how to manage it, and how to stay healthy, so goes the same for substance use disorders.  In a biopsychosocial model, such as ours, only a short time is spent on the (bio) biological part, or medical aspects of the illness...just enough for the patient to see this has been out of their control for a reason, usually due to a  brain and stomach chemistry.  Next there is focus on the psycho part...teaching the patient the psychological aspects of the use disorder.  Then there is a focus on the social aspect and dealing with how to go back into the world and live with their illness.  

What's a typical day like? 

 Each program is different.  In our program, weekdays begin with a meditation group, where a meditation is read from One Day At A Time or other daily meditation readings and the group is led to discuss the thought for the day.  The thoughts always relate to recovering from substance use disorders.  The day continues with group sessions, with breaks in between and the last session at 7 pm. The content of each group includes open discussion about addiction, role playing, art therapy, focused relapse prevention.  Evening sessions include stress management, anger management, money management, assertiveness, codependency, spirituality, nutrition, twelve step education and family issues.  The weekend is more intensive and structured into four phases. 

 Broadly, the phases address (1) biochemistry, testing, assessing, focus on specific drugs and on addiction in general, (2) relationships, feelings, grieving, family, (3) identifying relapse risks and learning how to cope with each, and (4) values, strengths, empowerment and aftercare for continuing care treatment planning.

The typical day may also include random breath testing, random urine testing, and individual sessions as needed.

How do we know when someone is ready to leave rehab? 

Actually, addictions treatment needs to continue.  It may not have to continue in inpatient or residential but could be transferred to intensive outpatient or regular outpatient or a move to a halfway house.  There is strong evidence that shows the longer a patient stays in treatment, the better the outcome.

So, how do we know when it is time to take the next step, which is move to a more intensive or less intensive level of care?  We watch each patient's reaction and progress every day.  We read their homework and determine whether or not they are able to use what we are offering and how effectively are they hearing it.  We listen to what they say.  Our preferred protocol to move toward discharge from residential is that they remain in residential while returning to work, and we continue to monitor them and provide treatment each evening when they return from work.  Some patients are time limited by funding but we adjust with the individualized aftercare plan.  A twelve step phrase refers to their talking the talk and then walking the talk.  If the patient is in outpatient, we determine they are ready to complete when they have consistent negative urine and breath testing and have demonstrated they have made changes in their lifestyle to support their recovery.  They step down from one session a week to every other week, then less and less.

Why do patients go back to rehab. 

Shouldn't they be cured?  It seems it takes what it takes. 

Some patients begin their recovery after rehab and never relapse.  Some relapse once, and then are fine.  Others seem to need more treatment episodes.  Each time a patient returns to rehab, we look at what went wrong.  Often it is one of the following: they did not follow up with their aftercare plan, they did not embrace twelve step work as an adjunct, they continued to spend time with others who have substance use disorders, they lacked skills to cope with stress when sober, they did not fully recognize hidden relapse risks.  So subsequent rehabs keep correcting what the patient and the program learn from the relapse. 

This is a treatable illness.  Rehab really does work, but it does not stand alone.  There must be continuing care, sometimes for six months to a year and it is very helpful to most to maintain involvement in AA and NA.  Some people have other illnesses and these must be addressed at the same time be they mental or physical.  Some will need medication. 

So, that is rehab!