Rehab – What More Could You Want?
Rehab at a 28 days at a residential treatment facility – what more could you want to treat a drug addiction or alcoholism? Short answer: so, so much more!
Rehab is but one part of addiction treatment. Continuing care is equally important. Why? Because the individual is healing a chronic, often relapsing brain disease.
The common perception is that finally getting a loved one with a drug or alcohol addiction into a 28-day residential rehab treatment program will take care of the “problem” and that all will return to “normal” as soon as treatment is done. Unfortunately, ALL is not well, nor does it return to “normal” for some time.
Why is Rehab Not Enough?
Because addiction – whether it’s an addiction to illegal or prescription drugs or to alcohol — is a chronic, often relapsing brain disease. The very nature of this disease is that it causes chemical and structural changes in areas of the brain that are vital to a person’s ability to think straight, behave normally and act responsibility. It is not possible to heal all of the neural circuitry impacts caused by the brain disease of addiction in just 28 days.
Nonetheless, an addict/alcoholic can make great progress in rehab, which is typically a 28-day stay at a residential treatment program or an IOP (intensive outpatient program, whereby the person lives at home and visits the treatment center for treatment program offerings). And 28-day rehab programs are but one of the ways** a person goes about beginning their recovery, which is defined as abstinence AND a productive, enjoyable, forward-moving life. But it takes continuing care to carry on the progress that begins in rehab.
For you see, 21st century brain and addiction-related research now shows that treating addiction must follow the same treatment protocols as treating other diseases, such as cancer, diabetes or heart disease. Instead of the old acute care model (i.e., 28-day rehab), treating addiction must follow the disease management model, which is a three-pronged approach and involves: 1) detox/stabilization, 2) rehabilitation (rehab) and 3) continuing care (also known as after care).
Just as a person with diabetes, heart disease or cancer has a continuing care program/plan to help them continue their recovery once the acute care treatment (e.g., surgery, radiation, chemo) is complete, so too must the alcoholic / addict. These continuing care plans must go far beyond the “typical” drug testing and 12-step meeting attendance monitoring. They must include plans for how to integrate with the family; for how to deal with the fall-out of not dealing with “life” while in their addiction (e.g., credit destruction, parenting issues, relationships problems, foreclosure, lost jobs, lost friendships — the “life” situations than can trigger a person who is in early recovery (day 29, 30, 45 or 72, for example) to relapse; for what the family needs in order to help themselves and in that process, help their loved one.
Quoting from my recent book, 10th Anniversary Edition If You Loved Me, You’d Stop!:
A More Detailed Explanation of Phase 3: Continuing Care Beyond Rehab
Because addiction is a brain disease, it is highly unlikely that all aspects of healing the brain can be completed in 10, 28 or even 60 days. Yes, a great start can be made, but a continuing care (a.k.a. an after care) plan that extends “treatment” for at least a full year is critical. This is not to be confused with being “in treatment” at a facility.
A continuing care plan is a specific strategy that outlines how the addict/alcoholic is going to maintain abstinence and a joy-filled life after the detox/stabilization and rehabilitation phases have been completed. Think of it as relapse prevention. And, “What does this mean?”
The addict/alcoholic’s embedded addiction-related neural networks will be triggered by any number of cues – sound, sight, memory, the smell of alcohol, an emotion, a stressful person or situation. Therefore, planning how to prevent and/or handle such cues is critical. Let’s face it, treatment for a heart disease patient or diabetic doesn’t stop after the person is stabilized, nor is it assumed a patient’s diabetes or heart disease goes away after the rehabilitation effort. Instead, those patients are counseled, provided education and behavioral modification strategies, and then they are given a continuing care plan and follow-up with further modifications, if necessary. This same approach must be used with treating addiction. For as you can imagine by now, healing, developing and changing neural networks takes time.
As with rehabilitation, there are a wide range of opportunities and options to include in a continuing care plan. These might include: ___[fill in the blanks]___________ .
___________________________________________
**Important: It must be understood that not all addicts/alcoholics need go through a formal 28-day rehab treatment program in order to recover. Not all can afford nor do they need such a program and not everyone is open to it. Regardless of the methods chosen – residential, 12-step programs, medical assistance, outpatient, therapy with an addictions specialist, group therapy, cognitive behavioral therapy, yoga, exercise, nutrition, stress reduction techniques, or some combination – the objective remains the same: abstain from the substance entirely and follow a disease management approach that involves detox/stabilization, rehabilitation and continuing care. This blog post provides additional information, “Addiction Treatment: What to Look For.”
- You may also wish to look at the Family Continuing Care consulting services I provide with my partner in this work, Caroll Fowler, by clicking here > Help for Families | Family Continuing Care Plans. Why involve the family in continuing care? The brain and behavioral changes an addict/alcoholic experiences as they progress in their disease, in turn, set up SHDD (secondhand drinking/drugging) impacts for family members and friends. Living and coping with SHDD, over time, causes family members and friends to suffer physical, emotional and behavioral changes, as well. It becomes something of a dance that needs to be addressed and when addressed can greatly aid an addict/alcoholic in their long-term recovery and the family member in enjoying their own lives independent of the alcoholic/addict’s recovery progress.
Lisa Frederiksen
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Well written, Lisa. I recently read that more than 1/3 of treatment centers who responded to an Addiction Professional informal survey admitted that they provide NO aftercare services for rehab clients. In other words, addicts finish 28 days and then are DROPPED BY TREATMENT CENTERS! Aftercare can and should include attending support groups provided by treatment centers (online or in person), phone calls, or even emails. Responsibility is inherently on the addict to recovery, but our treatment centers can do a MUCH BETTER job at helping the chronic nature of the disease by providing more services!
Thank you, Lee. And thank you for raising reading awareness about the numbers of treatment centers that do not provide any aftercare services for rehab clients!
So true and such an important message to get out — that there is no one way (or right way) to do treatment or recovery…
[…] I especially apprecated that continuing care was emphasized (as highlighted in the bold quote below) because 21st century brain and addiction-related research has shown that addiction (to drugs or alcohol) must follow the disease management model – not the acute care model – which is why having support in the months following detox and rehab is critical to recovery success. See my related blog post, “28-Day Residential Treatment – What More Can You Want?” […]
Lisa, I think you have many excellent points here. One other thing that happens with young addicts is that their emotional development is stalled. The younger they start and the longer they are in their addictive addiction the more they have lost out on ‘normal development’ . If an addiction starts in the teenage years and lasts until their 30’s or 40’s they have then ‘missed out’ on all the experiences that would have brought them into adulthood. Add to that their ‘credit score is rock bottom. It is so important that they have a solid support system in place to help them not only in their recovery but also help them ‘learn’ what they have missed out on.
Thank you, Bev, and I absolutely agree with all that you’ve said here – it’s such a complicated disease and one that needs a variety of treatment options as tools for recovery. Thanks for adding your thoughts – much appreciated!