What Happens in Rehab?
Rehab facilities are often the first step to getting clean or sober. By providing a combination of medical and psychological care, skills development, and isolation from drugs and drug use, treatment centers can provide a gateway to allow substance abusers to find themselves so that they can learn how to stay clean.
However, choosing to attend rehab is a big step. If you or a loved one is suffering from a substance use disorder, you are probably wondering what happens in rehab, how does it work, and what should you expect.
While every rehabilitation center is different and you will receive different care depending on the program and therapy you choose, most follow a similar treatment structure.
What Happens in Rehab Before Treatment
In most cases, you will follow a specific intake structure designed to give your counselor, therapist, and doctor’s the information they need to treat you appropriately.
What to Expect in Rehab
While every patient moves through the stages of addiction recovery at their own pace, your rehabilitation treatment will likely move through several stages which include different types of treatment and different goals or focuses. Knowing what to expect in rehab can help you to plan, make the right decisions for your needs, and choose whether to attend an inpatient or outpatient program.
Pharmacotherapy and medication management are offered in almost all rehabilitation programs. Here, your physician will administer medication to target specific substance use disorders, to prevent withdrawal symptoms and even to block the effects of a substance should you take it. Detox medication such as buprenorphine (Subutex), Disulfiram (Antabuse), Naltrexone (Revia), benzodiazepines (diazepam, chlordiazepoxide), anticonvulsants (Depakote, Tegretol), anti nausea medication, and antidepressants are used to treat patients detoxing from substances.
Some, like buprenorphine work to block the effects of substance abuse, so that even if you slip up and abuse, you do not get the high from it. Most are used to reduce withdrawal symptoms down to a safe level or to reduce them entirely, so that you can withdraw with minimal personal discomfort, without life threatening symptoms like seizures, or in an outpatient setting.
In inpatient residential care, you are given full medical attention with full access to a physician, who will monitor your vitals, withdrawal symptoms, and administer medication such as methadone or Suboxone to help manage your withdrawal symptoms. Inpatient detox is typically held in a medical facility or in the clinic’s in-house medical detox center. This detox lasts up to about 14 days to ensure that drugs or alcohol are fully out of your system.
Intensive outpatient programs (IOP) are designed to help you through detox with minimal supervision, meaning that they are only suitable for patients with mild to moderate withdrawal symptoms. Here, you typically visit a physician for 15-20 minute checkups once per day and detox typically lasts about 4-7 days. In most cases, your initial physical assessment will include a Clinical Institute Withdrawal Assessment, which will help your physician or counselor to determine if you qualify for ambulatory detox or if you must be referred to inpatient care to withdraw safely.
This is often considered to be the most difficult period of recovery, because you must overcome the strongest cravings, experience withdrawal symptoms, and begin to learn coping skills that will help you to remain clean or sober. After detox, you will begin to work with a therapist or trained addiction counselor who will help you to begin to overcome cravings and triggers, so that you can learn the tools to remain clean or sober after you leave.
Early abstinence typically involves moving through detox, beginning to learn new life skills, and learning to see your addiction in context as something that is treatable.
Understanding the effects of drugs and alcohol on the brain and body
Learning to see substance use disorder in context with other health and behavioral problems
Understanding the process of withdrawal
Learning strategies for fighting and ignoring cravings and triggers
Identifying high-risk situations or triggers for substance abuse
Coping with cravings and triggers
Understanding how prescription and over-the-counter medication affects your sobriety
Understanding and using support and mutual-help groups such as 12-step
Toxicology screening to ensure that you are not using
Your maintaining abstinence stage will typically include skills development, coping skills, stress management, anger management, relaxation, self efficiency, nutrition, exercise, and other tools which you can use to build a healthy lifestyle.
In addition to continuing therapy you can expect to learn:
Stress management skills
Advanced handling triggers
Responding to slips and substance use
Structuring your time
Handling negative emotions
Living with enablers
Managing a family dynamic
Understanding healthy vs. Unhealthy relationships
Daily living skills (money management, housing, legal assistance, etc.)
Parenting (where applicable)
Stress management and life balance
Fitness and health
Discharge is typically 30-90 days after intake, but may extend as long as 18 months after intake. This is when you leave rehab completely and move into an aftercare program or sober house, seek out group support, and take up the responsibility of maintaining your substance free life on your own.
An aftercare plan designed around your life to help you decide what to do in specific situations. For example, you may have specific strategies, people to contact, people to avoid, things to do or take care of, and specific strategies for coping in case of triggers.
A sober living home or sober home is a bridge between rehab and regular life, where you can live in a group home under supervised care. This can help you to adjust to living outside of rehab, while having someone available to help monitor you, provide accountability, and ensure that you do not start using again.
An alumni program allows you to stay in touch with rehabilitation and other recovering addicts after discharge from a residential treatment program. Alumni programs help you to connect with others who have recovered, work to offer continued therapy, and provide encouragement and accountability through progress checks and follow ups.
Many residential treatment centers will require you to have remained sober outside of treatment for a certain amount of time (months to years) before enrolling in an alumni program. Others enroll newly recovered individuals to boost their contact with indivdiuals who have remained clean or sober for a long period of time. Alumni programs offer sober events, group meetings and therapy, support networks, and other services, but exact functions vary from group to group.
Ongoing recovery can include phone support, therapy, network assistance, and other aid depending on the rehabilitation program. In most cases, ongoing recovery includes support for 1 year or longer, allowing you to call to get help, to talk through cravings, and to see a therapist or addiction consultant as needed.
Most aftercare will include an introduction to a group therapy that meets your personal goals and needs. This is important because it allows you to move away from your rehabilitation clinic and back into your life, without dropping the support and accountability that comes with it. Group meetings can help you to stay clean or sober by providing motivation, accountability, and like-minded friends who will listen and understand or help you with cravings.
There are many types of group therapy, and your rehabilitation center may offer their own, or they may connect you with a compatible program in your area.
How Does Rehab Work
A rehabilitation program works by giving you a structured plan that will help you to detox, undergo behavioral therapy, and learn skills to help you to stay clean or sober. Depending on the facility, this may include one or more of a variety of common treatment models and therapies.
Cognitive Behavioral Therapy is a comprehensive treatment strategy designed to tackle both cognitive and behavioral problems in addiction. The treatment is divided into two stages: functional analysis and skills training. These allow you to first determine which areas of behavior and thinking cause problems and then work to fix them. CBT is evidence based and one of the most popular addiction therapies, because it is proven to reduce both short and long-term substance use. CBT includes individual therapy, group therapy, family therapy, and skills training.
Dialectical Behavior Therapy is a cognitive behavioral treatment designed to help patients recognize dialectical behavior, extremes of emotions, and addiction. DBT is unique in that it creates individual prioritization schedules for the patient, to attempt to tackle the most pressing issues first. DBT typically helps you deal with life threatening behavior, resistance to therapy, to improve your quality of life, and then to build skills and coping mechanisms, in that order. DBT is comparable to CBT in effectiveness, and includes individual therapy, coaching, group therapy, and phone coaching.
EMDR combines cognitive behavioral therapy with rapid eye movement treatment offering patients a combination of therapies. While somewhat controversial, many patients experience success with EMDR through the focus on building strong patient-therapist relationships, cognitive behavioral therapy, and thorough follow-up process for patients to ensure their success. EMDR includes primarily individual therapy divided into 8 phases of progress, moving you from addicted and learning about your addiction to processing emotions and behavior patterns, to learning skills and techniques to improve your life.
Many rehabilitation centers work using a 12-step model. Because 74% of all treatment centers offer some form of the 12-step model, it is highly likely to be available in any treatment center you choose. The premise of the 12-step model is that your group supports each other on your way towards getting clean, while learning skills, accepting a higher power, and building tools to have a happy and sober life.
Every rehab will include some form of skills development which will often include nutrition, stress management, anger management, and life skills. These will vary depending on the treatment center.
Group therapy is an intrinsic element of nearly any rehabilitation program. Here, you will receive skills training, go over emotional and behavioral problems, discuss problems as a group, and work together to overcome obstacles. Group therapy allows you to be challenged and inspired by your peers who have experiences like your own, which can be crucial in helping you to overcome barriers to your recovery.
Most rehabilitation centers offer a variety of complementary or alternative therapies to supplement primary therapy. These can be evidence-based but may not be, and may be elective or mandatory with the program depending on your treatment plan or your personal preference.
Nutrition therapy is a mandatory element of many rehabilitation programs, because it is a required element of complete rehabilitation. In nutrition therapy, you will receive a healthy diet, learn to care for yourself and eat so that your nutritional needs are met after leaving rehab, and possibly given intensive supplements to correct nutrition deficits while in therapy.
A proper nutrition schedule and plan is crucial to complete recovery because you need it to build your health, to completely recover from addiction, to fight cravings, and to reduce the damage caused by substance abuse. Because nutritional deficiencies can cause cravings, crashes similar to drug cravings, health problems, and depression, learning to manage and maintain a healthy diet enables you to recovery.
Exercise is an increasingly mandatory element of rehabilitation because it helps your brain to recover so that you can be healthy. Light to moderate exercise has been shown to boost the mood, reduce cravings, and give you more energy, so that you feel better and are more prepared for the day.
Many rehabilitation centers offer programs designed to help you build exercise habits, learn safe and effective exercise options, and to simply enjoy working out with yoga, dance, aerobics, horseback riding, and other activities.
Mindfulness is a science-based complementary treatment that can help you to reduce stress, manage your emotions, manage cravings, and improve behavior patterns to reduce substance use or abuse. While not effective on its own, studies show that continued use of mindfulness greatly reduces the chances of relapse.
Equine therapy or horse therapy involves caring for, interacting with, and training with horses under the supervision of a mental health expert or counselor. This treatment is used to build responsibility, emotional awareness, responsibility, independence, impulse control, social responsibility, and self-awareness, all of which can help you to stay clean or sober.
Acupuncture is typically offered to help calm the body, stimulate blood flow, and stimulate nerves. In some cases, acupuncture may be part of a spiritual treatment as well, but not always. Acupuncture has been shown to stimulate neurotransmitter production, which can help relaxation and boosting the mood.
Music & Art Therapy
Art and music therapy works to give patients an outlet where they can relax, learn new skills, and focus on something outside of themselves. Like equine therapy, music and art therapy works to build self reliance, responsibility, habits, and impulse control, which can help you in other areas of recovery.
What’s Important in Rehab
Choosing a good rehab center means selecting a facility that can offer the kind of care and treatment that will help you to get clean or sober, support you as you work to improve yourself, and offer follow up care to help you adjust to living outside of rehab. The center you choose, what they offer, and how they approach treatment affects what happens in rehab, so it is crucial that you choose a clinic that can offer everything you need to recover.
Your Case Manager
Your case manager or counselor will control your experience at rehab. It is crucial that you be able to work with a quality and qualified case manager who cares about you and your well being.
A good rehab center will provide qualified and trained staff, licensed nurses, and licensed therapists or psychologists. Rehabilitation facilities vary a great deal in quality, with some offering little more than glorified hotel service so it is important that you seek out a facility with a fully qualified staff who can offer you the in depth medical and psychological care that you need.
Your therapist or counselor should be fully qualified, but should also be able to build a relationship with you. Treating patients with addiction often means looking past the addiction to find the roots of that addiction, including emotional and behavioral problems, and your therapist must be willing to do the work to achieve that. This necessitates treating you as a person with problems not as an addict, so that the therapist can treat you and not just your addiction.
Structured Plans for Recovery
A good rehab center should offer structured plans for therapy, treatment, activities, and group activities, so that you know what to do and why. Planning your recovery ensures that every aspect of your recovery is accounted for, including nutrition, exercise, behavioral therapy, etc. While structured plans are important, your facility should also work to update treatment plans based on new information, so that you always receive the most relevant treatment.
Inpatient rehab is isolated and prevents you from seeking entertainment outside of the facility. It is important that your facility provide a variety of activities and entertainment options. While basic rehab centers will provide table games like ping pong, this can become boring and demotivating over a period of 30-90 days. A quality rehab facility will offer a wide variety of entertainment such as a swimming pool, ball-based sports like tennis or baseball, hiking, horseback riding, water sports, or even surfing if you are attending near an ocean.
Paying attention to amenities will allow you to choose a facility that stimulates your imagination, allows you to inspire and motivate yourself, and makes it easy for you to find something healthy to do. Activities like swimming, biking, or playing baseball relieve stress, provide an outlet from therapy, and can help you to learn to enjoy yourself without substances.
Inpatient care involves a very structured and organized day, which plans your activities, progress, and treatment throughout the day. While much of the day is planned, it is set at a pace which reduces stress while allowing you time to relax, interact with other patients, and take part in voluntary activities or entertainment. While specific amenities and opportunities will vary depending on the treatment center, you can expect a typical day in rehab to follow this pattern:
Intensive Outpatient Program
An intensive outpatient program is significantly more relaxed and less structured than an inpatient program because it is designed to allow you to attend to work and other responsibilities throughout the program.
You live in your own home or a sober living home, set your own hours, go to work, take care of family, or otherwise handle responsibilities. In most intensive programs, you can expect to attend therapy and group sessions for 3-6 hours per day, during which you will experience therapy, skills training, group therapy, and sometimes complementary therapies. Educational sessions are typically 1-2 hours each, family therapy is about the same, and CBT or DBT is typically 1.5-3 hours in length.
In some cases, you may be able to attend morning therapy sessions.
Evening sessions are typically held after 6 PM, sometimes after 8PM, allowing you to leave your workplace and drive to rehab.
Many intensive outpatient programs begin with daily meetings of 3-6 hours, but decrease in intensity after the first 30-90 days.
Understanding what happens in rehab, how it works, and what to expect can help you to make the best decision, choose a treatment model that works for you, and even help you to come to terms with the decision to go. Hopefully this information is enough to guide you towards a decision.
If you or a loved one is suffering from a substance use disorder, it is crucial that you get help. A rehabilitation center can help you to detox and build the tools you need to stay clean or sober so that you get your life back.