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.’



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Related: Residential alcohol treatment center, drug rehabilitation, addiction, substance abuse, alcoholism, 12 step, alternative to 12 step, recovery program

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.


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Related: Residential alcohol treatment center, drug rehabilitation, addiction, substance abuse, alcoholism, 12 step, alternative to 12 step, recovery program

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?

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My email: betteraddcare@yahoo.com

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


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My email: betteraddcare@yahoo.com

Residential Alcohol Drug Rehab: Success Rates

This article has been updated on August 6, 2007; please go here

Residential Alcohol Drug Rehab: Cost

This article has been updated on August 4, 2007; please go here