No Wrong Door

By David Sack, M.D.

Getting an addict into drug rehab isn’t always an easy task. Getting them to stay there can be even harder. Here are five of the most common reasons people leave drug rehab against medical advice, along with suggestions to help the addict stay committed to their recovery.

1. “Detox is too painful.”

Research shows that the first week of drug rehab is the time when most addicts ask themselves, “What the heck am I doing here?” Withdrawal symptoms, drug cravings and an unfamiliar environment can fill the addict with anxiety at the same time they are deprived of their primary coping mechanism: drugs. Some addicts rationalize that they felt better when using drugs and give up on rehab before treatment really begins.

Prevention Tip: Detox can be made more comfortable with medication and alternative therapies such as neurofeedback, acupuncture and massage. Even if the addict isn’t feeling great, they should try to get involved in as many treatment activities as possible.

Rather than isolating, their peers will help them realize they are not alone and see the hope that treatment brings. The earlier the addict develops trust and rapport with a therapist, the more likely they will listen to the therapist’s recommendations and push through the uncertainty.

2. “I’m not like these people.”

This is a common assertion made after the addict attends their first 12-Step meeting or group therapy session. It is the nature of the disease for addicts to think they are different, smarter or stronger than other addicts. This belief allows them to put up emotional walls between themselves and others and to avoid doing the soul-searching work of recovery.

Prevention Tip: If an individual would fare best in the company of like-minded peers, try to find an appropriate drug rehab program for their needs. Once in treatment, cognitive-behavioral therapy can help the addict turn their focus on differences into recognition of similarities. Education about denial can teach the addict that their disease is driving them to rationalize leaving rehab.

3. “I don’t like it here.”

If an addict wants to go back to using drugs, they must find a justification to do so, both for their own peace of mind and to appease their loved ones who desperately want them to get well. Rather than accepting responsibility for their own recovery, they may place the blame elsewhere – often on the food, accommodations, rules, treatment schedule, staff or other patients.

Prevention Tip: In some cases, the addict’s concerns may be legitimate. Perhaps something can be done to make them more comfortable, such as changing roommates or switching therapists. Or perhaps another treatment center would be a better match, particularly if the individual struggles with co-occurring mental health disorders that aren’t being addressed.

It is always wise to stay involved with treatment and listen to a client’s concerns to determine whether they can be addressed or the individual is merely looking for an excuse to leave. In the latter case, it is essential for family members and other treatment professionals to present a united front, offering loving reminders about why the addict needs to complete treatment. Family involvement and family therapy aid in the process, but “rescuing” an addict from drug rehab merely enables the addiction to continue.

4. “I already know this stuff.”

In addiction recovery, there are certain themes that get repeated throughout treatment. This is because repetition is how we learn. Sometimes it isn’t until the second or third go-around that the addict truly embraces a particular recovery principle or gains new insight. In some cases, the addict may use this excuse to avoid dealing with the painful memories and feelings being explored in therapy.

Prevention Tip: There are many ways to show addicts that no matter how much they think they know, they can always learn more. These include having outside speakers share their stories of recovery, offering alternative therapeutic modalities that the addict hasn’t yet explored, maintaining a full schedule of recovery-related activities, and discussing the likely outcome if the addict follows through on their plan to leave.

5. “I can do this on my own.”

At some point during treatment, most addicts develop a type of confidence that is both healing and potentially damaging. After maintaining their sobriety for a while, they feel healthier than ever and are assured of their ability to stay clean. It is at this point that some believe they are “cured” of addiction and anxiously wish to return to their families and careers.

Prevention Tip: Research shows that the longer an addict stays in treatment the better their chances of avoiding relapse. Believing they “know it all” may be a sign of progress but is also a red flag that more education and treatment are necessary. Step-down levels of care (e.g., moving from inpatient to outpatient or a transitional living environment) allow addicts to test their new recovery skills with ongoing professional support.

In many ways, drug rehab is an exercise in faith. We ask addicts to draw on coping, interpersonal and distress tolerance skills they haven’t yet developed, based on the assurance of others that recovery is possible. Change is hard for an addict, but stillness can be even harder. With the support of family and a team of professionals, addicts can stay still long enough to experience the many rewards of recovery.

David Sack, M.D., is board certified in psychiatry, addiction psychiatry, and addiction medicine. He is CEO of Elements Behavioral Health, a network of treatment centers that focus on addiction treatment, eating disorders, and dual diagnosis.

Helping a loved one who is addicted to drugs or alcohol requires a lot of love and patience – and a fair amount of research. In addition to deciding whether your family would benefit from the services of an interventionist, you will need to carefully evaluate your drug rehab options.

If you’ve looked into drug rehab at all, you know it can be difficult to find the one that is best suited to your loved one. The sheer number of rehabilitation centers, compounded by the fact that they all make the same claims, can make the decision process overwhelming.

What features are truly important? How can you dig through the marketing talk to figure out what’s really being offered? Here are 10 must-ask questions for any drug rehab you’re considering:

1. Is the facility licensed and accredited?

Many drug rehab centers claim to provide a high standard of care. The best way to substantiate those claims is through objective third parties. Look for drug rehabilitation centers that have been licensed by the state and accredited by such national organizations as the Joint Commission and CARF (the Commission on Accreditation of Rehabilitation Facilities). These accrediting bodies require programs to meet rigorous standards of patient care and quality programming.

2. Does the staff have the credentials to provide expert care?

A drug rehab program is only as good as the people providing patient care. The therapists and staff will be the ones “in the trenches” with your loved one, exploring deep-seated issues and offering guidance on how to live a happy, productive, and sober life.

While life experience, particularly a personal recovery story, can make the staff relatable, it is also important that they have the qualifications to provide high-quality care. The treatment team should include licensed drug counselors and master’s level therapists, among other specialists. A favorable staff-to-patient ratio is another important consideration.

3. Does the drug rehab center treat co-occurring mental health disorders?

Most people who struggle with addiction also suffer from one or more co-occurring mental health disorders, such as depression, anxiety, or a personality disorder. While all of these conditions are highly treatable, they require a specialized type of care from a multidisciplinary treatment team.

Research shows that integrated treatment that addresses all disorders simultaneously is the only effective way to address dual diagnosis. Many drug rehab programs claim to treat dual diagnosis, but the ones that do so effectively will have special programming for dual disorder patients and access to a psychiatrist and other professionals.

4. What is the philosophy of the treatment center?

The 12-Step principles serve as the foundation of treatment at some of the most effective drug rehab programs. If the treatment center you’re considering doesn’t utilize the 12 Steps, find out why and if alternatives, such as SMART recovery and Life Ring, are available. Decades of research have proven the value of 12-Step programs, which provide a framework for lifelong recovery and offer meetings in most communities all over the world.

5. What kind of reputation does the drug rehab have?

There are few indicators of quality as reliable as the informed opinions of others. While online reviews can be dubious, programs that have made a good name for themselves in the community typically have been around for many years and have happy customers recommending their services to others. Those with strong reputations are also likely to welcome you onsite for a tour and provide names of alumni who are willing to share their experiences and advice.

6. Will treatment be tailored to the specific needs of my loved one?

Every drug rehab center has a core “program” as the guideline for treatment. But the best drug rehabs will then tailor this program to the specific needs of each patient, seeking out the blend of therapies that will give that individual the best opportunity for lasting recovery. As the patient grows in their recovery, the treatment plan adjusts to their changing needs.

7. Will my loved one be safe and comfortable?

Recovery requires rigorous honesty, a willingness to confront the past, and a great deal of soul-searching. While the work of recovery isn’t always comfortable, the experience of drug rehab can be.

A number of drug rehab centers offer all of the amenities of resort living, such as swimming pools, private rooms, beautiful views, and highly desirable locations. Some provide assistance with legal problems, interventions, and other services. It is also important that the drug rehab foster an environment of safety and support, where the patient’s privacy is well-guarded and their emotional security protected.

8. What types of therapies and activities are offered?

Typically, a drug rehab center that offers a wide variety of therapies (including gender-specific options) will give your loved one the best opportunity to find what works for them. Most programs offer the basics, including medical detox, individual, group, and family therapy, and cognitive-behavioral therapy.

Other programs go a few steps further, offering art therapy, equine therapy, EMDR for trauma, experiential therapy, and others. Better yet, some programs will offer programming designed to treat mind, body, and spirit, including yoga, acupuncture, massage, and other holistic therapies. Make sure to ask about relapse prevention and continuing care planning as well long-term treatment options.

Also be sure to take into account the types of activities offered and whether they are a match for your loved one. Are there certain types of activities your loved one enjoys? Are they an outdoors person or more of a city dweller? Some programs promote outdoor recreation such as hiking or rock climbing, while others may schedule outings to theaters, shops, and local entertainment venues.

9. Does the program work with insurance?

Cost shouldn’t be an obstacle to getting quality drug rehab treatment. Even some of the most luxurious drug rehabs accept insurance and will work to maximize your benefits and/or create a payment plan.

10. Will I be part of my loved one’s treatment?

Family members and loved ones are an important part of drug rehab treatment. Whether entering short- or long-term treatment, the eventual goal is for the patient to return home to their family. In order for this transition to be successful, family members must learn about the disease of addiction and how best to support their loved one in recovery.

The best drug rehab programs strongly encourage family involvement throughout treatment. Although there may be a short “blackout” period when the patient is not in contact with family members during the first few days of treatment, the program should offer family therapy, visitation, and a family program through the rest of the patient’s stay.

Getting straight answers to these questions will simplify your life at a time when life is anything but simple. With this important decision out of the way, you and your loved one will have taken the first step in the incredible transformation that happens during drug rehab.