Your substance of choice, behavioral addiction, or mental health diagnosis will dictate the type of treatment you will need. Whether you enter rehab voluntarily or not is immaterial when your life is on the line. Your angry, resentful, resistant butt needs to be in a seat. Luckily there are as many rehabs as there are substances and conditions, and you have to start somewhere. Prepare for your rehab by arming yourself with information that will make the process smoother.
Entering rehab for the first time, and hopefully, the only time is a daunting proposition. You have no idea of the process or the expectations. Your family will be doubly clueless because they have just watched you spiral down and they don’t know anything about healthy boundaries, enabling, codependency, effective communication or the cycle of addiction.
Rehab or treatment is a process. It will feel overwhelming in the beginning, but you will soon adapt to the daily schedule.
At intake, you will fill in a bunch of forms. There will be the financial arrangement and payment, collection of insurance information, HIPAA confidentiality and reporting rules, rehab center rules, a copy of the schedule, and other site-specific paperwork.
If you are entering a facility that has detox, you will have a few other forms to take care of. You will be required to be cleared by a medical professional to enter the facility. Any prescription medication will be administered as per the doctor’s instructions, and release of information forms will be signed.
Each rehab facility will have a rule about how many hours abstinence you have to have prior to entering. Others will just require a medical sign-off to enter their detox facility and then progress into treatment.
For the duration of your stay, you will be assigned a counselor/case manager. Depending on the difficulty of your detox, it may be a few days before you meet your counselor.
Together you will develop a treatment plan. You will meet one-on-one to discuss your substance use, the consequences, and how you feel about being in rehab. You will discuss everything from your childhood, family, and everything in-between.
Your counselor will help you prioritize and set goals to fix the legal and personal problems. They will also help you make a plan for your future.
Each time you meet, you will discuss how you are doing on your goals, how you feel, what barriers you are dealing with, and how you feel your recovery is going.
You have done a lot of damage to yourself physically and psychologically, materially, relationship-wise, financially, spiritually, socially and stability wise.
Working with a counselor on a regular basis will keep you on track and help you tackle difficult topics.
The difficulty of your detox will depend on your substance of choice, how long you have been using, how much you have been using and how your physical and mental health is.
There are specific medications available to help with alcohol withdrawal, opioid/heroin withdrawal. Other medications can be prescribed for short-term management of anxiety, insomnia, and substance-induced conditions such as depression, phobia, mania, and psychosis.
The goal of detox is to rid your system of substances so you can begin to heal. As much as possible will be done to help you through this period.
Detox is not going to be a picnic. At some points, you may feel like you just want to die. It does get better, just give it a few days and you will be feeling a lot better.
JOINING GROUPS WHILE DETOXING
You will be encouraged to join groups and scheduled activities as soon as you are able. You will still be detoxing, but you need to start the program a.s.a.p. You need all of the information, education, coping skills, and tools that can be squeezed into a short time.
It is also better to detox around people who can offer emotional support, who have been there, and understand what you are going through. These people will also offer their encouragement and are proof that you can do it too.
If you are physically incapacitated your counselor will come and meet with you in detox so you can begin to build a healing relationship.
STRONG FEELINGS, EMOTIONS, AND BEHAVIORS
If you entered rehab because your family staged an intervention, you got caught up in the court system, social services, work EAP program, or were otherwise forced into treatment you will be harboring some anger and resentment.
If you are in treatment to make someone else happy, as a negotiation tactic, to get someone off your back, or to just take a break from your substance abuse for a bit you will have some strong feelings about that.
Even if you chose to come to treatment, fear of the unknown, of living without substances, of facing any trauma, problems, or the things you have been self-medicating and hiding from, have you panic-stricken.
You will cycle through thoughts, feelings, emotions, and behaviors so fast you won’t know what’s hit you. One moment you will be furious and acting out, and the next crying with despair or doubled over laughing at antics.
This is normal. Substances alter your brain and your body. You may never have learned the skills you need to run your life as a responsible adult.
Rehab is a safe place to feel what you are feeling and have health professionals and peers who are empathetic and trained to help you work through it all.
One day you will feel like you can take on the world and the next you will be so sick you can’t function. Treatment will give you the skills and tools you need to continue your recovery. Don’t give up.
Rehabs have a busy schedule that begins around 7 am and ends at 10 pm. You are kept very busy for a variety of reasons. 28 days is such a small amount of time to work on your recovery.
You will learn about substance abuse, biological, psychological and spiritual implications, discussions, education, coping skills, assignments, meetings, small group sessions, meditation, exercise, and challenges.
28 days is barely enough time to begin to make changes to yourself and your routines. This is such a short time to develop a solid relapse prevention plan and an aftercare plan. You will only begin the internal work that will lead to long-term change.
Most likely you have been out and about without a schedule or routine. Building a new healthy routine helps you remain clean and sober by keeping you on track throughout your day.
NUTRITION, SLEEP, AND EXERCISE
Chances are you have not been eating healthy meals, getting adequate sleep, or consistently exercising. You will probably put on weight in rehab. The food is nutritious, served 3 times a day and you will have access to snacks.
There is the inside joke that you put in the ‘freshman 15’ in rehab. You probably need it, so let your body get stronger and healthier.
Lights out is usually around 11 pm. This gives you time to socialize and to do journal work or exercises and assignments for the day.
Getting back into a proper sleep schedule gives your body a chance to heal and gives you enough hours of sleep to feel rested and energized the next day.
On the daily schedule, you will be reintroduced to exercise in some form or another. This could be walking, gym equipment, volleyball, swimming, skills courses or yoga.
The day is often begun with a short meditation or daily affirmation.
Food, sleep, exercise, and meditation provide a healthy foundation for your recovery. These allow you to feel better and think better.
The average day is full of groups. Community group gets everyone together and is often held first thing in the morning to discuss what is going on with people, what is up for the day, and any other announcements. This group will also discuss any problems that are coming up.
In order to make good decisions in recovery, you will need to learn the necessary coping skills. Skills groups can cover relapse prevention, communication, healthy boundaries, identifying high-risk situations, playing the tape through, process groups, anger management, and gender groups.
Process groups are especially useful to work through feelings, emotions, behaviors, and issues that are overwhelming you.
Gender groups make it easier to discuss personal issues that are better understood by your gendered peers.
Led by a medical professional, such as a therapist, you will learn specific techniques to counter situations you will find yourself in during recovery. These groups are more than just sitting and talking.
There will be a lot of education and in turn, you will work on solutions to your problems.
You will learn about your family of origin and how genetics and family expectations and actions have affected your core beliefs and values. If you had a dysfunctional family then some of your core values are going to be destructive instead of constructive.
Role-playing can help prepare you for real-world situations.
There will be handouts and exercises to help you get in touch with yourself and how to make better decisions.
Bio-psycho-social refers to how your addiction affects you overall. You will look at the biological, psychological and social effects of your substance abuse.
Addiction has touched every cell in your body. It has affected your base biology. There could be permanent neurological damage or reduced functioning of organs throughout your body.
Addiction has caused disruption to your psychology, neurotransmitters, and ability to process feelings, emotions, and behaviors. Mental health conditions can be sparked by substance use, withdrawal, or as a result of long term substance abuse.
Socially, you have caused chaos. There is a good chance you have isolated yourself. You have changed friends and the types of people you hang out with. You avoid anyone who has negative things to say about your use. You avoid family and loved ones, and social responsibilities.
These groups will prepare you to deal with the effects of your substance use as you move through early recovery and beyond.
You will also look at methods to moderate your thoughts, feeling, and actions. You will learn coping skills and make backup plans.
Socially, you will make plans to rebuild relationships and reunite with the people who are closest to you.
ASSIGNMENTS & JOURNALING
One of the first written assignments you are given is your biography. This includes when you first drank, smoked, or used and, the progression of your substance use and how it influenced your life. This will include any major trauma or stressors in your life, broken relationships, lost jobs, homes, and where you have landed right now.
The biography will be shared in group and discussed. This is a wrenching assignment because you face a lot of your fears. You have a chronological document that shows you exactly where you came from and where you are now.
Making a list of the ways your life is currently unmanageable or out of control is a black and white record of all of the problems you have created with the chaos and drama of your using. This also gives you a place to start to find solutions.
A daily journal is a good way to keep a tally on your thoughts feelings and opinions on yourself and the environment. Journaling is a good practice for getting problems out of your head for the night. If anything really comes up, it can be discussed in process group.
A majority of rehabs have some form of peer-led support meeting. AA and NA are well known 12-Step groups. H&I (Hospitals and Institutions) come onto the facility and bring a meeting to you once or twice a week.
You will hear a speaker share their story. The speaker shares what it was like, what happened, and what it is like now. They share their experience, strength and hope with you.
After the speaker, a topic is chosen from the literature and the floor opened up to anyone who wants to speak.
Meetings last about an hour. Sometimes you will go to an outside meeting to mingle with the community and find a temporary sponsor to begin working the steps while you are in rehab.
Meetings are important as you begin to build your support group for when you exit rehab. Community support groups are going to be extremely important to you after you leave; these are the people who will help you through the really difficult times.
There will be a specific program for your family and loved ones to attend. They will learn communications skills, how to set healthy boundaries, signs of enabling and codependency, and will have an opportunity to ask questions.
For a portion of this program, you will join your family and practice some of the skills you have both learned through the program.
There will be an MFT or two who you can book private sessions with if your family wants extra help.
There will be time to just relax, read a book, work on your assignments, take a walk, socialize and take a nap. Sometimes there is a movie night for those who want to go.
In recovery, it is important to take time out for activities that you enjoy. You need to schedule self-care into your routine.
The weekend schedule is a little less hectic than during the week. You are still up early but there are fewer groups and more free time.
Sunday is usually visiting day. For a few hours, you can hang out with your family and friends, or have your sponsor visit.
Soon after visiting ends there will be a process group. Visiting day is fraught with emotion, and tempers can run high. You might have expectations that your family will bring you whatever you demand, and when they don’t you’ll be upset;
Your family may refuse to do something for you. Or they may get on your case about something, Anger and resentment will go both ways, accusations, finger pointing, the whole nine yards!. There are a lot of triggers on family visiting day.
It can take hours to calm down, or be less upset, after visiting day. Having a process group to vent frustrations, or talk about good visits is a safe place to learn how to control your emotions and solve problems.
Rehab is literally a 28-day bubble. You are protected from the outside world and are responsible for yourself only on a daily basis.
You have no responsibility other than turning up for groups and following the rules, it’s pretty easy.
The outside is where all of the expectations, drama, chaos, trouble, and problems are. If you don’t work your recovery, all of the drama and chaos will continue when you graduate the program.
In your treatment plan, you will have goals and steps to take care of business. If you have legal obligations you will be dealing with those in rehab. You will have a buffer and people to help you with paperwork.
The truth of the matter is, if you really want to use, visiting day is rife with contraband entering facilities. Most facilities don’t check visitors. BUT, if you get high (and caught), your visitors will be banned and you will be dismissed from the program.
Most facilities aren’t even locked down. You can walk out at any time you like. The courts might not like it, your family won’t, significant others won’t, and you will be on your own. Families and courts become rather upset when you ditch rehab.
Another danger is rehab romance. It happens a lot. A group of adults all together in rehab, getting better, feeling better, isolated from outside and making eyes at one another. It is very easy to get caught up in a budding romance.
There are varying levels of it. Friendship and eating meals together, sneaking off together, always hanging out together, and then there’s being caught in situations you don’t want to get caught in, and then you’re thrown out of rehab.
While you are focused on a new romance, you are not focused on your recovery. It’s not worth it. You can’t control yourself just yet; you certainly can’t cope with a relationship. Bad idea!
There is also the danger of crushing on one of the staff, or your counselor. Staff in rehab facilities are there to help you. They often have the patience of saints the show compassion, empathy, are willing to listen, they help you make decisions about your life, they smile, they encourage.
It is easy to believe that this is personal. It is professional interest, it’s your treatment plan, and they are there to help you. There is nothing more than that. This can be dangerous and destructive to both parties.
Treatment center professionals have signed multiple documents that specifically ban them from anything but professional contact with clients for a number of years.
THE SECOND HALF
By the second or third week, you will be feeling pretty good, your body will be looking better and you will have regained energy. Your mind will be clearing and you will have better control of your emotions.
You will begin to have a positive can-do attitude and be willing to take on your problems. In fact, you will declare you are cured and will never drink, use, or revert back to eating or behavioral disorders. Um, wrong.
This is what is called the pink cloud. Your mind has negated all the bad things associated with using and is keeping you on an artificial high. It is unrealistic and unsustainable. You are going to come back to earth a hurry.
You will be full of good ideas and big plans for the future. Plans are good, but they have to be realistic. Having long-term plans are great, but you need to plot the small steps, over time, that will get you there.
You will learn about short-term, medium-term, and long-term goals and lots of planning. As you develop your exit plan you will take your goals into account.
An aftercare plan will be formulated. Most rehabs will have aftercare or an alumni group. They will definitely have outpatient treatment referrals and referrals to doctors, psychiatrists and therapist’s f you need them.
THE LAST WEEK
The last week is usually a blur. You are raring to go. But go where?
Returning to the same house, with the same people, in the same neighborhood where you ran amok, is not a good idea. You will be back out there in short order.
Rehab is generally 28 days because that is all that insurance companies will pay for. It is some messed up determination that was made way back when not long after alcoholism was deemed a disease and not a moral issue.
This determination then made it possible for alcoholics to receive treatment in medical settings.
Subsequently, drug addiction, behavioral addiction, and other mental health issues came up on the radar, and they too got lumped into a 28-day inpatient treatment program.
The truth of the matter is, it did not take 28 days to mess up your life. And it is not going to take 28 days in rehab to fix it.
EXIT PLANNING AND CONTINUING TREATMENT
Recovery is lifelong. Early recovery is hard. The first year is hard. It can take a considerable amount of time and energy to get through the first 12 months of recovery. Relapse statistics soar within the first 30 days out and continue through the first 3 years. Relapse numbers decline after 1-3 years and continue to drop the longer you are in recovery.
Recovery is a slow process. You need to give yourself the best chance possible. That means making the best decisions for you when making an exit plan.
If you can get 45-90 days in residential treatment, do it. Go into a sober living or transitional home after rehab and stay there for as long as you need to. Take advantage of outpatient and aftercare groups.
You can learn how to live independently while surrounded by others in recovery. You will have rules and routines, and the opportunity to find a job, go to school or continue outpatient treatment.
Continue with counseling for yourself, as a couple, as a family, everyone should be involved in recovery.
INTENSIVE OUTPATIENT / OUTPATIENT / ALUMNI GROUPS
If you entered rehab under your medical insurance there is a good chance you can sign up for intensive outpatient (IOP). IOP usually 6-8 weeks, 3-5 days a week from morning to mid-afternoon. You will have meeting requirements, drug testing, and assignments.
Outpatient (OP) will generally offer groups a few evenings a week with peer group meetings and drug testing.
Ongoing care is usually a monthly alumni group or drop-in group.
AFTER YOU LEAVE
I know people who have walked out of the doors of rehab, are picked up by a friend and are loaded not an hour later.
Others tough it out until they can’t keep it together anymore. They throw up their hands, wailing it’s too hard. All with a few short weeks.
And there are yet more who knuckle down and get through it. These people use their support groups, their sober contacts, their new friends, and family, and therapy to get through the hard times. They use every single tool they have learned in treatment.
There will be unexpected cravings and urges. Out of the blue. There will also be behavior changes months, weeks or days prior to an actual relapse.
In rehab, you will have learned how to identify these behaviors and have a plan to deal with them.
Stay connected to others in recovery. Use the knowledge and tools you learned in rehab. Reach out and tell someone what you are feeling. Ask for a sober buddy to hang out with you. It will pass.
Life in itself is difficult. There are always challenges and responsibilities that feel like they are going to crush you. They won’t. They’ll pass. But it will feel impossible at the time.
Once you believe in yourself, trust in yourself, and are willing to continue learning, you will get through anything,
A solid and often repeated mantra is; No new relationships for the first year! Get a plant and see if you can keep it alive. Then try a fish. Then maybe a fluffy animal. Only after you nurture yourself and other living things are you ready for a new relationship.
Go to rehab. It is worth it. You are worth it.
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Read about the ways addiction will kill you.
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