I am ENTITLED to substances, drugs, and/or alcohol...
-because it gives me the shortest possible route to euphoria.
-in order to temporarily forget my rotten past.
-because my current living and working conditions are well-below others.
-because I made a few little mistakes, yet I have to face consequences that far outweigh my actions, and that is not fair.
-to help me temporarily numb my physical or emotional pain.
-because I am too powerless/diseased to do anything about it.
-because “everybody” else entitles themselves.
Do you self-prescribe to one more of the above entitlements? How would you feel if any of your loved one’s lived their lives according to one of the above entitlements? How do you feel knowing that your hard-earned tax dollars go to imprisonment and/or treatment of people that believe that they are entitled to their choice of any of the above?
Thinking of all the positive people in history, all those that we would make positive role models of… did they live their lives according to entitlements or did they make their own way? A life, ultimately, that one could be proud of.
Now consider your life, after addiction. Let’s assume what most people in the grips of addiction assume: a mundane life, a boring existence. The absence of negative consequences that you self-inflict, and afflict on all those around you with drinking and drugging aside: what can be expected from a clean and sober life? Some products of the ordinary life to consider: better relationships (whether significant; or with friends, co-workers, and everybody else you come in contact with, however trivial), children, pets, productivity, participation and involvements, and just experiencing the world through clean and sober senses. The list would be endless; however, according to history textbooks, ordinary. I am not saying that your life couldn’t ever take a turn for the extraordinarily positive (and the possibility of this happening to someone clean and sober, versus addicted, is many-fold higher). Also, maybe in the small world around you now, contrasting your currently addicted lifestyle with anything clean and sober might be seen as somewhat extraordinary.
How many people, on their deathbeds, would say that the best part of their lives happened during their alcohol and drug-use years? I bet, with few exceptions, that they would claim that addiction would clearly mark the worst years of their lives. The value of retrospection is that you can truthfully evaluate life before, during, and after addiction; including the totality of all experiences, positive and negative.
I appreciate your feedback, especially by email!
My email: betteraddcare@yahoo.com
Related: Residential alcohol treatment center, drug rehab, addiction rehabilitation, substance abuse, alcoholism, twelve step, alternative to 12 step, recovery program, prescription drugs, before rehab, best rehabs
Saturday, August 11, 2007
Wednesday, August 8, 2007
Addiction: Changing minds on diseased brains
I have recently re-discovered a gem of an article on addiction-as-disease. The author recommends a shift of “…discourse about sickness and addicts to a dialogue about health and people.”(1)
Click here to view the article. (2)
Click here for another article that summarizes current thoughts in the field on this subject, including extensive reference to the article above. (1)
I have a question for you. Whether your addiction (or that of a loved one) is a disease or not, why do you care?
I've seen the disease model 'debate' rage for many years. The addicted, researchers, and others seem so vested in whether addiction is a disease or not. The arguments for and against are passionate to the point of attacking both people and their opinions. I have seen the term "disease" defined so many times by both sides that its perceived ambiguity lends malleability to anyone's intent.
Again, why do YOU care? What interest do you have in seeing addiction defined either by the disease model or by its refutation? How is seeing this issue from one perspective or another worthy of your interest (or anxiety). Take a contrarian view: how would a paradigm shift in your belief system change you? Answering these questions to yourself honestly may give you some valuable insight where you may need it the most. Try it.
1. Retrieved August 8, 2007, from http://www.basisonline.org/2007/02/the_dram_vol_32.html ; The DRAM Vol. 3(2) - Addiction-as-Disease: It Is All It’s Constructed to Be, February 14, 2007
2. Retrieved August 8, 2007, from http://sociology.ucsc.edu/directory/reinarman/addiction.pdf ; Reinarman, C. (2005). Addiction as accomplishment: The discursive construction of disease. Addiction Research and Theory, 13(4), 307-320
I appreciate your feedback, especially by email!
My email: betteraddcare@yahoo.com
Related: Residential alcohol treatment center, drug rehab, addiction rehabilitation, substance abuse, alcoholism, twelve step, alternative to 12 step, recovery program, prescription drugs, before rehab, best rehabs
Click here to view the article. (2)
Click here for another article that summarizes current thoughts in the field on this subject, including extensive reference to the article above. (1)
I have a question for you. Whether your addiction (or that of a loved one) is a disease or not, why do you care?
I've seen the disease model 'debate' rage for many years. The addicted, researchers, and others seem so vested in whether addiction is a disease or not. The arguments for and against are passionate to the point of attacking both people and their opinions. I have seen the term "disease" defined so many times by both sides that its perceived ambiguity lends malleability to anyone's intent.
Again, why do YOU care? What interest do you have in seeing addiction defined either by the disease model or by its refutation? How is seeing this issue from one perspective or another worthy of your interest (or anxiety). Take a contrarian view: how would a paradigm shift in your belief system change you? Answering these questions to yourself honestly may give you some valuable insight where you may need it the most. Try it.
1. Retrieved August 8, 2007, from http://www.basisonline.org/2007/02/the_dram_vol_32.html ; The DRAM Vol. 3(2) - Addiction-as-Disease: It Is All It’s Constructed to Be, February 14, 2007
2. Retrieved August 8, 2007, from http://sociology.ucsc.edu/directory/reinarman/addiction.pdf ; Reinarman, C. (2005). Addiction as accomplishment: The discursive construction of disease. Addiction Research and Theory, 13(4), 307-320
I appreciate your feedback, especially by email!
My email: betteraddcare@yahoo.com
Related: Residential alcohol treatment center, drug rehab, addiction rehabilitation, substance abuse, alcoholism, twelve step, alternative to 12 step, recovery program, prescription drugs, before rehab, best rehabs
Monday, August 6, 2007
Residential Alcohol Drug Rehab: Success Rate Myths
As an industry insider, I could shorten this article to one sentence: Don’t believe anything you see and hear about a rehab’s success rate, statistics, or testimonials. But, there is so much more to be said on how the consumer can use success rate information to make a better choice.
Success rates in rehab advertising are surprisingly complicated constructs, especially for the following reasons:
-Many alcohol and drug residential rehabs don’t even try to measure how well their guests do after completing their program. If they don’t care enough to know how well they are accomplishing their mission, should this be a red flag for you?
-Some addiction programs call retention rates “success rates” where the “retention rate” refers to the percentage of guests who complete the residential part of the program. Retention rate, as a separate measure, is important information in itself: if the rehab has trouble keeping their guests for the duration of attendance, that is certainly a sign of a problem. However, how well one does after rehab is the question here, regardless of their attendance during the program.
-(and most importantly...) Success rate research has no agreed upon standards, so every program has a different methodology; and usually one that presents the rehab in the most positive light (imagine that). This creates the problem of “comparing apples to oranges.” One program might measure relapse rates, another might ask if a person has been sober in the last week, month, or year; still another might call any reduction (including harm reduction) in drinking or drugging a success.
How would you measure ‘success?’ Perhaps in one of the following ways…
-Whether or not the person leads a relapse-free completely clean and sober life. Or…
-Whether the person has relapsed multiple times but has not gone back to her old pattern of drinking or drugging. Or…
-Finally, what if the person has gone back to his old pattern of drinking or drugging, for months or years, but as long as he hasn’t done so recently, say, in the last thirty days or so, –would you even consider this a ‘success?’
…Rehabs will proudly display their success rate percentage without ever mentioning how they define success – a definition that could be quite different from yours.
Many rehabs that keep success statistics do so by surveying a sample of their program completers (from recent graduates to others who have completed their program years ago). The survey question is of the variety, “Are you currently drinking or using drugs?” If the person answers “no” than the rehab will include it in their success rate. However, is that person’s ‘current’ sobriety a direct result of the rehab’s program? What if the person completed their program, returned to their previous pattern of drinking and drugging, went to another program, and then stopped because of this second program – should the previous rehab get credit for this? No, but according to their methodology they will. What if the person relapsed back to his old ways after leaving the program but eventually (months or years later) stopped on his own –should the rehab take credit for that? Again no, but yet again, they will.
Gathering data can be tricky too: what if the participant can’t be reached, or he refuses to participate in the survey? Would this indicate a higher likelihood of drinking or using? Would the participant claim she is clean, sober, and relapse-free in order to please the surveyor; or answer inaccurately out of a sense of shame? Would the participant be compelled to claim sobriety out of fear that the survey may not be 100% confidential?
An extremely small number of rehabs that claim a high success rate actually explain their research methodology. Most would correctly fear that it would simply not stand up to any measure of scrutiny. Upon careful review, one can usually see flaws in data gathering, analysis, conclusions, and, most importantly, how the rehab represents “success” to their potential customers on their website and over the phone. Rehabs will try to get as much advertising and sales mileage as possible out of success rates, even if the truth can only be stretched a few inches.
One trend that has been spotted is the use of third-party research or survey companies that are paid to independently verify accuracy and (most importantly to the rehab’s advertising efforts...) add perceived legitimacy to the rehab’s claimed success rate. Here are the problems with this approach: (1) flaws in the rehab’s data collection can be just as easily duplicated by the research company (see above paragraph beginning with “Gathering data…”); (2) no research company can absolutely claim that the rehab gave them a fair (or truly representational) sampling of their program completers; for instance, a client database can be easily queried to provide a biased retrieval sample to the research company (unbeknownst to them); and (3) just as with the rehab’s own claims of success, an outside research company’s analysis and conclusions are rarely derived from a sound scientific method (objectivity, full disclosure, and reproducibility) yielding results that are just as suspect.
The success rate should be important, both to the rehab and its potential customers. A rehab should care about its ability to provide a valuable service to its clientele, and therefore constantly monitor outcomes. In fact, a consumer is advised to re-think any rehab that cannot provide a substantive answer to the question of that rehab’s success rate.
In a rehab’s zeal to claim a high success rate, one wonders if their “research” is manipulated beyond any measure of truth-in-advertising. Even those rehabs that try their best to accurately represent their success rate could be using research methodology that wouldn’t hold up to even the most elementary scrutiny.
So what is the consumer to do? First, don’t believe anything regarding a rehab’s success rate claims. By starting with this attitude, you won’t be setting yourself up for disappointment upon failed expectations.
Second, if a rehab’s research methodology is described in clear detail on their Web site, or other sales material, then review it carefully using the information you learned in this article. When you find flaws, or if you have questions, contact the rehab to get the clarification you need.
Third, if the rehab claims a certain success rate, but does not describe their research methodology in clear detail, ask them to describe it to you over the phone (if they can’t otherwise send you a description in writing). This sounds like a poor alternative, because it is. It should make you wonder why the rehab would state a success rate yet not provide information on their Web site as to how they arrived at such a number.
Fourth, if you don’t feel comfortable with a rehab’s stated success rate, and such information is important to you, just keep persevering until you find one that can give you the necessary degree of comfort you need to make that important admission decision.
A short note on testimonials…
About the nicest thing one can say about testimonials, especially as used in the rehab industry, is that they are a marketing gimmick. Testimonials at best provide only anecdotal evidence of a program’s success. Also, who is to say that the testimonial, if even authentic, is still valid; did the person who wrote it since relapse or go back to his old habits (a retraction of a testimonial would probably be rare even in such a case)?
I appreciate your feedback, especially by email!
My email: betteraddcare@yahoo.com
Related: Residential alcohol treatment center, drug rehab, addiction rehabilitation, substance abuse, alcoholism, twelve step, alternative to 12 step, recovery program, prescription drugs, before rehab, best rehabs
Success rates in rehab advertising are surprisingly complicated constructs, especially for the following reasons:
-Many alcohol and drug residential rehabs don’t even try to measure how well their guests do after completing their program. If they don’t care enough to know how well they are accomplishing their mission, should this be a red flag for you?
-Some addiction programs call retention rates “success rates” where the “retention rate” refers to the percentage of guests who complete the residential part of the program. Retention rate, as a separate measure, is important information in itself: if the rehab has trouble keeping their guests for the duration of attendance, that is certainly a sign of a problem. However, how well one does after rehab is the question here, regardless of their attendance during the program.
-(and most importantly...) Success rate research has no agreed upon standards, so every program has a different methodology; and usually one that presents the rehab in the most positive light (imagine that). This creates the problem of “comparing apples to oranges.” One program might measure relapse rates, another might ask if a person has been sober in the last week, month, or year; still another might call any reduction (including harm reduction) in drinking or drugging a success.
How would you measure ‘success?’ Perhaps in one of the following ways…
-Whether or not the person leads a relapse-free completely clean and sober life. Or…
-Whether the person has relapsed multiple times but has not gone back to her old pattern of drinking or drugging. Or…
-Finally, what if the person has gone back to his old pattern of drinking or drugging, for months or years, but as long as he hasn’t done so recently, say, in the last thirty days or so, –would you even consider this a ‘success?’
…Rehabs will proudly display their success rate percentage without ever mentioning how they define success – a definition that could be quite different from yours.
Many rehabs that keep success statistics do so by surveying a sample of their program completers (from recent graduates to others who have completed their program years ago). The survey question is of the variety, “Are you currently drinking or using drugs?” If the person answers “no” than the rehab will include it in their success rate. However, is that person’s ‘current’ sobriety a direct result of the rehab’s program? What if the person completed their program, returned to their previous pattern of drinking and drugging, went to another program, and then stopped because of this second program – should the previous rehab get credit for this? No, but according to their methodology they will. What if the person relapsed back to his old ways after leaving the program but eventually (months or years later) stopped on his own –should the rehab take credit for that? Again no, but yet again, they will.
Gathering data can be tricky too: what if the participant can’t be reached, or he refuses to participate in the survey? Would this indicate a higher likelihood of drinking or using? Would the participant claim she is clean, sober, and relapse-free in order to please the surveyor; or answer inaccurately out of a sense of shame? Would the participant be compelled to claim sobriety out of fear that the survey may not be 100% confidential?
An extremely small number of rehabs that claim a high success rate actually explain their research methodology. Most would correctly fear that it would simply not stand up to any measure of scrutiny. Upon careful review, one can usually see flaws in data gathering, analysis, conclusions, and, most importantly, how the rehab represents “success” to their potential customers on their website and over the phone. Rehabs will try to get as much advertising and sales mileage as possible out of success rates, even if the truth can only be stretched a few inches.
One trend that has been spotted is the use of third-party research or survey companies that are paid to independently verify accuracy and (most importantly to the rehab’s advertising efforts...) add perceived legitimacy to the rehab’s claimed success rate. Here are the problems with this approach: (1) flaws in the rehab’s data collection can be just as easily duplicated by the research company (see above paragraph beginning with “Gathering data…”); (2) no research company can absolutely claim that the rehab gave them a fair (or truly representational) sampling of their program completers; for instance, a client database can be easily queried to provide a biased retrieval sample to the research company (unbeknownst to them); and (3) just as with the rehab’s own claims of success, an outside research company’s analysis and conclusions are rarely derived from a sound scientific method (objectivity, full disclosure, and reproducibility) yielding results that are just as suspect.
The success rate should be important, both to the rehab and its potential customers. A rehab should care about its ability to provide a valuable service to its clientele, and therefore constantly monitor outcomes. In fact, a consumer is advised to re-think any rehab that cannot provide a substantive answer to the question of that rehab’s success rate.
In a rehab’s zeal to claim a high success rate, one wonders if their “research” is manipulated beyond any measure of truth-in-advertising. Even those rehabs that try their best to accurately represent their success rate could be using research methodology that wouldn’t hold up to even the most elementary scrutiny.
So what is the consumer to do? First, don’t believe anything regarding a rehab’s success rate claims. By starting with this attitude, you won’t be setting yourself up for disappointment upon failed expectations.
Second, if a rehab’s research methodology is described in clear detail on their Web site, or other sales material, then review it carefully using the information you learned in this article. When you find flaws, or if you have questions, contact the rehab to get the clarification you need.
Third, if the rehab claims a certain success rate, but does not describe their research methodology in clear detail, ask them to describe it to you over the phone (if they can’t otherwise send you a description in writing). This sounds like a poor alternative, because it is. It should make you wonder why the rehab would state a success rate yet not provide information on their Web site as to how they arrived at such a number.
Fourth, if you don’t feel comfortable with a rehab’s stated success rate, and such information is important to you, just keep persevering until you find one that can give you the necessary degree of comfort you need to make that important admission decision.
A short note on testimonials…
About the nicest thing one can say about testimonials, especially as used in the rehab industry, is that they are a marketing gimmick. Testimonials at best provide only anecdotal evidence of a program’s success. Also, who is to say that the testimonial, if even authentic, is still valid; did the person who wrote it since relapse or go back to his old habits (a retraction of a testimonial would probably be rare even in such a case)?
I appreciate your feedback, especially by email!
My email: betteraddcare@yahoo.com
Related: Residential alcohol treatment center, drug rehab, addiction rehabilitation, substance abuse, alcoholism, twelve step, alternative to 12 step, recovery program, prescription drugs, before rehab, best rehabs
Saturday, August 4, 2007
Residential Alcohol Drug Rehab: The Embarrassing Fee
Good residential alcohol and drug rehabs have saved lives, families, and careers. How can you put a price on that? Good rehabs don't mind that I share the following information with you. This article (a true consumer alert) is about the numerous bad rehabs advertising all over the web with impunity.
First and foremost in the mind of someone searching for a residential drug and alcohol rehab is how much will it cost. Among the many other questions anyone might have, the concern about expense seems to rise to the top. But don’t tell that to your average rehab because they are under the delusion (shall we call it denial?) that money is not an issue. The proof? Just look at all their websites; hardly ever a mention of their fees. Or maybe, the cost of their program is such privileged information that you need to call them first to be worthy of getting any answer on how much it will cost you. The real answer why rehabs don’t advertise their fees is unfortunately far more sinister. Yes, in your moment of greatest need, the rehab will try anything to manipulate and cajole you into calling one of their caring/empathic/compassionate associates (i.e. salespeople) whose main purpose is to assist (i.e. sell) you in realizing that their fee is never too high to save your life or the life of your loved one.
Go to any rehab’s website and you will find lots of “information.” Ignore the fact that most such websites are a bit of a rough read because their site is continuously search engine optimized: the headers and body-text are heavy with repeated keyword usage. If you reveal the source (html) of their website you will see meta-titles and descriptions screaming out to all search engine spiders within listening distance. This means only one thing: what you are looking at is their well-polished online sales piece. Still, these rehab websites are seemingly packed with so much information, including the ever-present toll-free number to get live help 24/7. But something is missing in 97% of all such websites. Something that 97% of people who are interested in getting rehab for themselves or a loved one want to know. It's their price tag, but where is it? Go ahead: read their unusually verbose website word-for-word, check out all their links. Using logic, you might skip straight to their FAQ’s page, after all if 97%+ people want to know, it would certainly qualify to appear on their FAQ’s page. Oh, but it does not.
Most rehabs will induce people to call them first in order to get any information on the cost of their program. Here's why: by getting you on the phone, you become a “captive audience” often forced (by reasons of courtesy or gullibility) to listen to their sales pitch on why their price is justified, reasonable, or just downright generous (and why you should begin the admissions process immediately by sending in a non-refundable deposit).
Some rehabs (imitating those that they treat?) rationalize, and not-so-honestly, why you must call them to get their price quote: their prices change often, so you have to call to get their latest updated pricing information (even though websites are easily and frequently updated); everybody is different so their pricing must be customized to the individual (simply posting a fee schedule, or an itemized price list on their website would seem to solve this not-so-complicated issue); and my favorite… you must call and “qualify” yourself for their services first before cost is discussed. Some rehabs, without even giving you any idea about the cost, will describe in detail the convenient terms in which they will accept payment.
Ask the owners/operators of these rehabs why they must deliberately leave out their fees in order to compel their website visitors to call for such information, and you will get a consistent answer (the 'under-lying rationalization')... Their program is so helpful, the positive consequences of which are so beneficial, that this deceptive advertising practice is for the greater good. Greater good for the rehab? Au contraire: for the greater good of YOU (or your loved one), mired in the misery of addiction and its consequences. So, you see, all (97%) of these rehabs are not being up front about their fees for your own benefit. Now, if this doesn’t give you a warm feeling deep inside, don’t feel bad for two reasons. First, deception stinks. Second, rationalizations are what people do to assuage guilt and feel better about themselves; it is just this sort of manipulation that alcoholics and drug dependents get very good at over time. Maybe these rehab operators are learning a thing or two from their clientele?
A well-known principle in marketing is that when consumers are faced with an overwhelming number of choices they tend to choose early, then spend the rest of their time justifying to themselves why their choice was the best. By compelling the rehab consumer to call in order to get pricing information, the rehab has the golden opportunity of getting the consumer to buy early. A verbal commitment, or even a bed-doposit later, the consumer is on the hook. If you find this marketing practice deceptive, don't give them your business. Although since very few rehabs actually quote their fees on their sales literature, such a bold move may seriously limit your choices.
Note to Rehabs
Put pricing information on your Web site, if it isn't on your home page, than at least provide a clearly marked link from your home page and all other substantive pages on your Web site. Knowing that the MOST frequently asked question is about your fees, please include it on your FAQ's page, if you have one. If you feel that your fees are "complicated" or must be "customized" to the needs of the client, provide a well-annoted fee schedule, or at the very least, provide a price range with an explanation of why quoting a price range is necessary. If your prices change frequently, remember that it takes less than 10 seconds to update a text file on your Web site. Also, you can put a disclaimer, on the Web page that has your fee, simply stating that you fees are subject to reasonable change. If you still do not want to state your fees without the consumer having to call you, ask yourself why; and be as honest with your answer as you expect your clients to conduct themselves when they walk through your door in the hopes of transforming their lives.
Note to Consumers
Why should the fees of the rehab be important to you? For one, affordability is a 'yes or no' qualifier. Also, when pricing rehabs, ask yourself what your plan is if there is a relapse, or a return to the old patterns of usage behaviors. Good residential rehabs can work miracles, but are still far from achieving a 100% cure rate. Will you need money for another rehab? Will you need to be able to send your loved back to the same rehab for more time? Relapse or not, were you expecting to enroll in a local outpatient program (which has its own fees) after residential treatment to ease the transition into a clean and sober life?
If you spot an appealing rehab on the web, but can't find their fees, go ahead and call them for a price quote only. Yes, it seems unfair that the onus of gathering data that should be on their website or other sales materials is on you. Still, call their toll-free number, and before letting them gather any information on you, just ask them what their fees are. Then, unless you have other immediately pressing questions, hang up the phone, and let the information sink in. Don't make an impulsive buying decision on such an important service for you or your loved one. If you can't get a good idea of their fees within the first 10 seconds of the call, hang up the phone: don't fall for their dubious sales tactics. Remember, you are the one that must live with the consequences of your choice of a residential rehab. It would be a rare occurence for a consumer to find the best rehab for him or herself on the very first phone call. Great rehabs are out there, and it might take a few phone calls to find one.
Summary
As you probably can imagine, residential rehabs are typically expensive. And for good reason. Many factors go into a good residential facility to make it a safe, comfortable, and effective place to get well.
However, if a rehab doesn’t provide pricing information on their website it might be a hint of something a little more ominous than ‘oversight.’ Perhaps they might feel a little shame for providing a service that doesn’t measure up to the value of their potential customer’s money. Or, one good rationalization later, perhaps not.
***
As promised in a previous article, here are a few rehab websites that actually quote their fees (please email me with more examples and I will update this article!):
Duffys Myrtledale
Bayside Marin
Christian Rehab Options
Practical Recovery Services
Desert Canyon Treatment Center
***
I appreciate your feedback, especially by email!
My email: betteraddcare@yahoo.com
Related: Residential alcohol treatment center, drug rehab, addiction rehabilitation, substance abuse, alcoholism, twelve step, alternative to 12 step, recovery program, prescription drugs, before rehab, best rehabs
First and foremost in the mind of someone searching for a residential drug and alcohol rehab is how much will it cost. Among the many other questions anyone might have, the concern about expense seems to rise to the top. But don’t tell that to your average rehab because they are under the delusion (shall we call it denial?) that money is not an issue. The proof? Just look at all their websites; hardly ever a mention of their fees. Or maybe, the cost of their program is such privileged information that you need to call them first to be worthy of getting any answer on how much it will cost you. The real answer why rehabs don’t advertise their fees is unfortunately far more sinister. Yes, in your moment of greatest need, the rehab will try anything to manipulate and cajole you into calling one of their caring/empathic/compassionate associates (i.e. salespeople) whose main purpose is to assist (i.e. sell) you in realizing that their fee is never too high to save your life or the life of your loved one.
Go to any rehab’s website and you will find lots of “information.” Ignore the fact that most such websites are a bit of a rough read because their site is continuously search engine optimized: the headers and body-text are heavy with repeated keyword usage. If you reveal the source (html) of their website you will see meta-titles and descriptions screaming out to all search engine spiders within listening distance. This means only one thing: what you are looking at is their well-polished online sales piece. Still, these rehab websites are seemingly packed with so much information, including the ever-present toll-free number to get live help 24/7. But something is missing in 97% of all such websites. Something that 97% of people who are interested in getting rehab for themselves or a loved one want to know. It's their price tag, but where is it? Go ahead: read their unusually verbose website word-for-word, check out all their links. Using logic, you might skip straight to their FAQ’s page, after all if 97%+ people want to know, it would certainly qualify to appear on their FAQ’s page. Oh, but it does not.
Most rehabs will induce people to call them first in order to get any information on the cost of their program. Here's why: by getting you on the phone, you become a “captive audience” often forced (by reasons of courtesy or gullibility) to listen to their sales pitch on why their price is justified, reasonable, or just downright generous (and why you should begin the admissions process immediately by sending in a non-refundable deposit).
Some rehabs (imitating those that they treat?) rationalize, and not-so-honestly, why you must call them to get their price quote: their prices change often, so you have to call to get their latest updated pricing information (even though websites are easily and frequently updated); everybody is different so their pricing must be customized to the individual (simply posting a fee schedule, or an itemized price list on their website would seem to solve this not-so-complicated issue); and my favorite… you must call and “qualify” yourself for their services first before cost is discussed. Some rehabs, without even giving you any idea about the cost, will describe in detail the convenient terms in which they will accept payment.
Ask the owners/operators of these rehabs why they must deliberately leave out their fees in order to compel their website visitors to call for such information, and you will get a consistent answer (the 'under-lying rationalization')... Their program is so helpful, the positive consequences of which are so beneficial, that this deceptive advertising practice is for the greater good. Greater good for the rehab? Au contraire: for the greater good of YOU (or your loved one), mired in the misery of addiction and its consequences. So, you see, all (97%) of these rehabs are not being up front about their fees for your own benefit. Now, if this doesn’t give you a warm feeling deep inside, don’t feel bad for two reasons. First, deception stinks. Second, rationalizations are what people do to assuage guilt and feel better about themselves; it is just this sort of manipulation that alcoholics and drug dependents get very good at over time. Maybe these rehab operators are learning a thing or two from their clientele?
A well-known principle in marketing is that when consumers are faced with an overwhelming number of choices they tend to choose early, then spend the rest of their time justifying to themselves why their choice was the best. By compelling the rehab consumer to call in order to get pricing information, the rehab has the golden opportunity of getting the consumer to buy early. A verbal commitment, or even a bed-doposit later, the consumer is on the hook. If you find this marketing practice deceptive, don't give them your business. Although since very few rehabs actually quote their fees on their sales literature, such a bold move may seriously limit your choices.
Note to Rehabs
Put pricing information on your Web site, if it isn't on your home page, than at least provide a clearly marked link from your home page and all other substantive pages on your Web site. Knowing that the MOST frequently asked question is about your fees, please include it on your FAQ's page, if you have one. If you feel that your fees are "complicated" or must be "customized" to the needs of the client, provide a well-annoted fee schedule, or at the very least, provide a price range with an explanation of why quoting a price range is necessary. If your prices change frequently, remember that it takes less than 10 seconds to update a text file on your Web site. Also, you can put a disclaimer, on the Web page that has your fee, simply stating that you fees are subject to reasonable change. If you still do not want to state your fees without the consumer having to call you, ask yourself why; and be as honest with your answer as you expect your clients to conduct themselves when they walk through your door in the hopes of transforming their lives.
Note to Consumers
Why should the fees of the rehab be important to you? For one, affordability is a 'yes or no' qualifier. Also, when pricing rehabs, ask yourself what your plan is if there is a relapse, or a return to the old patterns of usage behaviors. Good residential rehabs can work miracles, but are still far from achieving a 100% cure rate. Will you need money for another rehab? Will you need to be able to send your loved back to the same rehab for more time? Relapse or not, were you expecting to enroll in a local outpatient program (which has its own fees) after residential treatment to ease the transition into a clean and sober life?
If you spot an appealing rehab on the web, but can't find their fees, go ahead and call them for a price quote only. Yes, it seems unfair that the onus of gathering data that should be on their website or other sales materials is on you. Still, call their toll-free number, and before letting them gather any information on you, just ask them what their fees are. Then, unless you have other immediately pressing questions, hang up the phone, and let the information sink in. Don't make an impulsive buying decision on such an important service for you or your loved one. If you can't get a good idea of their fees within the first 10 seconds of the call, hang up the phone: don't fall for their dubious sales tactics. Remember, you are the one that must live with the consequences of your choice of a residential rehab. It would be a rare occurence for a consumer to find the best rehab for him or herself on the very first phone call. Great rehabs are out there, and it might take a few phone calls to find one.
Summary
As you probably can imagine, residential rehabs are typically expensive. And for good reason. Many factors go into a good residential facility to make it a safe, comfortable, and effective place to get well.
However, if a rehab doesn’t provide pricing information on their website it might be a hint of something a little more ominous than ‘oversight.’ Perhaps they might feel a little shame for providing a service that doesn’t measure up to the value of their potential customer’s money. Or, one good rationalization later, perhaps not.
***
As promised in a previous article, here are a few rehab websites that actually quote their fees (please email me with more examples and I will update this article!):
Duffys Myrtledale
Bayside Marin
Christian Rehab Options
Practical Recovery Services
Desert Canyon Treatment Center
***
I appreciate your feedback, especially by email!
My email: betteraddcare@yahoo.com
Related: Residential alcohol treatment center, drug rehab, addiction rehabilitation, substance abuse, alcoholism, twelve step, alternative to 12 step, recovery program, prescription drugs, before rehab, best rehabs
Thursday, August 2, 2007
BEFORE rehab: Ideas most rehabs will NEVER share with you
Note: Some people may need to go directly to a residential rehab program; the ideas presented below may only delay the inevitable and necessary admission into such a program. However, for a few people, especially those that are strongly ready, willing, and able to begin a clean and sober life (and don’t have a significant history of relapse), the following ideas might save your family more money than any other online article on this subject:
Voluntary admission to a local ‘outpatient,’ community-based program
Ever abundant DUI’s and drug possession crimes have created a very large market of state-licensed local services (available almost everywhere in the United States) that specialize in court-ordered education and group therapy programs with adjunctive services including random drug and alcohol testing and Antabuse (and Naltrexone) monitoring. If the person abusing alcohol and/or drugs is seriously ready to make a change, it is actually easy to set up a ‘custom-tailored’ program. These services will help the participant and his family (or employer, if necessary) monitor recovery and provide extrinsic motivation for relapse prevention. Your local phone directory, yellow pages, or online directory can provide listings under “addiction” "alcoholism" or "drug abuse."
Any outpatient program will have a reasonable fee schedule for its services. Typical fees for random drug testing: per urinalysis $10-$20; breathalyzer $5-$10 each. The usual procedure for random drug and alcohol testing: participant calls the outpatient facility every single day (although many are closed Sundays and Holidays), to find out if he is required to come in that day to submit breath and/or urine for testing. You can set up drug and alcohol testing for multiple times a week, once a week, twice a month, or once a month.
Antabuse (Disulfiram) and Naltrexone monitoring (both for alcohol abusers only, see below under “Antabuse and Naltrexone”) is usually around $5 per visit. Once the participant receives the prescription from the pharmacy (Antabuse and Naltrexone must be prescribed by a physician), he gives it to the 'outpatient' program. Several times during the first week (“loading dose"), and 2-3 times per week thereafter, the participant comes in to take her Antabuse usually with the following procedure. Outpatient staff will crush the Antabuse tablet into a powder than dissolve it in a cup of water, the participant drinks the solution in front of the staff member who then inspects the cup for any leftover tablet powder (if so, than more water is added to it, it is stirred or shaken, and given back to the participant to finish it). Once the dose is taken, the participant must stay in a monitored area for about 30 minutes to discourage anyone from inducing vomiting. After 30 minutes the participant is free to go and an appointment is set up for the next visit.
Group counseling at these 'outpatient' programs is usually in two hour increments of group therapy or education and costs about $25-$40. Most such counseling is geared toward state required DUI education and therapy classes, but many counseling centers also offer groups for relapse prevention, anger management, domestic violence, etc. If you are voluntarily admitting yourself to their program you are NOT obligated to attend any of these sessions (if they pressure you to do this, just find another facility). If you have the financial means you may want to try it out, but if money is an issue see the section below on “AA, NA, or any similar 12-step program."
Finally, an "intake" is usually required to participate in any aspect of their program (fill out paperwork, brief interview) which costs about $25-$50.
Bonus: Many short-term residential rehabs recommend continuing your care through a local 'outpatient' program. By experiencing this before attending a residential rehab, you will know exactly what to expect afterward. If you, or your family, feel that a continuity of care is beneficial to leading a successful relapse-free clean and sober life; you may want to consider this program whether your residential facility recommends it or not.
AA, NA, CA, or any similar 12-step program
A large majority of residential rehab programs teach AA (Alcoholics Anonymous), NA (Narcotics Anonymous), CA (Cocaine Anonymous) and the general 12-step philosophy as an integral part of their program. It then (not surprisingly) becomes the most important part (if not the only part) of their aftercare program. So, a recommendation here of trying out AA, NA, or CA has the added bonus of allowing the participant a real-life experience in the very care that the majority of residential rehabs offer. If the participant likes the experience, but feels the need for residential care, then the choice of facilities can be narrowed to those that practice the 12-step philosophy. Likewise, if the participant does not like the experience, then she should seriously consider only those residential rehabs that provide alternatives to 12-step.
The first step to start attending meetings in your area is to contact with your local AA chapter. They can provide you with a directory of days, times, types, and places of meetings. Even in small communities, you will likely be surprised at the number of meetings held nearby on a weekly, and many times, daily basis. If you attend a meeting and have a general dislike for it, then at least you know better what may or may not work for you. If you just don’t like some of the participants at the meeting, remember that different AA meetings have different ‘personalities’ so you may find a meeting more to your liking elsewhere, or on a different day and time.
You can attend AA, even for a lifetime, at very little expense. If you have the means, you should donate a dollar during ‘collection’ time at the meetings. If you do not have the means, the donation is optional and is not required for participation. The only other costs are for the books necessary (especially, “Alcoholics Anonymous – Big Book, 4th edition, available in paperback) for you to fully vest yourself into the program. You do not have to buy the books at the meeting site (and don’t ever let anyone pressure you to do so), rather you can go to most any online bookseller to buy them either new or used. The free option: most public libraries have multiple copies available for checkout. You are encouraged to read the literature to make sure that this is the program that you can believe in. Full participation is strongly encouraged in this program.
If you are uncomfortable with the AA, NA, CA, and 12-step programs, you are advised to think twice before admitting yourself to a residential program that teaches these very same philosophies. When you eventually decide to go to a residential program, look for one that advertises itself as non-AA, non-12-step, or ‘alternative to 12 step.’ If you do like the 12-step philosophy, but you do need a residential program, you have a large selection to choose from that do teach 12-step, then expect you to continue regular meetings (an important component of their aftercare) in your local community.
Important: I am recommending AA as an option only. There are many other ways for a person to get well, and I have always believed that one-size-does-NOT-fit-all. I understand that there are many who oppose the teachings of AA, and I encourage anyone to do their research before making any serious commitments to any such program.
Antabuse (Disulfiram) and Naltrexone
Antabuse (usually for those that abuse alcohol, but has recently been tried for cocaine users) provides extrinsic motivation to remain relapse-free. Even a small amount of alcohol (one beer, one shot) will induce severe physical reactions in the user that are very uncomfortable. Antabuse can only be prescribed by a physician, and liver function tests (a simple blood test) are usually required prior to prescription. To make sure that the participant is actually taking the required dose of this medication certain procedures are necessary (otherwise the user may hide the pill under the tongue of inside the cheek to later spit out, or may induce vomiting after swallowing) – see above under “Voluntary admission to a local ‘outpatient,’ community-based program”). You can follow this same procedure for at-home monitoring of a loved one by simply purchasing a pill crusher at your local drugstore or supermarket.
Naltrexone reduces alcohol craving by lowering or eliminating the ‘pleasurable’ effects of drinking alcohol. Although it is not as popular (and some would say not as effective at preventing relapse) as Antabuse, it may be an alternative for some. Monitored use is recommended (see above under “Voluntary admission to a local ‘outpatient,’ community-based program”).
Church-based programs
If you are a person of faith, talk to your pastor, priest, deacon, or someone in the pastoral center that can talk to you about alcohol and/or drug abuse. Resources that might be available can range from free individual or group counseling, and in some cases, church-sponsored sober living facilities.
Therapeutic Communities (clean and sober living environments)
For some people with a long history of drug or alcohol use, a long-term (90+ days, but typically a year or more) structured living environment with a strong community support system already in place is an effective option.
Other options including counseling, self-care, and bibliotherapy will be discussed in a future article.
Combination
The best course of action for any individual that does not have an immediate need for residential rehab care, and is strongly motivated to pursue a free and sober lifestyle, is to try a combination of the above approaches. An example would be someone who signs up at an outpatient program for random drug and alcohol testing, tries AA/NA/CA, and if applicable: talks to his pastor for the availability of church resources. Another example might be the ‘alcoholic’ who goes on monitored Antabuse long enough (9 to 12 months) to decide whether some form of counseling, outpatient, or residential program is necessary to achieve fulfillment in living a clean and sober lifestyle.
I appreciate your feedback, especially by email!
My email: betteraddcare@yahoo.com
Related: Residential alcohol treatment center, drug rehab, addiction rehabilitation, substance abuse, alcoholism, twelve step, alternative to 12 step, recovery program, prescription drugs, before rehab, best rehabs
Voluntary admission to a local ‘outpatient,’ community-based program
Ever abundant DUI’s and drug possession crimes have created a very large market of state-licensed local services (available almost everywhere in the United States) that specialize in court-ordered education and group therapy programs with adjunctive services including random drug and alcohol testing and Antabuse (and Naltrexone) monitoring. If the person abusing alcohol and/or drugs is seriously ready to make a change, it is actually easy to set up a ‘custom-tailored’ program. These services will help the participant and his family (or employer, if necessary) monitor recovery and provide extrinsic motivation for relapse prevention. Your local phone directory, yellow pages, or online directory can provide listings under “addiction” "alcoholism" or "drug abuse."
Any outpatient program will have a reasonable fee schedule for its services. Typical fees for random drug testing: per urinalysis $10-$20; breathalyzer $5-$10 each. The usual procedure for random drug and alcohol testing: participant calls the outpatient facility every single day (although many are closed Sundays and Holidays), to find out if he is required to come in that day to submit breath and/or urine for testing. You can set up drug and alcohol testing for multiple times a week, once a week, twice a month, or once a month.
Antabuse (Disulfiram) and Naltrexone monitoring (both for alcohol abusers only, see below under “Antabuse and Naltrexone”) is usually around $5 per visit. Once the participant receives the prescription from the pharmacy (Antabuse and Naltrexone must be prescribed by a physician), he gives it to the 'outpatient' program. Several times during the first week (“loading dose"), and 2-3 times per week thereafter, the participant comes in to take her Antabuse usually with the following procedure. Outpatient staff will crush the Antabuse tablet into a powder than dissolve it in a cup of water, the participant drinks the solution in front of the staff member who then inspects the cup for any leftover tablet powder (if so, than more water is added to it, it is stirred or shaken, and given back to the participant to finish it). Once the dose is taken, the participant must stay in a monitored area for about 30 minutes to discourage anyone from inducing vomiting. After 30 minutes the participant is free to go and an appointment is set up for the next visit.
Group counseling at these 'outpatient' programs is usually in two hour increments of group therapy or education and costs about $25-$40. Most such counseling is geared toward state required DUI education and therapy classes, but many counseling centers also offer groups for relapse prevention, anger management, domestic violence, etc. If you are voluntarily admitting yourself to their program you are NOT obligated to attend any of these sessions (if they pressure you to do this, just find another facility). If you have the financial means you may want to try it out, but if money is an issue see the section below on “AA, NA, or any similar 12-step program."
Finally, an "intake" is usually required to participate in any aspect of their program (fill out paperwork, brief interview) which costs about $25-$50.
Bonus: Many short-term residential rehabs recommend continuing your care through a local 'outpatient' program. By experiencing this before attending a residential rehab, you will know exactly what to expect afterward. If you, or your family, feel that a continuity of care is beneficial to leading a successful relapse-free clean and sober life; you may want to consider this program whether your residential facility recommends it or not.
AA, NA, CA, or any similar 12-step program
A large majority of residential rehab programs teach AA (Alcoholics Anonymous), NA (Narcotics Anonymous), CA (Cocaine Anonymous) and the general 12-step philosophy as an integral part of their program. It then (not surprisingly) becomes the most important part (if not the only part) of their aftercare program. So, a recommendation here of trying out AA, NA, or CA has the added bonus of allowing the participant a real-life experience in the very care that the majority of residential rehabs offer. If the participant likes the experience, but feels the need for residential care, then the choice of facilities can be narrowed to those that practice the 12-step philosophy. Likewise, if the participant does not like the experience, then she should seriously consider only those residential rehabs that provide alternatives to 12-step.
The first step to start attending meetings in your area is to contact with your local AA chapter. They can provide you with a directory of days, times, types, and places of meetings. Even in small communities, you will likely be surprised at the number of meetings held nearby on a weekly, and many times, daily basis. If you attend a meeting and have a general dislike for it, then at least you know better what may or may not work for you. If you just don’t like some of the participants at the meeting, remember that different AA meetings have different ‘personalities’ so you may find a meeting more to your liking elsewhere, or on a different day and time.
You can attend AA, even for a lifetime, at very little expense. If you have the means, you should donate a dollar during ‘collection’ time at the meetings. If you do not have the means, the donation is optional and is not required for participation. The only other costs are for the books necessary (especially, “Alcoholics Anonymous – Big Book, 4th edition, available in paperback) for you to fully vest yourself into the program. You do not have to buy the books at the meeting site (and don’t ever let anyone pressure you to do so), rather you can go to most any online bookseller to buy them either new or used. The free option: most public libraries have multiple copies available for checkout. You are encouraged to read the literature to make sure that this is the program that you can believe in. Full participation is strongly encouraged in this program.
If you are uncomfortable with the AA, NA, CA, and 12-step programs, you are advised to think twice before admitting yourself to a residential program that teaches these very same philosophies. When you eventually decide to go to a residential program, look for one that advertises itself as non-AA, non-12-step, or ‘alternative to 12 step.’ If you do like the 12-step philosophy, but you do need a residential program, you have a large selection to choose from that do teach 12-step, then expect you to continue regular meetings (an important component of their aftercare) in your local community.
Important: I am recommending AA as an option only. There are many other ways for a person to get well, and I have always believed that one-size-does-NOT-fit-all. I understand that there are many who oppose the teachings of AA, and I encourage anyone to do their research before making any serious commitments to any such program.
Antabuse (Disulfiram) and Naltrexone
Antabuse (usually for those that abuse alcohol, but has recently been tried for cocaine users) provides extrinsic motivation to remain relapse-free. Even a small amount of alcohol (one beer, one shot) will induce severe physical reactions in the user that are very uncomfortable. Antabuse can only be prescribed by a physician, and liver function tests (a simple blood test) are usually required prior to prescription. To make sure that the participant is actually taking the required dose of this medication certain procedures are necessary (otherwise the user may hide the pill under the tongue of inside the cheek to later spit out, or may induce vomiting after swallowing) – see above under “Voluntary admission to a local ‘outpatient,’ community-based program”). You can follow this same procedure for at-home monitoring of a loved one by simply purchasing a pill crusher at your local drugstore or supermarket.
Naltrexone reduces alcohol craving by lowering or eliminating the ‘pleasurable’ effects of drinking alcohol. Although it is not as popular (and some would say not as effective at preventing relapse) as Antabuse, it may be an alternative for some. Monitored use is recommended (see above under “Voluntary admission to a local ‘outpatient,’ community-based program”).
Church-based programs
If you are a person of faith, talk to your pastor, priest, deacon, or someone in the pastoral center that can talk to you about alcohol and/or drug abuse. Resources that might be available can range from free individual or group counseling, and in some cases, church-sponsored sober living facilities.
Therapeutic Communities (clean and sober living environments)
For some people with a long history of drug or alcohol use, a long-term (90+ days, but typically a year or more) structured living environment with a strong community support system already in place is an effective option.
Other options including counseling, self-care, and bibliotherapy will be discussed in a future article.
Combination
The best course of action for any individual that does not have an immediate need for residential rehab care, and is strongly motivated to pursue a free and sober lifestyle, is to try a combination of the above approaches. An example would be someone who signs up at an outpatient program for random drug and alcohol testing, tries AA/NA/CA, and if applicable: talks to his pastor for the availability of church resources. Another example might be the ‘alcoholic’ who goes on monitored Antabuse long enough (9 to 12 months) to decide whether some form of counseling, outpatient, or residential program is necessary to achieve fulfillment in living a clean and sober lifestyle.
I appreciate your feedback, especially by email!
My email: betteraddcare@yahoo.com
Related: Residential alcohol treatment center, drug rehab, addiction rehabilitation, substance abuse, alcoholism, twelve step, alternative to 12 step, recovery program, prescription drugs, before rehab, best rehabs
Wednesday, July 11, 2007
Addiction Care: Change and Transition (Part Two)
Part one of “Change and Transition” discussed transition as the internal process occurring in the minds of addicts as they go through change. While the friends and loved ones of those that are recovering, and many rehab employees, focus only on the outward change (abstinence from alcohol and drugs) there is much more that lies beneath the surface. So much more in fact that it may help explain why relapse rates are so high in spite of all its associated negative consequences.
Addressing “endings” was discussed in the previous article as the necessary first phase of how the newly recovering person begins the internal process of transition. This article will concentrate on the next phase “the neutral zone,” and finally “the new beginning.” As with the first article, the information here is applied from the work of William Bridges & Associates (other links provided below).
The neutral zone, to all outsiders, will look like a long unproductive period of time where the person in recovery seems to be ‘on automatic’ or experiencing many false-starts. To the addict, the neutral zone is a frustratingly slow process that seems to go nowhere. This is the phase that begins serious ruminating on the disengagement, disidentification, disenchantment, and disorientation processes started soon after abstaining from drugs and alcohol.
Due to the length of time anyone might spend in the neutral zone, the seeming lack of concrete solutions or progress, and the unsettling emptiness without end --all contribute compelling (in the mind of the newly recovering) reasons to take a shortcut out of these feelings which leads to relapse. How the person in recovery addresses this phase is critical to the successful transition of the addict into a person that can achieve lasting satisfaction in a clean and sober lifestyle.
As all the old connections begin to weaken and break, and before new connections begin manifesting themselves, the person in recovery begins to wonder, “Is this all there is?” “Is this all I have to look forward to?”
The knowledgeable counselor will make the transition process so literal and accessible to the resident that the resident won’t fall into the frequent trap of thinking that they have already arrived at their destination when truly they just need to work through a lot more; and it will be an uncomfortable process. There is light at the end of the tunnel, even when all they see and feel is darkness.
Here is where dishonest and manipulative practices will backfire. Many rehabs make this same mistake over and over again. Maybe their counselors have too much time between when they were once seriously addicted (assuming that they’ve had a personal experience with addiction) to remember what they went through. Or, maybe, the rehab, after many waves of new residents have come and gone, have gotten into the same unfortunate habits: unrelenting and frequent pep talks and ‘rah-rah’ sessions. These constant displays of enthusiasm and joy (bordering on giddiness) lie in stark contrast to what the typical resident is feeling at this time. It also looks calculated and fake. Certainly counselors can model the happiness and satisfaction with life that they are feeling, but it must be tempered by communicating understanding and empathy to what the resident truly might be living through. The usual path that the seriously addicted have taken to full recovery was more of a “hmmm” than an “AHA!” Displaying otherwise will likely make recovering addicts feel that they are unique in their “unwellness” further compelling them to take the shortcut back to their more predictable world of substance abuse.
Since the neutral zone can be long-lasting, rehabs have quite a problem. Most residents can only stay in a residential rehab for a short time (usually about 30 days) because of medical insurance limitations, expense, time away from the job, or time away from family. The resident is released then long before they are ‘internally’ ready.
So what is a rehab to do with its clientele who will only stay in the residential setting for the short term? Actually, plenty. A few rehabs are already doing some of the following…
-Precare, where possible (unfortunately, detox may be the first part of the residential experience), that begins the process of educating the newly recovering in what they can expect to feel internally as they transition to someone living a clean and sober life.
-As early as possible in the residential setting: explain, in detail, the transition process to the resident. Newly recovering addicts don’t feel comfortable in their own skin. By helping them understand all the unsettling emotions swirling about in their minds they will feel that there is a simple and understandable explanation for what they are going through. They are, in a sense, a normal person going through a normal process. Ultimately this may help them feel more in control of their recovery and lead to greater participation in their own transition.
-Individual counseling is more effective than group therapy in addressing the internal manner of transition. Although transition follows a predictable course, each person’s path is unique.
-Allow some solitude and reflective time for residents.
-Journaling can be encouraged for some residents; this should not be forced on residents who might not fit that type of learning or expressive style.
-Writing or talking about an autobiographical history of previous transitions can help put their current experiences in context.
-Educate the family of the recovering person’s inner blueprint of transition.
-Aftercare should reinforce an expectation that life will get better but not without trials and struggles. Techniques should be taught (or reinforcing what should already have been taught) to deal with these negative feelings and occurrences in a healthy way.
The final phase of transition is “the new beginning.” This is where rehabs tend to put most if not all of their efforts. They see a new resident, fresh from detox, as embarking on a changed life free of all the alcohol, drugs, and substances that kept the addict shackled and his family in a perpetual nightmare. Many rehabs see this as a simple flip of the switch or a turn of the key. This simplistic view yields little success. These rehabs will concentrate on the person’s goals, dreams, aspirations when that person has yet to break all the cognitive and emotional connections with his old self, and doesn’t have much of a clue what cognitive and emotional connections he will eventually have with his new self.
However if “endings” and “the neutral zone” are competently covered, “the new beginning” can be addressed in the following ways.
First, beginnings are messy. Full of hope, confusion, idealism, failures, small steps forward, false starts, and the big one: disappointment. This disappointment could just be the result of the rehab setting the wrong expectations, or communicating poorly about them.
Examples of the chaos common in the new beginning: (1) the father who wants to reconnect with his wife and young children enthusiastically plans activities such as a trip to the zoo, a day at the children’s museum, a night at the campground; but finds the only result is cranky kids, an argumentative wife, and lots of stress; (2) the wife who finds peace and enjoyment from physical activity, nature, and outdoor events; but the spouse would rather pursue leisure in an unplanned mostly indoor life; (3) the young man who is eager to go back to his job brimming with so many great ideas on improvements to his company’s operations, profits, and service, but finds management only passionate about maintaining the status quo.
Of course, most of those that have been clean and sober for a long period of time will tell you how much better life is, and how they are happy, satisfied, and fulfilled. What many of them may have forgotten though is the rough, unforgiving road that got them there.
This needs to be communicated to the newly recovering. The new beginning is not an orderly process, there isn’t a simple procedure to follow. Setting the right expectations, taking the long view, emphasizing an understanding of the inner processes inherent to starting something new and putting something old completely behind them is a good start. Reinforcing this concept throughout the residential program and following up accordingly with a well managed aftercare is also a good start.
The person in recovery that is in-tune with her thoughts and feelings in the context of the process of transition will be best suited for rolling with disappointment and looking for opportunity (or any positive) wherever it may occur. Far from finding that AHA! moment, there will likely be many more subtle hints waiting to be discovered. The resident who has come to terms with his ending of the old life, and has accommodated the discomforts of the neutral zone, will be able to find and capitalize on these new ideas, feelings, and connections to the rewarding life that follows.
William Bridges & Associates Official Website
Books
Articles you can read online
I appreciate your feedback!
My email: betteraddcare@yahoo.com
Related: Residential alcohol treatment center, drug rehabilitation, addiction, substance abuse, alcoholism, twelve step rehabs, alternative to 12 step, recovery program
Addressing “endings” was discussed in the previous article as the necessary first phase of how the newly recovering person begins the internal process of transition. This article will concentrate on the next phase “the neutral zone,” and finally “the new beginning.” As with the first article, the information here is applied from the work of William Bridges & Associates (other links provided below).
The neutral zone, to all outsiders, will look like a long unproductive period of time where the person in recovery seems to be ‘on automatic’ or experiencing many false-starts. To the addict, the neutral zone is a frustratingly slow process that seems to go nowhere. This is the phase that begins serious ruminating on the disengagement, disidentification, disenchantment, and disorientation processes started soon after abstaining from drugs and alcohol.
Due to the length of time anyone might spend in the neutral zone, the seeming lack of concrete solutions or progress, and the unsettling emptiness without end --all contribute compelling (in the mind of the newly recovering) reasons to take a shortcut out of these feelings which leads to relapse. How the person in recovery addresses this phase is critical to the successful transition of the addict into a person that can achieve lasting satisfaction in a clean and sober lifestyle.
As all the old connections begin to weaken and break, and before new connections begin manifesting themselves, the person in recovery begins to wonder, “Is this all there is?” “Is this all I have to look forward to?”
The knowledgeable counselor will make the transition process so literal and accessible to the resident that the resident won’t fall into the frequent trap of thinking that they have already arrived at their destination when truly they just need to work through a lot more; and it will be an uncomfortable process. There is light at the end of the tunnel, even when all they see and feel is darkness.
Here is where dishonest and manipulative practices will backfire. Many rehabs make this same mistake over and over again. Maybe their counselors have too much time between when they were once seriously addicted (assuming that they’ve had a personal experience with addiction) to remember what they went through. Or, maybe, the rehab, after many waves of new residents have come and gone, have gotten into the same unfortunate habits: unrelenting and frequent pep talks and ‘rah-rah’ sessions. These constant displays of enthusiasm and joy (bordering on giddiness) lie in stark contrast to what the typical resident is feeling at this time. It also looks calculated and fake. Certainly counselors can model the happiness and satisfaction with life that they are feeling, but it must be tempered by communicating understanding and empathy to what the resident truly might be living through. The usual path that the seriously addicted have taken to full recovery was more of a “hmmm” than an “AHA!” Displaying otherwise will likely make recovering addicts feel that they are unique in their “unwellness” further compelling them to take the shortcut back to their more predictable world of substance abuse.
Since the neutral zone can be long-lasting, rehabs have quite a problem. Most residents can only stay in a residential rehab for a short time (usually about 30 days) because of medical insurance limitations, expense, time away from the job, or time away from family. The resident is released then long before they are ‘internally’ ready.
So what is a rehab to do with its clientele who will only stay in the residential setting for the short term? Actually, plenty. A few rehabs are already doing some of the following…
-Precare, where possible (unfortunately, detox may be the first part of the residential experience), that begins the process of educating the newly recovering in what they can expect to feel internally as they transition to someone living a clean and sober life.
-As early as possible in the residential setting: explain, in detail, the transition process to the resident. Newly recovering addicts don’t feel comfortable in their own skin. By helping them understand all the unsettling emotions swirling about in their minds they will feel that there is a simple and understandable explanation for what they are going through. They are, in a sense, a normal person going through a normal process. Ultimately this may help them feel more in control of their recovery and lead to greater participation in their own transition.
-Individual counseling is more effective than group therapy in addressing the internal manner of transition. Although transition follows a predictable course, each person’s path is unique.
-Allow some solitude and reflective time for residents.
-Journaling can be encouraged for some residents; this should not be forced on residents who might not fit that type of learning or expressive style.
-Writing or talking about an autobiographical history of previous transitions can help put their current experiences in context.
-Educate the family of the recovering person’s inner blueprint of transition.
-Aftercare should reinforce an expectation that life will get better but not without trials and struggles. Techniques should be taught (or reinforcing what should already have been taught) to deal with these negative feelings and occurrences in a healthy way.
The final phase of transition is “the new beginning.” This is where rehabs tend to put most if not all of their efforts. They see a new resident, fresh from detox, as embarking on a changed life free of all the alcohol, drugs, and substances that kept the addict shackled and his family in a perpetual nightmare. Many rehabs see this as a simple flip of the switch or a turn of the key. This simplistic view yields little success. These rehabs will concentrate on the person’s goals, dreams, aspirations when that person has yet to break all the cognitive and emotional connections with his old self, and doesn’t have much of a clue what cognitive and emotional connections he will eventually have with his new self.
However if “endings” and “the neutral zone” are competently covered, “the new beginning” can be addressed in the following ways.
First, beginnings are messy. Full of hope, confusion, idealism, failures, small steps forward, false starts, and the big one: disappointment. This disappointment could just be the result of the rehab setting the wrong expectations, or communicating poorly about them.
Examples of the chaos common in the new beginning: (1) the father who wants to reconnect with his wife and young children enthusiastically plans activities such as a trip to the zoo, a day at the children’s museum, a night at the campground; but finds the only result is cranky kids, an argumentative wife, and lots of stress; (2) the wife who finds peace and enjoyment from physical activity, nature, and outdoor events; but the spouse would rather pursue leisure in an unplanned mostly indoor life; (3) the young man who is eager to go back to his job brimming with so many great ideas on improvements to his company’s operations, profits, and service, but finds management only passionate about maintaining the status quo.
Of course, most of those that have been clean and sober for a long period of time will tell you how much better life is, and how they are happy, satisfied, and fulfilled. What many of them may have forgotten though is the rough, unforgiving road that got them there.
This needs to be communicated to the newly recovering. The new beginning is not an orderly process, there isn’t a simple procedure to follow. Setting the right expectations, taking the long view, emphasizing an understanding of the inner processes inherent to starting something new and putting something old completely behind them is a good start. Reinforcing this concept throughout the residential program and following up accordingly with a well managed aftercare is also a good start.
The person in recovery that is in-tune with her thoughts and feelings in the context of the process of transition will be best suited for rolling with disappointment and looking for opportunity (or any positive) wherever it may occur. Far from finding that AHA! moment, there will likely be many more subtle hints waiting to be discovered. The resident who has come to terms with his ending of the old life, and has accommodated the discomforts of the neutral zone, will be able to find and capitalize on these new ideas, feelings, and connections to the rewarding life that follows.
William Bridges & Associates Official Website
Books
Articles you can read online
I appreciate your feedback!
My email: betteraddcare@yahoo.com
Related: Residential alcohol treatment center, drug rehabilitation, addiction, substance abuse, alcoholism, twelve step rehabs, alternative to 12 step, recovery program
Monday, July 9, 2007
Addiction Care: Change and Transition (Part One)
Change can be dramatic and it can happen in an instant. Examples are everywhere of people who have abruptly stopped drinking or drugging, quit smoking, turned to vegetarianism, stopped watching television, or started exercising daily.
Even most chronic addicts seem to take the 28+ days at a residential treatment facility in stride without taking a drink or doing a drug.
THE problem: just as it was “easy” to change, it is even easier to change back.
When rehabs talk about change they are idealizing about permanent change. What makes this ‘permanence’ happen? How does one make their change “stick?” To answer this question would be a good start to addressing the terminal problem of addiction: its chronic and recurrent nature.
Here’s one possible solution: transition.
William Bridges devoted his life to the study of transitions as experienced by individuals, groups, and corporations. He is the author of 10 books and The Wall Street Journal picked him as one of the top ten executive development speakers in the U.S. (2006).
Two of his books I found most pertinent to this discussion are “Transitions: Making Sense of Life’s Changes” and “The Way of Transition: Embracing Life’s Most Difficult Moments” (Go to any online bookseller if you want to read the highly rated reviews on these books).
Bridges doesn’t directly apply his life’s work to addiction recovery, and I can’t seem to find anybody else that applies Bridges' principles of transition to those currently in rehab. Applications of the principles and processes described in his literature are my own, but hopefully you will see how it would make a lot of sense to anyone currently battling addiction.
“Transition is not just a nice way to say change. It is the inner process through which people come to terms with a change, as they let go of the way things used to be and reorient themselves to the way that things are now.” (Source)
Change is external (the different practices or behaviors one can observe) while transition is internal (a reorientation of beliefs, motivations, and thought processes that must be made in order for the change to stabilize and persist).
The problem with most rehabs is that they pretend that the change their clients’ make (starting a clean and sober life within the residential rehab) is on ‘automatic.’ And if (the big “if”) their clients remain clean and sober after leaving the rehab, it is just an extension of this simple change process. Change, then, is a fragile undertaking, and its delicate nature may at anytime be easily shattered resulting in relapse.
While change is observable at the surface, there are many uncomfortable issues occurring internally in the mind of the addict.
There is a sequence to this ‘madness’: (1) Endings; (2) Neutral zone; and (3) Beginnings.
Endings…
Before embarking on a life-changing course, one must first begin with the process of letting go of their old alcohol or drug abusing life.
The idea of having to say goodbye to everything associated with a negative behavior pattern, or grieve the loss of any of the positive (internal) things surrounding alcohol or substance abuse doesn’t make much sense to people that have never dealt with a serious addiction. For addicts, however, this represents a practical hurdle.
It is also a step that is readily skipped by the recovering addict, because it is either taking taken too seriously (feared), or not seriously enough. The idea of forever abstaining from their drink or drug of choice can be so disconcerting that the addict will avoid this step; also, there are those that think they are ‘beyond’ all that, they think it is silly to give much thought to ‘endings,’ because they feel like that have already put that all behind them.
Change is represented as a barrier, while transition is a path. To get through the barrier (change), one must follow the path (transition). To get started, Bridges suggests asking a question that will start to dissolve those ‘inner connections’ one has to the old self: “What is it time for me to let go of?”
To a recovering addict or alcoholic, giving up booze and drugs is the obvious change; so, “what parts of them are now out of date?” Perhaps all of their ideas or beliefs connecting the substance to all the previous pursuits of their addicted lives: ways of making life more exciting, easing social situations, dulling anxiety and stress, hiding depression or the negative feelings about all their current circumstances. Maybe their drug made their job, home, or relationships tolerable. Maybe drinking gave them a sense of routine and regular connection with friends; or masked their sensitivity to loneliness.
When a habit, behavior, or a way of life comes to an abrupt end one may begin experiencing a certain degree of all of the following: disengagement, disidentification, disenchantment, and disorientation.
Disengagement from the routines, roles, and behaviors that were a part of their addicted lives leaves one feeling disconnected and lost. The person in early recovery can’t count on all the old patterns of feedback that helped them identify with who they were and how they functioned before.
Disidentification can be the internalized result of disengagement, or as a direct response to their newly adopted clean and sober lifestyle. To a person who has never had a serious problem with addiction, sobriety would seem to be the best way to get to know oneself. However, for the addicted, that uneasiness with self may have been part of what the addiction was meant to resolve or at least hide. The struggle of identity can be fierce, but progress can only be made as the person in recovery lets go of who they think they were to open themselves up to the possibilities of who they will eventually become.
Disenchantment will occur as the addict begins to recognize that substantial constructions of their former systems of thoughts and beliefs were just ‘in their heads.’ True reality is layered with a person’s perceptions of how things ought to work. The “old view” was once okay, and even worked quite well, but it is now inadequate and unworkable. This often results in the addict trying to make everything conform to her old view, but with failing results. The addict will likely blame everybody and everything outside of themselves before seeing that only the right revision of their thoughts and beliefs will provide the best results.
Disorientation is a very real and unsettling feeling; ask any recovering addict who has an honest awareness about their current situation. Being lost without any clear direction of where to go will appear to outsiders as someone who is disconnected and “not all there.” People who have never had a serious issue with addiction will wonder why the recovering addict just doesn’t get on with life, why they don’t seize upon their clean and sober lifestyle with passion and enthusiasm. The sense of emptiness permeates the recovering addict who may experience the ending of their addictive lifestyle as a symbolic death or abandonment.
With all of these distressingly uncomfortable thoughts, many addicts will opt for a “shortcut” out and back to their familiar drinking and drugging ways. This is where most rehabs really miss the boat. They are concentrating on ‘new beginnings’ without adequately addressing all of the frenetic and persistent internal processes going on in their freshly detoxed client’s mind. It doesn’t matter how many negative consequences have already resulted from the addicts chronic or recurrent behaviors, or even how many more are likely to occur should the addict relapse. What really seems to matter is whether the addict can accept and work-through all of the uncomfortable issues swirling incessantly within their heads long enough to eventually experience the real rewards of a relapse-free clean and sober lifestyle.
The second part of this article will concentrate on the final two processes of transition: the neutral zone and the new beginning.
William Bridges & Associates Official Website
Books
Articles you can read online
I appreciate your feedback!
My email: betteraddcare@yahoo.com
Related: Residential alcohol treatment center, drug rehabilitation, addiction, substance abuse, alcoholism, twelve step rehabs, alternative to 12 step, recovery program
Even most chronic addicts seem to take the 28+ days at a residential treatment facility in stride without taking a drink or doing a drug.
THE problem: just as it was “easy” to change, it is even easier to change back.
When rehabs talk about change they are idealizing about permanent change. What makes this ‘permanence’ happen? How does one make their change “stick?” To answer this question would be a good start to addressing the terminal problem of addiction: its chronic and recurrent nature.
Here’s one possible solution: transition.
William Bridges devoted his life to the study of transitions as experienced by individuals, groups, and corporations. He is the author of 10 books and The Wall Street Journal picked him as one of the top ten executive development speakers in the U.S. (2006).
Two of his books I found most pertinent to this discussion are “Transitions: Making Sense of Life’s Changes” and “The Way of Transition: Embracing Life’s Most Difficult Moments” (Go to any online bookseller if you want to read the highly rated reviews on these books).
Bridges doesn’t directly apply his life’s work to addiction recovery, and I can’t seem to find anybody else that applies Bridges' principles of transition to those currently in rehab. Applications of the principles and processes described in his literature are my own, but hopefully you will see how it would make a lot of sense to anyone currently battling addiction.
“Transition is not just a nice way to say change. It is the inner process through which people come to terms with a change, as they let go of the way things used to be and reorient themselves to the way that things are now.” (Source)
Change is external (the different practices or behaviors one can observe) while transition is internal (a reorientation of beliefs, motivations, and thought processes that must be made in order for the change to stabilize and persist).
The problem with most rehabs is that they pretend that the change their clients’ make (starting a clean and sober life within the residential rehab) is on ‘automatic.’ And if (the big “if”) their clients remain clean and sober after leaving the rehab, it is just an extension of this simple change process. Change, then, is a fragile undertaking, and its delicate nature may at anytime be easily shattered resulting in relapse.
While change is observable at the surface, there are many uncomfortable issues occurring internally in the mind of the addict.
There is a sequence to this ‘madness’: (1) Endings; (2) Neutral zone; and (3) Beginnings.
Endings…
Before embarking on a life-changing course, one must first begin with the process of letting go of their old alcohol or drug abusing life.
The idea of having to say goodbye to everything associated with a negative behavior pattern, or grieve the loss of any of the positive (internal) things surrounding alcohol or substance abuse doesn’t make much sense to people that have never dealt with a serious addiction. For addicts, however, this represents a practical hurdle.
It is also a step that is readily skipped by the recovering addict, because it is either taking taken too seriously (feared), or not seriously enough. The idea of forever abstaining from their drink or drug of choice can be so disconcerting that the addict will avoid this step; also, there are those that think they are ‘beyond’ all that, they think it is silly to give much thought to ‘endings,’ because they feel like that have already put that all behind them.
Change is represented as a barrier, while transition is a path. To get through the barrier (change), one must follow the path (transition). To get started, Bridges suggests asking a question that will start to dissolve those ‘inner connections’ one has to the old self: “What is it time for me to let go of?”
To a recovering addict or alcoholic, giving up booze and drugs is the obvious change; so, “what parts of them are now out of date?” Perhaps all of their ideas or beliefs connecting the substance to all the previous pursuits of their addicted lives: ways of making life more exciting, easing social situations, dulling anxiety and stress, hiding depression or the negative feelings about all their current circumstances. Maybe their drug made their job, home, or relationships tolerable. Maybe drinking gave them a sense of routine and regular connection with friends; or masked their sensitivity to loneliness.
When a habit, behavior, or a way of life comes to an abrupt end one may begin experiencing a certain degree of all of the following: disengagement, disidentification, disenchantment, and disorientation.
Disengagement from the routines, roles, and behaviors that were a part of their addicted lives leaves one feeling disconnected and lost. The person in early recovery can’t count on all the old patterns of feedback that helped them identify with who they were and how they functioned before.
Disidentification can be the internalized result of disengagement, or as a direct response to their newly adopted clean and sober lifestyle. To a person who has never had a serious problem with addiction, sobriety would seem to be the best way to get to know oneself. However, for the addicted, that uneasiness with self may have been part of what the addiction was meant to resolve or at least hide. The struggle of identity can be fierce, but progress can only be made as the person in recovery lets go of who they think they were to open themselves up to the possibilities of who they will eventually become.
Disenchantment will occur as the addict begins to recognize that substantial constructions of their former systems of thoughts and beliefs were just ‘in their heads.’ True reality is layered with a person’s perceptions of how things ought to work. The “old view” was once okay, and even worked quite well, but it is now inadequate and unworkable. This often results in the addict trying to make everything conform to her old view, but with failing results. The addict will likely blame everybody and everything outside of themselves before seeing that only the right revision of their thoughts and beliefs will provide the best results.
Disorientation is a very real and unsettling feeling; ask any recovering addict who has an honest awareness about their current situation. Being lost without any clear direction of where to go will appear to outsiders as someone who is disconnected and “not all there.” People who have never had a serious issue with addiction will wonder why the recovering addict just doesn’t get on with life, why they don’t seize upon their clean and sober lifestyle with passion and enthusiasm. The sense of emptiness permeates the recovering addict who may experience the ending of their addictive lifestyle as a symbolic death or abandonment.
With all of these distressingly uncomfortable thoughts, many addicts will opt for a “shortcut” out and back to their familiar drinking and drugging ways. This is where most rehabs really miss the boat. They are concentrating on ‘new beginnings’ without adequately addressing all of the frenetic and persistent internal processes going on in their freshly detoxed client’s mind. It doesn’t matter how many negative consequences have already resulted from the addicts chronic or recurrent behaviors, or even how many more are likely to occur should the addict relapse. What really seems to matter is whether the addict can accept and work-through all of the uncomfortable issues swirling incessantly within their heads long enough to eventually experience the real rewards of a relapse-free clean and sober lifestyle.
The second part of this article will concentrate on the final two processes of transition: the neutral zone and the new beginning.
William Bridges & Associates Official Website
Books
Articles you can read online
I appreciate your feedback!
My email: betteraddcare@yahoo.com
Related: Residential alcohol treatment center, drug rehabilitation, addiction, substance abuse, alcoholism, twelve step rehabs, alternative to 12 step, recovery program
Thursday, July 5, 2007
Residential Alcohol Drug Rehab: Aftercare (Continuing Care, Extended Care)
So many rehabs advertise that they have an aftercare program, yet very few describe it, and usually in vague terms if at all. Why is that? It would seem that if they do have an aftercare program (instead of just an obligatory notion of one), it would be simple to describe their process in writing on their website. Surely it is not proprietary, and if they are proud of it, they have no other reason to keep the details of it hidden. Some talk of relapse prevention, others talk of ongoing support; but what does that mean, how will it ‘look’ when implemented for you or your loved one? Is there a fear of setting expectations early, such that the rehab will feel committed (libel) to a well-described aftercare program? Prove me wrong, but I bet the “aftercare” concept is more useful to the vast majority of rehabs as a way to sell their program and fill their beds rather than a serious module of their overall treatment plan.
There are two types of participants that need no aftercare, so any effort on them is just a waste of the rehab’s resources (staff and money). The first type is the one we all hope for: they are at a point in their recovery where they can self-sustain their clean and sober lifestyle without relapse. This person needs no further contact from the rehab, and, in fact, may do rather well without it as they have reacculturated themselves to a new addiction-free life. The other type of program alumni that wouldn’t benefit by a rehab’s aftercare is the one that we all fear: they relapse into their previous addictive patterns and will likely ignore and actively avoid all contact from the rehab. Aftercare then has its strongest benefit on those that fall somewhere in-between.
Some rehabs will refer the program graduate to a third-Party support or monitoring agency; this may best be described as an outpatient (although very little medical supervision, if any, is in place) service. Prosecutions of DUI’s and drug possession crimes have created a very large market of local services (available almost everywhere in the United States) that specialize in court-ordered education and group therapy programs with adjunctive services including random drug and alcohol testing. If the participant is compliant, it is easy to set up a program (you don’t need a referral from the rehab!). These services will help the participant and his family (or employer) monitor recovery and provide extrinsic motivation for relapse prevention. Your local phone directory, yellow pages, or online directory can provide listings under “addiction” "alcoholism" or "drug abuse." Any such outpatient program will be at an additional expense to the participant. Typical fees: drug testing (per urinalysis) $10-$20; Breathalyzer $5-$10 each; two hours group therapy $25-$40. An "intake" is required (fill out paperwork, brief interview) which usually costs $25-$50. The usual procedure for random drug and alcohol testing is that the participant calls the outpatient facility, everyday (although many are closed Sunday's and Holidays), to find out if he is required to come in that day to submit a breath or urine for testing. You can set up drug and alcohol testing for multiple times a week, once a week, twice a month, once a month, etc.
Before listing all the possible components of a continuing care program, a note needs to be made on 12 step rehabs aftercare programs. Many 12 step rehabs advertise aftercare, but further investigation reveals that it is nothing more than a referral to AA, NA, and CA meetings local to the participant. In some cases the facility itself will offer weekly AA meetings in-house. But unless the participant has a special affinity towards the rehab’s 12 step meeting, he may find other meetings in his area more conducive to the days and times he wants to attend. Also, different AA meetings have different ‘personalities’ so the person in recovery may find a meeting more to her liking elsewhere. If you are interested in going to AA meetings in your area, you do not need a referral from a rehab. Simply get in contact with the local AA chapter in your area. They can provide you with a directory of days, times, types, and places of meetings. Even in small communities, you will likely be surprised at the number of meetings held nearby on a weekly, and many times daily, basis. I would hope that 12 step rehabs don’t take advantage of this type of aftercare advertising (but many do), because it is free and available to anybody right now.
Here is a list of possible components in continuing care, each one followed by brief examples. Very few rehabs actually do more than a small number of these; this list is only meant to show what is out there.
Facility-initiated contact
-Regular contact by phone or email following a schedule that diminishes in frequency of contact over time (as recovery progresses and matures).
Meetings and group or individual counseling provided at the facility
-This is only potentially effective for those that live within a convenient travelling distance from the facility. There may be weekly group meetings or therapy, and one-on-one counseling by appointment or during “office hours.”
Participant-initiated contact
-The participant is given contact phone numbers and email addresses to use whenever she feels a need to talk to someone at the facility. 24/7 access to a live contact is most preferable; although some facilities state a return call or email within a certain time frame.
Facility-mediated family (or close friends) support
-This could be a hotline for pre-approved family members or friends to call if the participant is unable or unwilling to make contact. Aside from just providing someone to talk to, referral to local community resources is usually the protocol here.
Facility-tutored independent study or practical exercises
-The participant does assigned homework, then reports back to a contact at the facility for feedback and guidance. The assignments are to reinforce what was learned during the residential stay and provide a structured method of transitioning back into the participant’s community.
Facility-provided online resources
-Alumni access to part of the facility’s website that may host a discussion board, podcasts, videos, articles, and updates.
Scheduled events and social activities for alumni
-This is only potentially effective for those that live within a convenient travelling distance from the facility. Facility will let interested alumni know of special events and get-togethers to reconnect with other alumni (and sometimes program staff).
Alumni (peer) support
-The facility may provide a network (contact list) of alumni willing to stay connected for the purpose of supporting recovery.
And other support services: job search assistance, resume help, interview coaching, educational guidance counseling, anger or stress management, and other life skills.
No rehab will provide all the services above. Most will provide just a few if any. The more in-depth the aftercare and the more services that the rehab offers will come at a higher price; all the additional staffing and expenses are passed on to the consumer.
One sales gimmick that rehabs may try to use on you when you inquire about their aftercare program is their insistence that it is “tailor-made” or “customized” to the participant and so a plan is difficult to describe in detail to you. Demand a better explanation: have them go over best case and worst case scenarios until it is clear what the rehab will and won’t provide in aftercare.
If a rehab’s aftercare program is important to you, it is a very good idea to get ALL the details regarding their aftercare program in writing. Do this before making any commitment (ie… payment) to that rehab. If they truly believe in the services that they provide, this shouldn’t be too much of a problem.
I appreciate your feedback!
My email: betteraddcare@yahoo.com
Related: Residential alcohol treatment center, drug rehabilitation, addiction, substance abuse, alcoholism, 12 step rehabs, alternative to 12 step, recovery program
There are two types of participants that need no aftercare, so any effort on them is just a waste of the rehab’s resources (staff and money). The first type is the one we all hope for: they are at a point in their recovery where they can self-sustain their clean and sober lifestyle without relapse. This person needs no further contact from the rehab, and, in fact, may do rather well without it as they have reacculturated themselves to a new addiction-free life. The other type of program alumni that wouldn’t benefit by a rehab’s aftercare is the one that we all fear: they relapse into their previous addictive patterns and will likely ignore and actively avoid all contact from the rehab. Aftercare then has its strongest benefit on those that fall somewhere in-between.
Some rehabs will refer the program graduate to a third-Party support or monitoring agency; this may best be described as an outpatient (although very little medical supervision, if any, is in place) service. Prosecutions of DUI’s and drug possession crimes have created a very large market of local services (available almost everywhere in the United States) that specialize in court-ordered education and group therapy programs with adjunctive services including random drug and alcohol testing. If the participant is compliant, it is easy to set up a program (you don’t need a referral from the rehab!). These services will help the participant and his family (or employer) monitor recovery and provide extrinsic motivation for relapse prevention. Your local phone directory, yellow pages, or online directory can provide listings under “addiction” "alcoholism" or "drug abuse." Any such outpatient program will be at an additional expense to the participant. Typical fees: drug testing (per urinalysis) $10-$20; Breathalyzer $5-$10 each; two hours group therapy $25-$40. An "intake" is required (fill out paperwork, brief interview) which usually costs $25-$50. The usual procedure for random drug and alcohol testing is that the participant calls the outpatient facility, everyday (although many are closed Sunday's and Holidays), to find out if he is required to come in that day to submit a breath or urine for testing. You can set up drug and alcohol testing for multiple times a week, once a week, twice a month, once a month, etc.
Before listing all the possible components of a continuing care program, a note needs to be made on 12 step rehabs aftercare programs. Many 12 step rehabs advertise aftercare, but further investigation reveals that it is nothing more than a referral to AA, NA, and CA meetings local to the participant. In some cases the facility itself will offer weekly AA meetings in-house. But unless the participant has a special affinity towards the rehab’s 12 step meeting, he may find other meetings in his area more conducive to the days and times he wants to attend. Also, different AA meetings have different ‘personalities’ so the person in recovery may find a meeting more to her liking elsewhere. If you are interested in going to AA meetings in your area, you do not need a referral from a rehab. Simply get in contact with the local AA chapter in your area. They can provide you with a directory of days, times, types, and places of meetings. Even in small communities, you will likely be surprised at the number of meetings held nearby on a weekly, and many times daily, basis. I would hope that 12 step rehabs don’t take advantage of this type of aftercare advertising (but many do), because it is free and available to anybody right now.
Here is a list of possible components in continuing care, each one followed by brief examples. Very few rehabs actually do more than a small number of these; this list is only meant to show what is out there.
Facility-initiated contact
-Regular contact by phone or email following a schedule that diminishes in frequency of contact over time (as recovery progresses and matures).
Meetings and group or individual counseling provided at the facility
-This is only potentially effective for those that live within a convenient travelling distance from the facility. There may be weekly group meetings or therapy, and one-on-one counseling by appointment or during “office hours.”
Participant-initiated contact
-The participant is given contact phone numbers and email addresses to use whenever she feels a need to talk to someone at the facility. 24/7 access to a live contact is most preferable; although some facilities state a return call or email within a certain time frame.
Facility-mediated family (or close friends) support
-This could be a hotline for pre-approved family members or friends to call if the participant is unable or unwilling to make contact. Aside from just providing someone to talk to, referral to local community resources is usually the protocol here.
Facility-tutored independent study or practical exercises
-The participant does assigned homework, then reports back to a contact at the facility for feedback and guidance. The assignments are to reinforce what was learned during the residential stay and provide a structured method of transitioning back into the participant’s community.
Facility-provided online resources
-Alumni access to part of the facility’s website that may host a discussion board, podcasts, videos, articles, and updates.
Scheduled events and social activities for alumni
-This is only potentially effective for those that live within a convenient travelling distance from the facility. Facility will let interested alumni know of special events and get-togethers to reconnect with other alumni (and sometimes program staff).
Alumni (peer) support
-The facility may provide a network (contact list) of alumni willing to stay connected for the purpose of supporting recovery.
And other support services: job search assistance, resume help, interview coaching, educational guidance counseling, anger or stress management, and other life skills.
No rehab will provide all the services above. Most will provide just a few if any. The more in-depth the aftercare and the more services that the rehab offers will come at a higher price; all the additional staffing and expenses are passed on to the consumer.
One sales gimmick that rehabs may try to use on you when you inquire about their aftercare program is their insistence that it is “tailor-made” or “customized” to the participant and so a plan is difficult to describe in detail to you. Demand a better explanation: have them go over best case and worst case scenarios until it is clear what the rehab will and won’t provide in aftercare.
If a rehab’s aftercare program is important to you, it is a very good idea to get ALL the details regarding their aftercare program in writing. Do this before making any commitment (ie… payment) to that rehab. If they truly believe in the services that they provide, this shouldn’t be too much of a problem.
I appreciate your feedback!
My email: betteraddcare@yahoo.com
Related: Residential alcohol treatment center, drug rehabilitation, addiction, substance abuse, alcoholism, 12 step rehabs, alternative to 12 step, recovery program
Saturday, June 30, 2007
Residential Alcohol Drug Rehab: Staffing and Hiring Practices
The Addiction Counselor
(Depending on the rehab, “counselor” can have the following position titles: instructor, therapist, mentor, psychologist, sponsor, teacher, facilitator, and more)
If the goal is for the rehab participant to go from a person with an addiction problem to a person that fully embraces the clean and sober lifestyle, than what can we demand of those that are helping her do this? Character, personality, knowledge, communication and instructional skills come easily to mind. What else?
You won’t find a lot of happy-go-lucky types going to rehab as a result of their alcohol, drug, and substance abuse issues. In fact, many of them can be downright “prickly.” For good reason: many are suffering through family, relationship, financial, legal, health, employment, esteem, or any of a host of other usual consequences. Such a person is constantly looking for reasons (usually outside of themselves, especially at the beginning of their recovery) to live a life that is completely clean and sober. They may be defensive, somewhat closed-minded, and feel that everyone is trying to control them. Consequently, they may test everyone’s patience and empathy.
The addiction counselor will be held to a high standard by the rehab client/guest. A good teacher education program (or licensed counselor or psychologist program) at any university will diligently train for professional dispositions and modeling (of good behaviors). A good addiction counselor must have these qualities in every respect. And not just while ‘on the clock’ – they will be observed at all times, and judged accordingly.
Here is how some rehab participants will self-talk (in quotes...) when presented with certain counselor types: When the counselor is…
Confrontational
“Nobody’s going to TELL me what to do.”
Educated or a 'Know-it-all'
“She thinks her degree is going to make me change?”
Overweight
“This guy has something to tell me about self-control?”
A Smoker/Chewer (tobacco)
“His addictions are okay, but mine aren’t?”
Anxious, temperamental
“She needs a drink.”
Moody, cranky, depressed
“This is what I have to look forward too when I’m sober?”
…you get the picture.
A special case of counselor-type needs a more in-depth mention here: whether the counselor has personally experienced serious addiction problems and has successfully transformed herself into someone who is excelling at the clean and sober lifestyle. Many people just beginning their recovery process will tell you that a person that hasn’t seriously experienced addiction has nothing to say to them. They are too used to “normal” people -- from family, exes, judges, bosses, police officers, doctors, psychologists, etc. -- telling them what to do and why they must do it. They feel that the “un-experientialized” counselor will have no frame of reference; worse, the counselor may be perceived to have another motive (perhaps the counselor was raised by an alcoholic father and now that he is no longer a helpless child he can try to change other people and feel better about his sense of control – really: this isn’t that far from what newly recovering alcoholics and addicts think).
Some might argue that addiction counselors who have never experienced personal addiction issues can offer a perspective to those recovering by demonstrating ‘normal’ (in the sense of never having addiction problems). Certainly an ex-addict with years of a clean and sober life behind her will have a sense of this kind of normal… she may eventually get to a point of not even recognizing herself as an “ex-addict.” However the clientele/patient in rehab is usually nowhere near this kind of experienced know-how of a clean and sober lifestyle. Such a rehab participant may feel a disconnect between themselves and their counselor on a very personal level on such a pertinent ‘detail.’ Worse (as in the previous paragraph): having been ‘counseled’ by plenty of people that may never have had personal addiction problems (again: family, exes, judges, bosses, police officers, doctors, psychologists, etc.) they may not be entirely receptive to such a counselor.
Here is a sticky situation that most rehabs don’t like to admit to their potential customers: there is a potential that staff members may relapse. This is why some rehabs don’t hire ex-addicts or alcoholics (especially former participants of their own program) –they fear that this will create the ultimate form of negative advertising. There is a serious problem with this line of reasoning: honesty. Rehab treatment centers must hold themselves to the highest honesty standards, because this is one of the most important traits that they are hoping to turn-around in the rehab participant. Those that have abused alcohol and drugs have usually habituated themselves into behaviors of manipulation, deception, lies, and omissions. Rehab participants also know better. A rehab that tries to hide the fact that some people may relapse (including, yes, some of their own program graduates) isn’t fooling anyone. So, what should a rehab do when one of their staffers relapses? Try honesty: use it as a real life example of error and poor judgment; model appropriate consequences (such as termination of employment), and open it up as a point of discussion to the participant’s own worries and insecurities regarding relapse prevention.
Rehabs should never hire someone right out of a rehab program to be an addiction counselor (this may seem obvious, but this actually occurs). There should be a period of time of reintegration in society to allow the program graduate to practice the skills necessary for a clean, sober, and relapse-free lifestyle. Only then can such an addiction counselor provide anything of substance to rehab participants.
‘Credentials’ of addiction counselors may include educational requirements, certification, or licensing. Whether a particular rehab requires professional qualifications of its counselors depends a lot on that rehab’s philosophy and practices of care. Many 12 step programs, keeping with the nature and historical relevance of AA, have no need for such outside credentials. Instead their counselors are ‘sponsors’ who have received their education and experience through so many meetings, step study, book study, and living sobriety in the context of their 12 step experience. Alternatives to 12 step exist that take the view that most people who have substance abuse issues are not diseased and powerless, and therefore do not need professionals with either medical or psychology credentials to help them achieve lasting sobriety. In fact, some feel that by telling those in early recovery they have a problem that only medicine or psychology could treat may feel that the center of control for their addiction lies outside of them. Still others do believe that credentials are necessary to diagnose co-morbidity (dual diagnosis) and treat the recovering addict through medicine and/or various psychological methods. A good rehab that does not engage medical staff or practicing psychologists will screen their potential customers for such underlying disorders and refer them appropriately.
Non-Counseling Personnel
(Including but not limited to: kitchen and dining staff, housekeeping, events coordinator, groundskeeping, maintenance, reservations or admissions, administration, drivers, and more)
All of these positions can be considered “hospitality” if there is any interaction between these staff members and the rehab guest. The non-counseling staff, at good treatment centers, is usually well-trained for the customer service skills required in this unique, sometimes unpredictable, and closed environment. The demands placed on these employees are usually much higher than similar positions in the work force. Very few other jobs will rigorously test the staff member’s empathy, patience, tact, maturity, and emotional stability. Unless the pay-grade is raised substantially in comparison to similar jobs available in other businesses, it is hard to attract good employees to rehab jobs.
This creates a dilemma. Many rehabs will not hire graduates from their program because of a fear that they might be a walking, talking, (and relapsing?) bad advertisement for their program. Yet other rehabs will hire program graduates (perhaps after they have reintegrated with common society); and these rehabs will tell you it is because such employees are the best advertising for their program. So which is it? One will probably draw their own conclusions here.
For a person seeking rehab (or one of their concerned family members or friends), one reassuring option that good rehabs can offer them is to be able to talk to a graduate of their program. Written testimonials aren’t that convincing because they offer only one perspective of a person at a fixed point in time. Written testimonials (privacy of the individual is protected) make for good advertising regardless of how that person has done since, and is currently doing (Have they relapsed? How many times? Are they still alive? Would they still recommend the program today?) There is a difficulty in getting current unbiased recommendations of former program attendees. Imagine completing a rehab program and reintegrating yourself back into society, family, and job; and then being asked by the rehab if you wouldn’t mind fielding occasional phone calls from potential rehab customers asking about your experience. A ‘compromise’ to this situation would be to have some program completers on staff (or as volunteers) to talk to potential customers. Also, having program graduates around those that are currently attending rehab can add meaningful context to their early recovery experience.
A rehab which has a good retention rate (a high percentage of attendees finish the program – indicating a comfortable atmosphere and sound methodology), and a good success rate (a high percentage of program completers go on to lead clean and sober lives), and, by all subjective opinion, offers a valuable service, has nothing to fear of its former clientele and won’t have employment or reference policies that keep them ‘hidden.’
I appreciate your feedback!
My email: betteraddcare@yahoo.com
Related: Residential alcohol treatment center, drug rehabilitation, addiction, substance abuse, alcoholism, 12 step, alternative to 12 step, recovery program
(Depending on the rehab, “counselor” can have the following position titles: instructor, therapist, mentor, psychologist, sponsor, teacher, facilitator, and more)
If the goal is for the rehab participant to go from a person with an addiction problem to a person that fully embraces the clean and sober lifestyle, than what can we demand of those that are helping her do this? Character, personality, knowledge, communication and instructional skills come easily to mind. What else?
You won’t find a lot of happy-go-lucky types going to rehab as a result of their alcohol, drug, and substance abuse issues. In fact, many of them can be downright “prickly.” For good reason: many are suffering through family, relationship, financial, legal, health, employment, esteem, or any of a host of other usual consequences. Such a person is constantly looking for reasons (usually outside of themselves, especially at the beginning of their recovery) to live a life that is completely clean and sober. They may be defensive, somewhat closed-minded, and feel that everyone is trying to control them. Consequently, they may test everyone’s patience and empathy.
The addiction counselor will be held to a high standard by the rehab client/guest. A good teacher education program (or licensed counselor or psychologist program) at any university will diligently train for professional dispositions and modeling (of good behaviors). A good addiction counselor must have these qualities in every respect. And not just while ‘on the clock’ – they will be observed at all times, and judged accordingly.
Here is how some rehab participants will self-talk (in quotes...) when presented with certain counselor types: When the counselor is…
Confrontational
“Nobody’s going to TELL me what to do.”
Educated or a 'Know-it-all'
“She thinks her degree is going to make me change?”
Overweight
“This guy has something to tell me about self-control?”
A Smoker/Chewer (tobacco)
“His addictions are okay, but mine aren’t?”
Anxious, temperamental
“She needs a drink.”
Moody, cranky, depressed
“This is what I have to look forward too when I’m sober?”
…you get the picture.
A special case of counselor-type needs a more in-depth mention here: whether the counselor has personally experienced serious addiction problems and has successfully transformed herself into someone who is excelling at the clean and sober lifestyle. Many people just beginning their recovery process will tell you that a person that hasn’t seriously experienced addiction has nothing to say to them. They are too used to “normal” people -- from family, exes, judges, bosses, police officers, doctors, psychologists, etc. -- telling them what to do and why they must do it. They feel that the “un-experientialized” counselor will have no frame of reference; worse, the counselor may be perceived to have another motive (perhaps the counselor was raised by an alcoholic father and now that he is no longer a helpless child he can try to change other people and feel better about his sense of control – really: this isn’t that far from what newly recovering alcoholics and addicts think).
Some might argue that addiction counselors who have never experienced personal addiction issues can offer a perspective to those recovering by demonstrating ‘normal’ (in the sense of never having addiction problems). Certainly an ex-addict with years of a clean and sober life behind her will have a sense of this kind of normal… she may eventually get to a point of not even recognizing herself as an “ex-addict.” However the clientele/patient in rehab is usually nowhere near this kind of experienced know-how of a clean and sober lifestyle. Such a rehab participant may feel a disconnect between themselves and their counselor on a very personal level on such a pertinent ‘detail.’ Worse (as in the previous paragraph): having been ‘counseled’ by plenty of people that may never have had personal addiction problems (again: family, exes, judges, bosses, police officers, doctors, psychologists, etc.) they may not be entirely receptive to such a counselor.
Here is a sticky situation that most rehabs don’t like to admit to their potential customers: there is a potential that staff members may relapse. This is why some rehabs don’t hire ex-addicts or alcoholics (especially former participants of their own program) –they fear that this will create the ultimate form of negative advertising. There is a serious problem with this line of reasoning: honesty. Rehab treatment centers must hold themselves to the highest honesty standards, because this is one of the most important traits that they are hoping to turn-around in the rehab participant. Those that have abused alcohol and drugs have usually habituated themselves into behaviors of manipulation, deception, lies, and omissions. Rehab participants also know better. A rehab that tries to hide the fact that some people may relapse (including, yes, some of their own program graduates) isn’t fooling anyone. So, what should a rehab do when one of their staffers relapses? Try honesty: use it as a real life example of error and poor judgment; model appropriate consequences (such as termination of employment), and open it up as a point of discussion to the participant’s own worries and insecurities regarding relapse prevention.
Rehabs should never hire someone right out of a rehab program to be an addiction counselor (this may seem obvious, but this actually occurs). There should be a period of time of reintegration in society to allow the program graduate to practice the skills necessary for a clean, sober, and relapse-free lifestyle. Only then can such an addiction counselor provide anything of substance to rehab participants.
‘Credentials’ of addiction counselors may include educational requirements, certification, or licensing. Whether a particular rehab requires professional qualifications of its counselors depends a lot on that rehab’s philosophy and practices of care. Many 12 step programs, keeping with the nature and historical relevance of AA, have no need for such outside credentials. Instead their counselors are ‘sponsors’ who have received their education and experience through so many meetings, step study, book study, and living sobriety in the context of their 12 step experience. Alternatives to 12 step exist that take the view that most people who have substance abuse issues are not diseased and powerless, and therefore do not need professionals with either medical or psychology credentials to help them achieve lasting sobriety. In fact, some feel that by telling those in early recovery they have a problem that only medicine or psychology could treat may feel that the center of control for their addiction lies outside of them. Still others do believe that credentials are necessary to diagnose co-morbidity (dual diagnosis) and treat the recovering addict through medicine and/or various psychological methods. A good rehab that does not engage medical staff or practicing psychologists will screen their potential customers for such underlying disorders and refer them appropriately.
Non-Counseling Personnel
(Including but not limited to: kitchen and dining staff, housekeeping, events coordinator, groundskeeping, maintenance, reservations or admissions, administration, drivers, and more)
All of these positions can be considered “hospitality” if there is any interaction between these staff members and the rehab guest. The non-counseling staff, at good treatment centers, is usually well-trained for the customer service skills required in this unique, sometimes unpredictable, and closed environment. The demands placed on these employees are usually much higher than similar positions in the work force. Very few other jobs will rigorously test the staff member’s empathy, patience, tact, maturity, and emotional stability. Unless the pay-grade is raised substantially in comparison to similar jobs available in other businesses, it is hard to attract good employees to rehab jobs.
This creates a dilemma. Many rehabs will not hire graduates from their program because of a fear that they might be a walking, talking, (and relapsing?) bad advertisement for their program. Yet other rehabs will hire program graduates (perhaps after they have reintegrated with common society); and these rehabs will tell you it is because such employees are the best advertising for their program. So which is it? One will probably draw their own conclusions here.
For a person seeking rehab (or one of their concerned family members or friends), one reassuring option that good rehabs can offer them is to be able to talk to a graduate of their program. Written testimonials aren’t that convincing because they offer only one perspective of a person at a fixed point in time. Written testimonials (privacy of the individual is protected) make for good advertising regardless of how that person has done since, and is currently doing (Have they relapsed? How many times? Are they still alive? Would they still recommend the program today?) There is a difficulty in getting current unbiased recommendations of former program attendees. Imagine completing a rehab program and reintegrating yourself back into society, family, and job; and then being asked by the rehab if you wouldn’t mind fielding occasional phone calls from potential rehab customers asking about your experience. A ‘compromise’ to this situation would be to have some program completers on staff (or as volunteers) to talk to potential customers. Also, having program graduates around those that are currently attending rehab can add meaningful context to their early recovery experience.
A rehab which has a good retention rate (a high percentage of attendees finish the program – indicating a comfortable atmosphere and sound methodology), and a good success rate (a high percentage of program completers go on to lead clean and sober lives), and, by all subjective opinion, offers a valuable service, has nothing to fear of its former clientele and won’t have employment or reference policies that keep them ‘hidden.’
I appreciate your feedback!
My email: betteraddcare@yahoo.com
Related: Residential alcohol treatment center, drug rehabilitation, addiction, substance abuse, alcoholism, 12 step, alternative to 12 step, recovery program
Thursday, June 28, 2007
Residential Alcohol Drug Rehab: Medical or non-medical setting?
To best address this question, two variables are considered: typical treatment progression, and the psychiatric profile of the individual client
First variable: Although arguments are fierce on the details, there are different, sequentially occurring phases in addiction recovery. In order: detoxification (withdrawal management), residential (inpatient), therapeutic community (half-way house), relapse prevention, after care (outpatient, regular support meetings), and self-care. Some programs would disagree on the necessity of some of these phases; other programs group certain phases together.
Is a medical setting required for any part of treatment? Only in the case of detoxification, if…
1. There is any possibility that the withdrawal symptoms are life-threatening.
2. Withdrawal is too uncomfortable to accomplish without medical supervision. This is difficult to determine, because it is dependent on the individual’s tolerance for physical, mental, and emotional discomfort.
For those that need medical detox: once you have safely detoxed, you can then choose any residential program for the duration of your rehab. If there is a fear that you can’t go from a detox facility to a non-medical residential facility without going back to drinking or drugging, then you might want to consider only those programs that do both detox and residential rehab. Medical detoxification is an additional and substantial expense.
After a person’s withdrawal symptoms have stabilized, a medical setting is not required for any other part of the treatment thereafter, unless the second variable (read below) is an issue.
Second variable: There are no two people with addiction problems that are exactly alike. However, simplifying for the sake of this discussion, there are two populations. One group that will need medical level (psychiatric) diagnosis and pharmacological support; and the other group that does not. The boundary between the two groups is fuzzy. Should one error towards one side or another? That depends on your perspective: should you give someone who may show some symptoms of depression, anxiety, or bipolar a diagnosis along with a prescription; or, would doing so diminish a person’s feeling of control over their addiction issue? Would medication enhance or interfere with treatment outcome?
A medical setting may be required if known or emerging (rarely, addictions may mask disorders beyond the awareness of the addict and others) psychiatric problems necessitate medical intervention and pharmacological support. This medical setting may be useful throughout all phases of treatment or just until the psychiatric issue is managed through medicine and patient compliance.
Dual diagnosis (or co-morbid) conditions are sometimes diagnosed more than necessary. A person that has lived a life of addiction is likely to have many problems with relationships, employment, finances, legal, health, self-esteem, etc. that may cause a great deal of stress, anxiety, grief, shame, and depression. These are normal human responses to the consequences of addiction. Unless these responses are so strong as to make life unmanageable, the simplest solution is to effectively communicate/educate the person on how they can best address these issues in the healthiest way possible.
Residential programs in medical settings cost substantially more (all other things being equal, which they rarely are). Medical settings tend to have more of a clinical ‘feel’ and may not be as comfortable or ‘normal’ to an addict trying to get well. Disagreement exists as to whether this might impact outcome.
I appreciate your feedback!
My email: betteraddcare@yahoo.com
Related: Residential alcohol treatment center, drug rehabilitation, addiction, substance abuse, alcoholism, 12 step, alternative to 12 step, recovery program
First variable: Although arguments are fierce on the details, there are different, sequentially occurring phases in addiction recovery. In order: detoxification (withdrawal management), residential (inpatient), therapeutic community (half-way house), relapse prevention, after care (outpatient, regular support meetings), and self-care. Some programs would disagree on the necessity of some of these phases; other programs group certain phases together.
Is a medical setting required for any part of treatment? Only in the case of detoxification, if…
1. There is any possibility that the withdrawal symptoms are life-threatening.
2. Withdrawal is too uncomfortable to accomplish without medical supervision. This is difficult to determine, because it is dependent on the individual’s tolerance for physical, mental, and emotional discomfort.
For those that need medical detox: once you have safely detoxed, you can then choose any residential program for the duration of your rehab. If there is a fear that you can’t go from a detox facility to a non-medical residential facility without going back to drinking or drugging, then you might want to consider only those programs that do both detox and residential rehab. Medical detoxification is an additional and substantial expense.
After a person’s withdrawal symptoms have stabilized, a medical setting is not required for any other part of the treatment thereafter, unless the second variable (read below) is an issue.
Second variable: There are no two people with addiction problems that are exactly alike. However, simplifying for the sake of this discussion, there are two populations. One group that will need medical level (psychiatric) diagnosis and pharmacological support; and the other group that does not. The boundary between the two groups is fuzzy. Should one error towards one side or another? That depends on your perspective: should you give someone who may show some symptoms of depression, anxiety, or bipolar a diagnosis along with a prescription; or, would doing so diminish a person’s feeling of control over their addiction issue? Would medication enhance or interfere with treatment outcome?
A medical setting may be required if known or emerging (rarely, addictions may mask disorders beyond the awareness of the addict and others) psychiatric problems necessitate medical intervention and pharmacological support. This medical setting may be useful throughout all phases of treatment or just until the psychiatric issue is managed through medicine and patient compliance.
Dual diagnosis (or co-morbid) conditions are sometimes diagnosed more than necessary. A person that has lived a life of addiction is likely to have many problems with relationships, employment, finances, legal, health, self-esteem, etc. that may cause a great deal of stress, anxiety, grief, shame, and depression. These are normal human responses to the consequences of addiction. Unless these responses are so strong as to make life unmanageable, the simplest solution is to effectively communicate/educate the person on how they can best address these issues in the healthiest way possible.
Residential programs in medical settings cost substantially more (all other things being equal, which they rarely are). Medical settings tend to have more of a clinical ‘feel’ and may not be as comfortable or ‘normal’ to an addict trying to get well. Disagreement exists as to whether this might impact outcome.
I appreciate your feedback!
My email: betteraddcare@yahoo.com
Related: Residential alcohol treatment center, drug rehabilitation, addiction, substance abuse, alcoholism, 12 step, alternative to 12 step, recovery program
Thursday, June 21, 2007
Residential Alcohol Drug Rehab: questions...
Some questions to think about…
Why aren’t there any unaffiliated, advertising-free websites or blogs that are intended to help people find appropriate alcohol and drug rehab programs? All I ever see are sales-pitches; how can the addicted or their loved-ones ever find a decent rehab?
Is a rehab’s approach to advertising, marketing, and admissions contradictory to their program's philosophy, perscribed practices, or qualities?
Imagine the ideal residential rehab. How would you picture them “getting the word out” on their program without expensive advertising (the cost of which is passed on to their customers), viral marketing, or less-than-altruistic (sales and) admissions approaches to “securing” their customer quota?
I appreciate your feedback!
My email: betteraddcare@yahoo.com
Why aren’t there any unaffiliated, advertising-free websites or blogs that are intended to help people find appropriate alcohol and drug rehab programs? All I ever see are sales-pitches; how can the addicted or their loved-ones ever find a decent rehab?
Is a rehab’s approach to advertising, marketing, and admissions contradictory to their program's philosophy, perscribed practices, or qualities?
Imagine the ideal residential rehab. How would you picture them “getting the word out” on their program without expensive advertising (the cost of which is passed on to their customers), viral marketing, or less-than-altruistic (sales and) admissions approaches to “securing” their customer quota?
I appreciate your feedback!
My email: betteraddcare@yahoo.com
Wednesday, June 20, 2007
Residential Alcohol Drug Rehab: Drug Testing
Almost all residential drug and alcohol rehab programs require random alcohol and drug testing of its guests. Here’s the first reason why: a guest needs to be clean and sober during their stay at the rehab facility if there is any hope of recovery. Another very important reason is the safety of other guests and staff at the facility.
[Yet another reason is that court-ordered “drug rehab” implies that the facility guarantees that the defendant isn’t continuing to abuse alcohol or drugs. In this case, drug testing ensures legal compliance.]
Some rehabs will clearly state on their websites that they conduct drug and alcohol testing. Most of these will say that it is done at “random” --however there are two other common non-random times that most facilities do drug testing: initial screening and post-incident.
The initial drug and alcohol screen establishes a baseline for any residual drug (or its measurable metabolite) still in the guest’s system. Some substances remain in the user’s system for an extended period of time. It wouldn’t make sense to do the first drug test a few days after the user arrives at the facility, get a positive reading, then remove the guest from the program for violation of its clean and sober policies.
The post-incident drug or alcohol testing is given whenever any staff member (or fellow guest) believes that someone might be under the influence of drugs or alcohol.
The four types of testing most common at residential drug rehabilitation programs are urine (most common drug test), Breathalyzer (most common alcohol test), saliva (also known as oral fluid-based testing), and blood (least common, with the exception of rehabs in a medical setting).
Urine testing is the most popular because it is the least expensive form of drug testing (Breathalyzers are the cheapest form of testing for alcohol). Another reason many rehabs may use urine testing: if the guest challenges the results of a positive test, the rehab can package the urine and send it to an outside lab for independent analysis.
To get the most accurate results from urine testing, rehab staff (of the same gender) must “watch” the guest produce the sample. The reason for this is that there has been a long history of people trying to alter their urine test by concealing another person’s urine and discreetly putting the specimen in the collection cup. Another increasingly popular method of altering the urine sample is to add a chemical adulterant to the urine. Most drug testing labs have the means of testing the urine for any adulterants; most rehabs do not have this ability on-site.
If the idea of having someone observe you while giving a urine sample makes you uncomfortable, you should talk to the rehab center staff before making your reservation. Refusal to give a drug test (for any reason) can be grounds for immediate dismissal (and usually without refund) from the facility.
Saliva (oral fluid based) testing is not as common as urine testing due to expense, but this form of testing is becoming more popular because it is less “invasive” and the sample cannot be adulterated. If properly administered, the results are as accurate, and in some cases more accurate, then urine testing.
Blood testing for drugs and alcohol is usually rare expect for medical rehab facilities. The reason: phlebotomists, nurses, or paramedics are necessary to safely take a sample of blood from the guest.
Most people understand the necessity of alcohol and drug testing to ensure compliance to the program’s standards, and safety to all other guests and staff. Anyone who has been through prior drug rehab, detox, and/or corrections won’t be all that surprised when they are handed their first specimen cup.
Rehab websites could do a much better job of explaining their policies and procedures regarding drug and alcohol testing. This detail should be followed up by rehab staff prior to starting the admissions process to minimize misunderstandings.
Home drug testing...
You or your loved-one may establish random drug-testing at home as part of the terms or conditions of an ultimatum (or family intervention). There are plenty of sources of drug testing kits and supplies for anyone to buy from drug stores and over the Internet. Most are for urine samples, some allow for saliva testing. Most allow for immediate testing results at home, others offer the option of sending a sample to a lab. For the test to be worthwhile it must truly be random (or anytime there is a suspician of drug or alcohol use), it must test specifically for the drugs that the person might be taking, and it must be free from the possibility of sample-switching or tampering (with adulturants) as mentioned above.
Outpatient or third-party drug testing...
Go to this blog article for more information.
Wikipedia article on drug testing
I appreciate your feedback!
My email: betteraddcare@yahoo.com
[Yet another reason is that court-ordered “drug rehab” implies that the facility guarantees that the defendant isn’t continuing to abuse alcohol or drugs. In this case, drug testing ensures legal compliance.]
Some rehabs will clearly state on their websites that they conduct drug and alcohol testing. Most of these will say that it is done at “random” --however there are two other common non-random times that most facilities do drug testing: initial screening and post-incident.
The initial drug and alcohol screen establishes a baseline for any residual drug (or its measurable metabolite) still in the guest’s system. Some substances remain in the user’s system for an extended period of time. It wouldn’t make sense to do the first drug test a few days after the user arrives at the facility, get a positive reading, then remove the guest from the program for violation of its clean and sober policies.
The post-incident drug or alcohol testing is given whenever any staff member (or fellow guest) believes that someone might be under the influence of drugs or alcohol.
The four types of testing most common at residential drug rehabilitation programs are urine (most common drug test), Breathalyzer (most common alcohol test), saliva (also known as oral fluid-based testing), and blood (least common, with the exception of rehabs in a medical setting).
Urine testing is the most popular because it is the least expensive form of drug testing (Breathalyzers are the cheapest form of testing for alcohol). Another reason many rehabs may use urine testing: if the guest challenges the results of a positive test, the rehab can package the urine and send it to an outside lab for independent analysis.
To get the most accurate results from urine testing, rehab staff (of the same gender) must “watch” the guest produce the sample. The reason for this is that there has been a long history of people trying to alter their urine test by concealing another person’s urine and discreetly putting the specimen in the collection cup. Another increasingly popular method of altering the urine sample is to add a chemical adulterant to the urine. Most drug testing labs have the means of testing the urine for any adulterants; most rehabs do not have this ability on-site.
If the idea of having someone observe you while giving a urine sample makes you uncomfortable, you should talk to the rehab center staff before making your reservation. Refusal to give a drug test (for any reason) can be grounds for immediate dismissal (and usually without refund) from the facility.
Saliva (oral fluid based) testing is not as common as urine testing due to expense, but this form of testing is becoming more popular because it is less “invasive” and the sample cannot be adulterated. If properly administered, the results are as accurate, and in some cases more accurate, then urine testing.
Blood testing for drugs and alcohol is usually rare expect for medical rehab facilities. The reason: phlebotomists, nurses, or paramedics are necessary to safely take a sample of blood from the guest.
Most people understand the necessity of alcohol and drug testing to ensure compliance to the program’s standards, and safety to all other guests and staff. Anyone who has been through prior drug rehab, detox, and/or corrections won’t be all that surprised when they are handed their first specimen cup.
Rehab websites could do a much better job of explaining their policies and procedures regarding drug and alcohol testing. This detail should be followed up by rehab staff prior to starting the admissions process to minimize misunderstandings.
Home drug testing...
You or your loved-one may establish random drug-testing at home as part of the terms or conditions of an ultimatum (or family intervention). There are plenty of sources of drug testing kits and supplies for anyone to buy from drug stores and over the Internet. Most are for urine samples, some allow for saliva testing. Most allow for immediate testing results at home, others offer the option of sending a sample to a lab. For the test to be worthwhile it must truly be random (or anytime there is a suspician of drug or alcohol use), it must test specifically for the drugs that the person might be taking, and it must be free from the possibility of sample-switching or tampering (with adulturants) as mentioned above.
Outpatient or third-party drug testing...
Go to this blog article for more information.
Wikipedia article on drug testing
I appreciate your feedback!
My email: betteraddcare@yahoo.com
Tuesday, June 19, 2007
Residential Alcohol Drug Rehab: Success Rates
This article has been updated on August 6, 2007; please go here
Monday, June 18, 2007
Residential Alcohol Drug Rehab: Cost
This article has been updated on August 4, 2007; please go here
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