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
Wednesday, July 11, 2007
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
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