This picture has nothing to do with rehab; it's a seaside resort in Southern China. There are rehabs that look like this, though. On the other end of the spectrum, I once attended a program in Upstate New York that was housed in a former tuberculosis sanitarium - the dental "truck" would pull up to what used to be the crematorium.
"Throughout human history," where to go to inpatient rehab has been one of the most important decisions of one's life. In fact, given the mortality rate of addiction and the fact that even the “top” programs have unimpressive to abysmal success rates, it may have life-or-death significance. Once you are there, you are essentially stuck, so choosing wisely pays dividends.
“I’ve been to six rehabs, and this one is the best, by far!” Is the kind of flex that you never, ever want your life to produce.
*This post is intended for people whose lives have been disrupted to such an extent by addiction that they are essentially ready to begin a new life upon discharge from inpatient. If you are returning to your previous house / job / relationship after 30 days or fewer of inpatient, much of this advice is not going to apply to you.
Insurance coverage is a deciding factor, I’m well aware, but scholarships are an under-considered option. If you find a program that sounds perfect for you, write them an email explaining why you believe that they can help you; these programs are always looking for success stories and future staff members.
Okay; here we go:
1. Find a rehab that offers multimodal treatment. You might think that you want 12-Step-based care, religiously informed treatment, or an experience heavy in one-on-one therapeutic work based on CBT, REBT, DBT, or other approaches (see chart below). The problem is that you won’t really know what is working for you this time until you’re there. Strong programs differentiate and provide options. For my overview of common therapeutic models, click here).
Borrowed from We Level Up. If you think that traumatic experiences play an especially important role in your continued use, you might want to look into programs that offer Eye Movement Desensitization and Reprocessing (EMDR) therapy; I have known a couple of people who swear by this, including a state trooper who investigated child homicides for most of his career.
2. Look for a rehab that addresses the mind-body connection by providing time for physical exercise every single day. Yoga, running / walking, swimming, horseback riding, group challenges, sports, whatever floats your boat. Insomnia is one of the near-universal complaints in inpatient treatment, and exercise is Nature's remedy for it.
Try to find a facility that will let you out for a group excursion at least once or twice because watching middle-aged alcoholics go full-on The Fugitive to sneak away for a drink is really something to behold.
3. Discuss aftercare in detail. Aftercare refers to the step-down treatment that you receive after inpatient, which often includes time in a half-way or three-quarter house, outpatient treatment at different levels of intensity, and participation in other recovery supports.
Because behavior can really only begin to change over the 30 days or fewer that you will spend in inpatient treatment, your chances of success are strongly dependent on what happens after that initial period.
If you get a generic “We work with the patient to find a program in their area that will accept them…” kind of response, beware. I would want to hear something along the lines of “We place most of our patients at X and Y Sober Living programs, which provide outpatient in-house [or send their residents to Z Program]; the typical length of stay is six months to a year, and we have a strong network of graduates who remain in the area long-term.”
This is possible to find. The most effective program that I attended was in a bougie county in Florida known for being a rehab destination, and the strength of the young recovery there – especially of opioid addicts who were not on methadone or buprenorphine – blew my mind. Many of my peers remained in the area for years, and at least a dozen of them ended up working in the field of recovery.
My strong advice is and always will be to avoid returning to your addictive “home base” if you have the option not to. Let’s be honest – if you’ve gotten to this point, your people could use a break from you anyway. Also, your brain will find it much easier to form new, recovery-friendly connections and ignore old, destructive cognitive / emotional patterns if you can physically remove it to a new area without the overlay of a complicated past.
4. Look into “alternative” treatments if the standard addiction treatment model hasn't worked for you. If you have tried “standard” inpatient and found that it didn’t stick, don’t give up. I know two people who did ibogaine treatment in Mexico; one achieved remarkable recovery, and one went right back to addiction. Another attended a “spiritual growth retreat” in Thailand that wasn’t focused on addiction at all, and what do you know? She beat a decade-long addiction without placing primary emphasis on that as her objective.
Addicts are a diverse population. We began using for many reasons; we continued using for many reasons; we were unable to stop using for many reasons. Whereas chronic depression or anxiety might drive someone else’s addiction, an unhealthy relationship at the center of my life or lack of a spiritual foundation might keep pulling me back. Good clinicians recognize this and emphasize the differences as much as the similarities because it is often the differences that provide the footholds for change.
5. Find a program that sets aside time for introspection. This is a personal priority. It might sound obvious, but this is my biggest pet peeve for both inpatient and outpatient - that some programs provide so little time in which to process, internalize, and implement all of the insight and therapeutic headway that their patients are making.
In particular, as you might guess, I am a fan of journaling. I find treatment vastly more effective when I have time to process growth through writing.
6. Ask about how the program encourages creative expression. This might sound like a luxury (or at least a secondary consideration), but my experiences in recovery have taught me otherwise.
I have little to no (visual) artistic talent, but in treatment, I am the High King of Mandalas. There’s something about making beautiful (or horrifying) art that is utterly absorptive and that nourishes a part of the soul that is dampened or depleted by addiction (that’s the best way that I can phrase that). It’s also an exciting feeling to have other people appreciate your work and to take part in creating with them. Rehab is the time to pick up a creative hobby as an adult. Given the circumstances and the crowd, no one is going to shame you for your lack of talent.
7. If you’re an opioid addict, find a program that isn’t going to railroad you onto buprenorphine or methadone. If you really need these medications, you can always start them shortly before or after discharge. However, if you’re going inpatient, it will always be my advice to first try recovery without the crutches (that often seem to shapeshift into handcuffs somewhere along the line). After you have experienced “happiness with a half-life,” as I call the misery of severe opioid addiction, being free of that “how long until I go into withdrawal?” thought-reflex is the greatest gift.
8. Do a quick Google search of each program name once you have a shortlist of contenders. In particular, if you see lawsuits and records of citations by state addiction treatment regulators (OASAS is the pertinent group in New York State), be careful.
9. Don’t worry too much about visitation and phone privileges. You will be encouraged to keep contact with outside parties to a minimum, and this is advice that you should heed. Inpatient should be a “hard reset”; many things about your previous life weren’t working for you, and you need time and physical distance to sort out what needs to be changed.
A final note of caution: There are some less-than-savory actors in the addiction treatment sector. Any offer of a program slot and a plane ticket "right now, today only," should be considered with the greatest skepticism. Some of the shadier treatment franchises spend significant sums of money training customer service reps to say the right things, and this can make it hard to differentiate reality from marketing hype.
This is where the Internet is your friend. Reach out on recovery forums and try to find graduates of the programs that you are considering. The rule about "too good to be true" applies here; I would expect to compromise and manage my expectations in finding a program.
I’d love for my readers to share experiences and advice below!
Happy Easter to everyone who is considering the ultimate rebirth for themselves or a loved one!
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