Is it possible Addiction Rehab is a problem itself?
As our communities begin to have more candid conversations about the opioid epidemic sweeping our nation, recovering addicts are speaking openly about the complex barriers to addiction rehab or other quality recovery programs. Recently, one of our staff at Surfside had a conversation with a young addict in their early twenties who has shuffled in and out of treatment for the past 3-4 years. Out of respect for his privacy, we’ll call him “Kyle.” Kyle recently returned to inpatient treatment after yet another painful relapse, which began with a few drinks and quickly escalated to snorting heroin again. He expressed frustration with a confusing pattern that has emerged in each of his relapses: he befriends a peer in treatment, convinced that they are on a path to recovery together, during the hot-potato discharge process he ends up in a typical peer-run sober house and eventually (days, weeks, months, sometimes even a year later) they decide to have a few drinks. A few drinks turns into a drive to the local cop spot and within days they’re getting high together.
One of the adages we hear repeatedly in treatment and recovery communities is the need to change “People, places and things.” But what happens when addiction rehab or the local peer-run sober house becomes part of the revolving door and the person you just got high with is sitting next to you a week later in group? As a person attempting to recover after a heartbreaking relapse, is this person a “drinking buddy” or a “friend in recovery?” When Kyle and his friends return to rehab feeling defeated, they become convinced that this time they’re desperate to stay clean and support one another. But utilizing the tools available in a treatment or addiction rehab center while surrounded by “using buddies” becomes more challenging every time the addict returns to the rehab. As professionals in the treatment field, we cannot boast about our dedication to recovery while failing to provide structured aftercare — statistics show that this will only land the addict back in treatment, in jail, or in a morgue. When we acknowledge the complicated nature of peer relationships in treatment, we understand it’s simply not enough to bus addicts to a 12-step meeting, only to hustle them out when the meeting is over, depriving them of the opportunity to expand their network beyond the four walls of treatment.
Florida, Arizona and California became problematic when a once decent model, partial care or partial hospitalization program (PHP) with housing, because it was easy to cycle people in and out. Many times the owners and operators have a network of sober living that they automatically refer to once the clients “complete treatment”. It becomes the standard discharge protocol. The sober living is rarely supervised or staffed. Once the addict uses, usually with people they met in the “treatment” program they are quickly put back in the partial care program.
Another Surfside staff member recently gave a presentation at another addiction rehab. During the presentation, one of the clients interrupted to say, “I want to come with you. Right now. I have the money.” Clinicians in the room encouraged him to “relax” because he needed to stay in treatment for another few weeks. This 23-year old man has bounced in and out of treatment over five times. During the discharge process, different programs do not engage the family and simply send the recovering addict to one of the local peer-run sober houses in the closest town. They often fail to engage the family, believing that by providing treatment, he’ll get clean and the family will rebuild itself – right? He makes it a few weeks or months in the unstructured environment only to fall in with the wrong crowd. Then he gets high.
More recently, a young women out of Pennsylvania was convicted of a horrible crime (see link). To make a long story short, she and another girl (we can call Jane) met in addiction rehab, stayed in touch and used together when they left. “Jane” asked her for heroin, she got it for her, the girls used together. “Jane” overdosed and died. The girl who was convicted was 18 at the time. She was barely an adult. In her heroin induced high, she panicked and covered up the drug use and left without calling the for help. The conviction will lead to jail time for the woman.
This case is heartbreaking. Can we look at this scenario and confidently say that justice was served? As a professional in the addiction treatment field for the last 15 years, I’ve watched drastic changes take place. I review this case and ask myself how we as healthcare professions failed to do our part. What was the initial discharge plan at the original treatment center? Were these young women simply sent home? Was education provided to the families? Were the individuals provided contacts and legitimate resources? Or was this the standard, “Ok, now it’s time to leave, insurance is up.”
Recovery is process that requires a concerted effort from both the addict and the professional community. We can not expect addicts and alcoholics that are powerless over substances to be able to manage their own lives the day they leave a treatment center. As we start a nationwide discussion about the addiction epidemic, it’s important to hear the voices of people like Kyle, who has a personal experience that is reflective of many young people struggling to get clean. In our structured sober living, we understand that the addict is an expert at their own experience and will use these challenges to fuel the work completed in our 4-phase life development program. By integrating residents with recovery communities through 12-step immersion and a adventure-based activities (like paintball or hiking) or in-house literature studies, residents build a broad network of men with time-tested experience. It’s critical that recovery is associated with hope and passion, not fear of failure. It’s time for us to stop using the revolving door. We need to change the face of addiction recovery, treatment and sober living.
If you are a provider or a family member, please ask yourself one question. “Am I doing/suggesting/referring someone to the same thing over and over expecting different results?”