Susan B. Winston LMFT

Shift Happens

The Real World of Rehab

While rehab may save your life, know what you are getting into before you enroll

Posted May 22, 2013

I have just had my first experience as a rehab therapist at a tony Malibu facility.  I believe in rehabilitation and quasi institutionalization for addicts.  It gives them a safe place to go and get clean.  In truth, really complete rehabilitation is a 90-day process, and most clients can only afford the 30-day treatment.  This is in large part why the relapse rate is dramatically high.  A staggering 90% of treated alcoholics will relapse at least once during the one-year period following treatment.  The data goes on to reveal that 80% continue drinking.  Close to 62% of drug users relapse and  50% of poly-substance users relapse.  The contributing factors to why the drug users and poly-substance users numbers are lower are that drugs are mostly illegal plus harder to get, and more expensive than alcohol.  Alcohol is not only legal but available in stores literally across the street.

To help combat such failure rates, if you are going to enter a rehab facility, know what you are getting into.  Make sure you visit and see the facility; meet the CEO and see if he really cares or is just a businessperson filling beds.  Meet the doctor on call and the psychiatrist who will be assigned to your case.  You do not want the initials MD to mean “more drugs.”  Put another way, working with a “Dr. Feel Good” is not going to solve your problem, rather it will exacerbate it.   For example, giving a meth user Adderral or Ritalin is a medical sin.  A doctor that misdiagnoses conditions outside your addiction is dangerous.  Check the credentials of the doctor and make sure he does not play games with your brain.  Very import, ask what drug interventions the doctor prescribes during detox and as well as further down the line.  Confirm the information you have gathered with your personal doctor before enrolling. 

Look at the staff.  Are they credentialed therapists vs. interns often used because of their lower pay grade?  Assess the nursing.  Is someone there overnight?  What is the monitoring system, and by this I mean how often does the staff check to make sure clients are where they are supposed to be?  The number of clients that “jump the fence” to go get high is significant.  These are all people who came voluntarily and couldn’t make it.  Sometimes a simple hourly check is enough to make sure clients stay.  When someone leaves a facility without completing their program, it can be hugely depressing to the remaining residents, often having a truly devastating effect.  Remember, these are not prisons.  Clients are mostly here voluntarily.

The world of detox is an up and down world.  Sometimes facilities are overflowing, and other times they are searching to fill the beds.  Make sure you are not being urged to stay just to keep a bed filled.  If you have completed your program and the medical team and your therapist agree that you stand a strong chance of not relapsing, don’t get caught in any pressure to remain.  The caution though is the proven fact that the longer the treatment, the greater the opportunity to succeed. 

In an industry that is rife with occupancy fluctuations, it is a common and broad practice to use independent contractors.  It is certainly the case for therapists who are then become the crux of periodic staffing depletions.  Put another way, staff is not guaranteed and quite possibly your personal therapist may be the one laid off.  Know what you are getting into and make sure that the therapeutic relationships you form are not going to be ripped from you mid-therapy

By way of background, transference and counter-transference, which is the relationship formed between a therapist and the patient, is a powerful part of therapy.  Negotiated correctly, it can be a forceful tool in addictive recovery.  At core it is the therapist who provides the behavioral therapy that is most proven to assist in treatment.  Whether it is one-on-one or group, that person should remain a part of the process throughout.  Ask if this is to be the case.

Rehab is not an inexpensive process but it can be lifesaving.  I’m a believer, and I’m a healer.  Find the help you need and be very smart about it.  Most of these high-end places are absolutely beautiful.  But well manicured does not mean that they have the means to the cure.