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
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
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