If you or your loved one is entering rehab for treatment of substance abuse or addiction, or co-occurring substance abuse and mental health disorder, even a combination of addictions, naturally you have concerns over what to expect. Most of the questions center around what actually happens, or what can you expect from drug rehab during the first 30 days.
In short, if you have selected an addiction treatment facility that carries certification from the Commission on Accreditation of Rehabilitation Facilities (CARF), you can expect that your needs (or those of your loved one) will be met with the highest level of professionalism and a personalized treatment program created to address the specific addiction and any co-existing problems or disorders.
But that doesn’t tell you what goes on during the first month after a patient is admitted to rehab. Let’s take it step by step.
Step 1: Intake Exam and Interview
The recovery process begins with the initial comprehensive examination and interview of the person who wants to overcome his or her addiction. This step, also called the interview and assessment process, is where counselors and medical staff collect information about the patient’s addiction, history, background, any underlying medical conditions, type and duration of addiction or addictions, frequency of use, date of last usage, and other pertinent information. Some medical tests may be required, such as a urinalysis or blood tests.
The results from the intake exam and interview allow the counselors and other treatment facility staff to create a personalized treatment program for the patient, and to determine the recommended length of treatment.
Step 2: Detoxification
In a comprehensive and integrated treatment facility, such as a residential drug and alcohol treatment facility, detoxification from harmful substances is the required first step. Detoxing from alcohol abuse or addiction is popularly referred to as “drying out,” and that’s a very simplified way of looking at it. Similar to alcohol detox, drug detox is the process of removing all traces of the abused substance from the body. All detox is carried out under 24-hour medical supervision and care.
In some treatment facilities that do not have on-site medically-supervised detox services, the patient cannot be admitted to active treatment until they have been drug- or alcohol-free for a period of 48 hours. This means that detox will have to take place at another facility, which should be a hospital that provides detox services. It is critically important that detox take place only under 24-hour medical supervision, as some withdrawal symptoms – particularly for long-term alcoholism – may be severe or even life-threatening.
Most withdrawal symptoms, however, range from mild to moderate. There are moderate to severe withdrawal symptoms for poly-drug addiction, or long-term alcohol and drug abuse, in some individuals. In addition, those with underlying medical conditions may require special attention to those conditions during the process of detoxing from drugs or alcohol.
For many addicts, the period of detoxification is between 1 to 3 days, although, as previously mentioned, long-term or multiple addictions may require a longer detox period. During detox, medications may be prescribed to help ease the symptoms of withdrawal or to eliminate or reduce cravings and urges to use.
Step 3: Active Treatment
While we’re referring to active treatment as step three, this is the period of treatment where the real work begins. It’s actually comprised of multiple elements utilizing various treatment modalities and services.
Research shows that patients who remain in and complete their addiction treatment program have a better chance of staying clean and sober and going on to live full, happy, and productive lives. Checking out early (quitting rehab) is often followed by relapse. The longer a patient stays in treatment, the better his or her chances are to achieve lasting sobriety and to be better prepared for effective recovery.
That said, the hard work in active treatment begins with the patient learning about the disease of addiction, meeting with a counselor that has been specifically assigned to him or her, meeting in groups, learning how to recognize and identify triggers to using, learning and practicing effective coping skills and mechanisms, and becoming familiar with the concept and process of network support by participating in 12-step group meetings.
Counseling also works to help the patient overcome emotional issues that may have precipitated or become aggravated by the addiction. It is often said that effective addiction treatment focuses on healing the mind-body-spirit. In line with this, many residential treatment facilities include meditation and relaxation techniques to help the patient learn how to balance their mental state so that they can better handle cravings and urges to use again.
Another important component of active treatment is relapse prevention. Before the patient can go back to his or her home environment, return to work, and rejoin society, he or she needs to be armed with strategies and tools to use to avoid falling into relapse. It’s one thing to identify the triggers – the people, places, and things that cause addicts to use – and it’s another to feel confident enough and have a plan to follow to be able to successfully overcome the cravings and urges to use. This is what relapse prevention is all about.
During active treatment, various treatment modalities may be utilized. These may include cognitive-behavioral therapy (CBT), dialectical behavioral therapy (DBT), somatic therapy, eye movement desensitization and reprocessing (EMDR), individual psychotherapy, family therapy, equine-assisted therapy, art therapy, psycho-educational groups, psychodrama, art therapy, stress management strategies, spiritual development, fitness and nutritional counseling, yoga/meditation, and acupuncture, among others.
Again, depending on the patient’s type and length of addiction, frequency of use and other contributing or underlying conditions or factors, the length of the recommended treatment program may vary. Some patients are in treatment for 30 days, while others may require 60 to 90 days. Patients with chronic, long-term, and co-occurring disorders may require continuing treatment, perhaps in an extended care program at the residential treatment facility, a therapeutic care center or a transitional sober living home.
All patients are encouraged to continue participation in 12-step group meetings as part of their ongoing recovery plan (which they develop with their counselor during treatment). And many patients have continuing care or aftercare as part of their overall treatment program.
Family Therapy and Communication
While family therapy has been mentioned, it is a vital part of the overall treatment program. Without the ability for better communication within the family and with the person in recovery, and education and counseling of family members about the disease of addiction and how to better support their loved one in recovery, no amount of treatment may be enough to prevent relapse. Your loved one simply cannot return to the status quo. Some things will have to change, not only for your loved one with the addiction, but within the family as well.
Keeping a “clean” house, free of alcohol and drugs, learning how to defuse situations or react in healthier ways to stress, becoming supportive of your loved one’s need to attend 12-step group meetings and pursue other elements of his or her recovery plan are crucial to his or her long-term abstinence and ability to pursue life goals.
Family members should be prepared for little or no communication with their loved one during the first phase of active treatment. The counselor and staff of the treatment facility will advise when it’s appropriate and recommended to visit. You can also expect to hear pleas to leave, promises to abstain, how difficult it is, and other requests and/or complaints. This is natural, since overcoming addiction and coming to grips with the psychological need to use is tough work. Treatment isn’t a picnic, but is necessary to overcome addiction. Denial, resistance, rationalization, lack of motivation, inability to effectively communicate – all of these may be hurdles your loved one needs to overcome.
Keep in mind that some patients adapt quickly, fully committed to doing whatever it takes to overcome addiction. Others take longer. Family support is the best thing that you can provide for your loved one as he or she goes through treatment and begins recovery.
Safe and Supportive Healing Environment
Perhaps most important to anyone considering entering treatment for drug and/or alcohol abuse or addiction is that they feel confident that they will be in a safe and supportive environment. This is conducive to optimum healing. When patients have the opportunity to stabilize medically and psychologically, they’re better able to learn about the disease of addiction, about themselves, what underlying causes and conditions led to their addiction or have prevented them from overcoming it in the past, learn how to change their behavior, and gain the necessary tools to aid in their ongoing – and lifelong – recovery.
What can you expect from drug rehab during those first 30 days? Expect that this is the beginning of the journey. Whether you are the person entering treatment or it’s your loved one, expect that there will be good days and bad days, times when you feel ready to conquer the world and times when you are fearful and uncertain. Know that the treatment professionals will work to provide the best foundation possible so that you or your loved one will be better equipped to manage addiction and live a happy and productive life in recovery.
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