Addiction can cost up to $200 per day.
What would you do with that money if treatment was affordable? Find out if your insurance covers treatment now!
I was introduced to the “rules of rehab” by a client at a high-end, non 12-step addiction treatment program, one that encourages client autonomy and doesn’t have a lot of rules. (It was one of the first treatment programs I visited while researching Inside Rehab.) In the past, he’d attended very different facilities, including one he described as a “lock-down” rehab.
As he described it, “You couldn’t leave the premises without an escort, and you had to sign in and out for meals. I thought the next thing they would do is shave my head and de-louse me! It was an awful feeling of confinement and debasement.” He also was denied access to his cell phone as well as reading materials that were not 12-step oriented.
Since these and other rules that are unheard of when treating other conditions or diseases seem to be fairly common at addiction rehabs, I decided to run some that I came across by experts in the field. Overall, Mark Willenbring, M.D., founder of St. Paul, Minnesota’s Alltyr addiction treatment clinic and former director of the Division of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism, said, “The rules are a throwback for the most part, and are a mix of pragmatic needs and guidelines for a spiritual retreat. Most 12-step rehabs are authoritarian and intrusive.”
Following are some specific rules of rehab that I encountered, along with commentary by experts in the industry:
At Practical Recovery’s non 12-step rehab facilities in San Diego, in some cases, restrictions may be needed to lower the chance that communicating through them will result in drugs being delivered to the rehab. However, their philosophy is to start from a position of client trust and to not use one-size-fits-all rules. Founder and director Tom Horvath, Ph.D. said that cell phones and laptops are allowed unless there’s a problem. Dr. Horvath added that for only a small number of people, “A complete transition into a new world is needed, to include no TV, computers, or cell phones.”
Avoiding triggers while in a rehab facility is one of the stupidest ideas of all. If you can’t practice while inside the ‘program,’ then you’ll be flooded with triggers after discharge but will have had no practice to develop skills.-Dr. Mark Willenbring
At Minnesota Alternatives, an outpatient facility specializing in treating people with substance use and mental health disorders, founder and director Paula DeSanto, MS, MSW said they don’t do a lot of urine testing because that’s not part of their “welcoming and accepting” philosophy. If clients feel safe to share about their substance use, there is less need for UA’s. “We don’t need to ‘catch them’ because they are honestly reporting. We generally test if a client wants one done to increase his or her own accountability – for instance, if a tough weekend is anticipated.”
Creating such artificial boundaries reflects rehabs’ belief that sex and relationships are somehow inherently unhealthy and dangerous.-Dr. David LeyPsychologist David Ley, Ph.D., Executive Director of New Mexico Solutions and author of The Myth of Sex Addiction stressed, “Blanket guidelines about male/female relationships are too one-size-fits-all.” His advice for rehabs? “Services should better prepare patients for being on their own by mimicking the real world, which obviously doesn’t separate by gender or prohibit relationships. Creating such artificial boundaries reflects rehabs’ belief that sex and relationships are somehow inherently unhealthy and dangerous. In individualized, affirmative, and recovery-oriented treatment that uses a more case-by-case approach, blanket prohibitions are outdated, foolish, and likely to impede long-term recovery.”
What about couples who want to attend rehab together, as did one couple I interviewed? One of them shared, “There were so many times we wanted to go places to get clean, but time would go by and the moments would pass because they [rehabs] wouldn’t take us as a couple. And we were willing to pay whatever it cost.” After they finally found a place willing to work with both of them, the woman in the couple told me, “Getting sober together was what worked.” Barbara McCrady, Ph.D., who studies the role of couples therapy in addiction treatment and also directs the Center on Alcoholism, Substance Abuse, and Addictions at the University of New Mexico said, “There are not scientific data backing the notion that couples should be separated in treatment, so flexible decision-making rather than a blanket rule makes the most sense.”
In the end, “Rules are conflict generating – they give providers all kinds of reasons to be critical, and provide convenient reasons to kick people out of treatment,” maintains Paula DeSanto. She added, “Rules disempower clients, tying into the idea of powerlessness – not only are you powerless over your substance use disorder, you’re powerless in our treatment setting. Finally, rules send the message to clients that they don’t need to think. How do rigid settings prepare and teach people to learn to manage their lives?”
Disclosure: Anne Fletcher works part time as Recovery Coaching and Family Services Specialist at Minnesota Alternatives
Photo Source: pixabay