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Do I need residential rehab to get sober?

A decision to enter residential rehab must be made based on experience with efforts to get sober in the past and current life stressors and risk factors for ongoing use and/or relapse. It is possible to get sober and stay sober outside of residential rehab if one has the right environment, support and treatment. It is also important to consider that if someone has not been able to maintain sobriety, spending some extended time in a sober environment with the right support may make all the difference.

The American Society of Addiction Medicine has established six dimensions of placement criteria that help guide determining what levels of care someone may need. These include,

  1. Past and current experience with substance use and withdrawal;
  2. Physical health history and current state;
  3. Thoughts, emotions and mental health needs and behavioral health history;
  4. Readiness and interest in changing;
  5. Risk of relapse or continued use;
  6. Healthiness of recovery environment and social support

The more problem areas one may have with each of these elements, the more structured support they may need to find success in sobriety. These should be reviewed with a healthcare professional. As stabilization is met with the above areas individuals should more successfully transition from an environment of more structured support to one of less structured support.

Are there different kinds of residential rehab?

Yes, residential rehab varies largely based on access to therapy and medical support. A good recovery environment is one that has access to daily therapy both structured and unstructured as well as access to medical providers. These services don’t need to be provided onsite but that is preferable. Structured therapy will focus on emotional process work; education around drug effects on the body and patterns of thinking; and learning and developing coping skills. Emotional challenges and triggers may come up that warrant immediate access to a counselor or therapist to work through. You don’t want to have to wait to the next day or the next van ride to the clinic. That is even more important in the context of urgent medical need.

Residential rehab also varies based on what therapy is being provided. Some may focus heavily on 12-step while others eschew 12-step models. There is no perfect therapy for everyone and no singular path to sobriety. Having access to a variety of competent therapists and supportive people is critical to finding what will work for you.

Do I need medicine to get sober?

A decision to take medicine should be made between you and your doctor. Considerations to take medicine should be based on withdrawal risk or symptoms; existing behavioral health needs; physical health problems; and cravings and risk for relapse.

Some withdrawal symptoms may go on for months. This is known as post-acute withdrawal. These often mimic mood and anxiety issues. Individuals may experience depression, jumpiness, insomnia, agitation, anxiety, poor focus and concentration among other things.

Taking medicine should be based on the analysis whether doing so is going to help or hinder the process of sobriety. If you and your doctor feel medicine is going to help your path to sobriety, they should be considered. It should also be noted that medicine may help relieve symptoms to make focusing on therapy more possible. Medicine should be ultimately viewed as a means to an end not the end itself.

How long do I need to be in rehab?

Research seems to show the longer the duration in rehab, the more successful rehab can be. This does not necessarily mean being in residential rehab for an extended period of time. That may be necessary if sobriety cannot otherwise be achieved and sustained. If sobriety can be achieved it should be possible to move out of higher structured environments to less structured ones. As you develop skills and confidence along with a supportive home environment the odds of successful sustained sobriety go up.

How long do I need to be engaged in therapy for addiction?

There should be regular engagement in focused community and professional support for an extended period of time. It would be wise to consider 18 months to 2 years as an appropriate timeline for weekly attendance to sober living goals. That would involve going to individual therapy, group therapy, 12-step, Smart Recovery, or something similar, or a combination of these.

Life comes in cycles of days, weeks, months and years. Substance use has likely been a part of daily life for a long time. As it has been used to cope with life stressors, these may cycle in months and years. It would be well advised to be engaged in support for ongoing growth as well as support in times when these cycles of life stress become more intense. As these may come when not expected, you could be thankful to have support to lean on during those times of need.

Are some therapies better than others?

Yes and no. Bottom line is you have to find what works for you. The best place to start is with well adopted modalities that have been studied for many years. These forms of therapy have stood the test of time and research. Basically, they work. Again, this may not hold true for every individual out there. You can find the right support.

Therapy and the provider delivering it should be ethically sound. The provider should have formal training in the modality of therapy used. Do not hesitate to ask these things of the provider.

The therapy should be sustainable. This means the requirements of the therapy to be effective for you must be something you can attend to. If the therapy requires three visits a week and you can only do one, it may not work. If therapy requires you to complete homework and you can’t get it done, the therapy may not be effective.

In the end, rapport is known to account for up to 60% of the effectiveness of therapy. Is there a human connection? Do you feel understood, supported and validated? These are for you as the client to know. If you don’t feel the support and connection is there bring it up. That may be a great opportunity for dialogue and development of that connection or an opportunity to have help in finding another therapist based on what you feel your needs are.

What do I do if I relapse?

If you relapse re-engage treatment as quickly as you can. Addiction may viewed like a chronic disease. People with heart disease, diabetes and other chronic illnesses have relapses too. They show up differently and have different consequences. Data shows these relapses occur at similar frequencies as drug and alcohol relapses.

Do I need to attend a 12-step program?

You do not need to attend a 12-step program to become sober or stay sober. That said, they can be very valuable and have helped millions of people. if you have not explored one, you should. There are all kinds of meetings and most likely very close to home. Exploring this, you may find a meaningful community you want to come back to.

What is inpatient treatment?

Inpatient treatment would be considered the highest level of care where medical concerns are of the highest priority. Inpatient care would be a hospital setting where there is constant medical monitoring. This may be warranted in states of severe drug or alcohol withdrawal. It may also be due to unstable physical health such as infection, liver disease, or cardiac problems. Inpatient care may also be needed for severe behavioral health problems, suicidality or intoxication. Treatment will generally last from days to weeks. Under most circumstances, there is not a lot of therapy done during inpatient treatment.

What is a partial hospital program (PHP)?

A partial hospital program may be a lot like a residential program without the overnight stay. This may be for someone who is not able to engage in daily work, school or family life without impairment but can tolerate unsupervised time overnight. Generally a program engages in daily service 8-12 hours each weekday. This would include therapy, activities and meals Monday through Friday. You would go home or stay somewhere else in the evening and weekend. A PHP may last 4-6 weeks or more based on need. Much of the programming would include elements similar to a residential treatment program.

What is an intensive outpatient program (IOP)?

Intensive outpatient program is generally three hours of group therapy three days a week. This is generally consistent days and times. Some programs may have a variety of times to choose to work with your schedule. An IOP program is generally structured for 12 weeks. This may be extended or repeated based on clinical need. The focus of groups is generally emotional processing; education around addiction; and building coping skills for stress and cravings.

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