As we saw in the last blog post, detox and rehab fall under ASAM’s level 4 of care. Level 4 (residential) is the highest or most intensive level of care, with Level 1 ‘outpatient counselling’ being the lowest. Many rehabs incorporate detox facilities on site and we explored what sort of drugs require detox and which require a ‘stabilization’ period. But what happens after detox and stabilization?
Detox and stabilization might take anything from 3 days to 2 weeks, dependent on the drug. After this stage, clients in rehab typically enter the psycho-social phase of treatment. This incorporates all the elements of rehab that people will be familiar with such as group therapy, one on one counselling and various adjunctive therapies such as mindfulness meditation, somatic experiencing, trauma-release exercise, auricular acupuncture or even art therapy.
WHAT GOES ON IN A REHAB?
In well run rehabs, there will be a treatment pathway, which whilst individualized to a degree, will seek to cover basic aspects of recovery for every client. Most centres will ask clients to make a timeline of their addictive behaviour or do written assignments which are designed to describe their addiction to others, both counsellors and peers in the community. Ordinarily this will be presented in a group format to allow the client the chance to ‘uncover’ their addiction with people who are suffering from the same compulsive behaviours. It gives us the chance to be challenged if we are not seeing all of the consequences of our behaviours, but also gives us a chance to gain identification with our peers.
Other typical areas of group discussion and therapy might be;
- Building healthy boundaries with others
- Denial of our condition and reservations about recovery
- How to regulate dysfunctional emotional states
- Family issues and dynamics
PHASE ONE OF TREATMENT – DEALING WITH THE ADDICTION
Typically, phase one of treatment (post-detox) might last 2-4 weeks, and concentrate on the details of the actual addiction. What drugs did we use … how much, where, with who … do we think we can stop … costs and consequences, and so on. This may seem morbid but the general idea is to bring the shame of the addictive behaviour into the light, and transform it by way of honesty and acceptance.
PHASE TWO OF TREATMENT – DEALING WITH THE EMOTIONS
Phase two of treatment (typically the second month) will focus more on ways of relating to others and ways to manage our emotions. We might describe our relationships at home to our peer group and take feedback on how they manage their relationships. We might explore our anger or fears and anxieties and learn CBT techniques or other ways of grounding ourselves, in order that we can learn to manage these emotional states which may cause us to relapse later.
When it comes to leaving treatment there should be a discharge plan in place for when you get home. The rehab may or may not provide aftercare as a service, but you should certainly be seeking some form of support IN ADVANCE of returning home. For some people this may be as simple as going to 12 step meetings every day and seeing a therapist in your home town once a week. But for some people, two or three months in an intensive residential setting followed by an immediate return home to work and other responsibilities, is a case of ‘too much too soon’. When this happens, sober living facilities or sober homes are a perfect setting for ‘extended care’ or what’s also known as ‘transitional living’.
SOBER LIVING / SOBER HOUSE
Sober living facilities or sober houses are effectively a level 3 care setting. They are one step down from rehab. They vary in intensity, but most are significantly less restricting than being in a primary treatment setting. For a start, you can move around at will, once you have completed the tasks for the day. Many sober homes at the intensive end of the scale will provide morning focus groups, and weekly counselling. Most will also insist on a certain amount of attendance at 12 step meetings or other recovery support groups.
Many however, are basically low level support ‘homes’ where drug use and alcohol consumption is not allowed, and where you may be randomly drug tested, and where a minimal level of supervision is applied.
At Alpha Sober Living for example, we are definitely at the more intense end of the scale. We begin our day with optional Qi Gong or strength training before proceeding to a mandatory group therapy where we usually concentrate on current events and our client’s current emotional status. Occasionally we also incorporate psycho-education, which is at a slightly higher level than it would be in rehab. For example, we might breakdown technical books on trauma or addiction biology, or learn about the history of the Buddhist meditation tradition.
In the afternoons clients can access one to one counselling, or other body based therapies like yoga and meditation, and do sports which are social in nature and intensive in their fitness effect such as Brazilian Jiu Jitsu and Muay Thai.
But this is just one approach. There are many out there.