The credibility of rehabilitation treatment
Legal, medical and social security entities, and society in general, broadly support therapeutic rehab treatment for people with substance use disorders. On the other hand, there are critics who pick holes in the need for treatment and question the integrity of the industry. The conflict sometimes causes uncertainty about the value of going to rehabs in South Africa.
Unfortunately, there are shortcomings in the rehab industry, but there is also a fair measure of ignorance and distortion concerning it. To get a clear picture, one should look at the matter in more detail.
There have been cases where people were misled into signing forms for treatment that differed from that agreed upon or treatment they never received. You should read legal documents and ask questions before signing anything. Often people are so emotional and desperate to get an addict into rehab, that they ignore basic legal precautions.
Other issues that occasionally surface are; humiliating punishment rules, the right to privacy in group meetings, cultural, racial, gender and religious issues. It is best to inquire about a centre’s moral and ethical principles beforehand and to avoid centres that respond in an evasive or undesired manner.
A more common criticism is that some centres promise paradise and then deliver poor outcomes due to slack management and outdated treatment methods.
Unfortunately, there is a tendency to generalise issues and to cast undeserved doubt upon the entire industry when it crops up. Overall, addiction rehabilitation facilities act in a trustworthy and honourable manner and satisfy a key requirement of society, as millions of addicts and their families, around the world, can testify.
The differences between rehab centres
As with most things in life, not all rehab centres are equal. Although they promise the same outcome, they differ in many respects. Some of the main differences are:
- Management style and ethics
- Types of treatment programs
- Quality, the experience of therapists
- Frequency of personal counselling
- Daily patient routines/schedules
- Online Outpatient rules and principles
- Variety and types of amenities
- The ambience in/around the facilities
Is therapy effective?
Ongoing research has proven that psychotherapeutic talk therapy treatment works. As with any product decision, do not assume you will get the same value or results everywhere. Ask about the treatment methods and other important issues before choosing a treatment centre that you feel comfortable with. Also accept that it may be necessary to repeat the treatment at a later stage to reinforce long-term stability.
Can treatment heal or cure addiction?
The circumstances that originally set off addiction and the physical damage that result from it can be managed and improved through treatment. However, people may remain vulnerable to relapses thereafter. This vulnerability remains, it means not all the elements of addiction are cycle can be removed through treatment because the circumstances that often cause people to use substances compulsively in the first place may forever be present in their lives.
The addiction can be healed, but not completely cured. This is why, after treatment, people with addiction disorders are referred to as recovering or in recovery and not recovered.
The distinction is important.
When a rehab centre promises to heal an addict, it does not mean they can completely cure the addiction. In fact, nothing can completely cure an addiction – The risk of a relapse is the one thing that will remain until the individual . The bright side is; as long as they remain sober, healed addicts, though not fully cured, can live a normal life.
(Note: keep in mind that the words healed and cured are often loosely bandied about, as there are no fixed official definitions for them and it also depends on the type of disorder, disease or illness.)
The question should actually be: How effective is rehab treatment for resisting relapses?
Because humans are extremely complex individuals, and life is just as diverse and complicated, there is no simple answer to this question, so read on:
During rehab treatment, competent therapists will teach addicts about all the identifiable triggers that may cause them to relapse. This strengthens the person’s ability to resist relapses when they resume normal life. However, how long they resist it, depends not only on the efficacy of treatment, but also on peoples’ inherent characteristics, their environments, the support they receive, and events in their lives.
Many people enjoy lifelong sobriety after just one treatment.
However, others relapse at some point and have to go for repeat treatment. There is no way to determine how many times they may need treatment before they reach stability. It may be once, or it may be many times. The fact is that, between treatments, they can live a normal life and avoid the harm of persistent abuse.
Unfortunately, many people mistakenly think the first treatment will guarantee lifelong sobriety.
This common misperception creates problems, such as people prematurely losing patience with a recovering addict when they relapse and summarily abandoning them. It also gives addicts unwarranted opportunity to worm their way out of going for treatment by arguing that treatment does not work.
It is true that the quality and type of treatment matters, though.
If a recovering addict relapses and there is doubt about the previous treatment, then look for a rehab centre that offers better prospects. Too often addicts are placed in archaic institutions with poor success rates, who exploit the ignorance of the lay public about the differences between rehab centres.
A relapse is not the end of the journey to stable recovery. It does not prevent you from choosing sobriety again. It is simply a stumble that can be overcome and the person will emerge stronger after each treatment episode. It serves as a learning experience. The saying; “practice makes perfect” is a fitting summary.
An interesting factoid is that recovering addicts sometimes have what is termed a “slip”.
It refers to a single, once-off indulgence by an addict, but it is not planned, they do not repeat it, need no treatment, and return to a state of abstinence immediately after the slip. This is often seen as a relapse by skeptics and the uninformed and falsely inflates the perception of relapses after treatment.
Critics who recklessly condemn therapeutic treatment, are ignorant of the immense tragedies their shortsighted opinions cause. There is no proven better alternative to therapeutic treatment. To oppose it, means virtually condemning addicts to death.
Why recovering addicts relapse
In essence, the same factors that cause addiction, can trigger relapses. Recovering addicts are no longer ignorant, but awareness of the harm begins to wear off and returning memories of the pleasant effects of addiction begin to dominate.
These are amplified by factors that include:
- Left-over legal, relationship, housing issues.
- Lack of transport and communication devices.
- Refusing help of friends and other caretakers.
- Not building or joining support networks.
- Feeling distrusted by family and society.
- Poverty and other hardships related to it.
- Lack of opportunity to generate an income.
- Traumatic, emotionally painful incidents.
- Other overwhelmingly demoralising events.
- Physical, emotional craving for a substance.
- Revival of old addictive friendship circles.
- The misleading charm of pernicious websites.
- Temptations in the immediate surroundings.
- Breaking the barrier with small indulgences.
- Poor treatment by an archaic rehab centre.
- Available wealth to finance an addiction.
Recovering addicts primarily require increased support by family and society, employment assistance or career advice, a change of environment, understanding by others and keeping alcohol / drugs away from them.
Qualities to look for in rehab centres
The bad signs:
Subject to your personal preferences, these are some of the signs of rehab centres you may want to avoid:
- Bureaucracy and sluggishness: An unwelcoming air of officialdom, disinterest or slack attitude, false promises about feedback, long delays.
- Outdated treatment modules: What types of treatment modules do they use for your problem? For example: AA, NA, 12-Steps, etc. Do research – modern psychotherapy if often preferred to other treatment modalities.
- Lack of customised programs: Do they design dedicated/customised treatment programs to suit personal/individual requirements? If not, then avoid them.
- Lack of counselling staff: How many patients per counsellor, and what are the qualifications? You want qualified therapists who are not flooded with work.
- Marginalised patients: How frequent and how long is person-to-person counselling? More is better. How much daily “free time” do patients have? Less is better.
- Humiliating rules: Is it compulsory, for example, to discuss very sensitive personal experiences during group meetings, when you would rather not discuss it in-group?
- Unreasonable rigidity: Inflexible rules with no exemption. For instance; compulsory participation in group therapy, even if you suffer from severe anxiety and cannot tolerate group scrutiny.
- A “punishment” culture: Do they focus on punishment (guilt/fear/threats/humiliation) as a treatment protocol instead of empathy and positive encouragement? You want the latter.
- Prejudice: Are there preferences about religion, culture, race, gender, sexual, age and similar moral issues? Better to know before you go.
- Dull dormitories: Are patients’ sleeping/living areas crowded, dull, depressive, with tacky windows, kitsch furniture, lack of personal security/privacy? Not good for recovery.
- Poor dietary protocol: Are menus planned by dieticians? Are menus rotated or do they repeat the same menu daily? A good, healthy diet is essential for recovery.
The good signs
Subject to personal preferences, these are positive signs of good rehab centres:
- Dynamic management style: Things run smoothly. Staff approachable, friendly, helpful.
- Modern techniques, quality therapists: Latest psychotherapy, not AA, 12-step or such.
- Specialist assessments: Detailed analysis to pinpoint areas requiring treatment attention.
- Full spectrum treatment modules: Ensures no concern is neglected during treatment.
- Multi-substance treatment programs: Ensures complete multi-ailment recovery.
- Customised treatment: Therapy programs tailored to individual requirements.
- Intensive personal interaction: At least one proper daily session with a counsellor.
- Focused on encouraging patients: Non-punitive approach aimed at positive motivation.
- Privacy, comfort (and luxury): Single room, nice furniture, windows, TV, microwave.
- Good diet: Healthy fresh food, professional menus, daily rotation, served in room, etc.
- Laundry service: Full laundry/ironing service. Or door-to-door collection and delivery.
- Appearance and hygiene: Access to a private barber, nail, beauty specialists and so on.
- Medical access: Access to nearby hospital, doctor, pharmacy, prescribed medication.
- Private or workplace intervention: Provided by the centre to negotiate on your behalf.
- Family accommodation: For partners/family members to share and receive counselling.
- Climate control: Cooling and heating equipment to control temperature in room.
- Recreation: Board/pool games, gym/exercise area, swimming pool, sport, library.
- Holistic access: Secluded area for private holistic services allowed during free time.
- Nice neighbourhood: Located in an exclusive area with pleasant climate and view.
- Upmarket luxury: Not a necessity, but excellent for mood/confidence rebuilding.
In addiction recovery, the atmosphere and comfort of a facility are important psychological factors. A good setting removes stressors and creates a better mood for recovery.
Alternatives to rehab treatment
Unless practising addicts undergo supervised medical detoxification before trying it, alternative treatments are not suitable for them. The alternatives also exclude personal therapeutic treatment by qualified therapists.
In some cases, therapeutic and scientific guidelines and advice are provided by the organisations and their members. Most alternatives are good options for helping recovering addicts to abstain after detoxification and/or psychotherapy.
The alternatives are not suitable for individuals with co-morbid mental disorders, such as depression, bipolar disorder, schizophrenia, self-harming behaviour, personality and post-traumatic disorders. It is also not for people who are risks to their own safety and that of others, or who are unable to stop or reduce addictive behaviour on heir own.
Cold turkey: A method to suddenly stop addiction on your own, with no medical or psychological assistance. Relies on willpower and perseverance. Very low success rate. Does not redress emotional disorders. Very dangerous, high risk method for substance abuse addicts, as it excludes medical supervision and involves severe, even life threatening, withdrawal symptoms.
Medically assisted detoxification: All practising substance abuse addicts should submit to a medically assisted withdrawal process under the supervision of a medical doctor or hospital. This allows for safe withdrawal from substance abuse and recovery of physical health. After detoxing, patients can decide on the way forward, but therapeutic treatment in a residential rehab centre is strongly advised.
Alcoholics Anonymous, Narcotics Anonymous and other 12-step programs: Voluntary organisations with many local branches. After-hours meetings and support run by recovering addicts with no professional assistance. Currently being debated as outdated and ineffective. Deemed effective when combined with psychotherapies. Some residential rehab centres use it as their core treatment program, in contrast to centres that prefer more advanced psychotherapies.
Self-empowering groups: Includes international voluntary groups and local church and social support groups for addicts. Run by people with shared interests who find their own path to long-term sobriety. Widespread, but not available everywhere. May not be suitable for practising addicts prior to medical detoxification.
Professional treatment at home: Useful for people who: Have medical conditions; are anxious or cannot function in group settings; where circumstances make it impractical to attend in-house residential treatment; where the person does not have the ability or capacity to cope with the transition from residential facility back to everyday life. Provided by private professionals. Not available everywhere.
Professional outpatient rehabilitation centre treatment: Suitable for people in circumstances that make it impractical to attend fulltime in-house residential treatment or where the person does not have the ability or capacity to cope with the transition from residential environment back to everyday life. Led by professional addiction therapists who work for established rehabilitation centres.
The accusations of skeptics and the hard facts
The skeptics: Rehab centres create unrealistic expectations.
The facts: All rehab centres want addicts to attend treatment and it is natural to point out the benefits of recovery to enhance a desire for it. However, some do try to attract you to them with overstated claims or promises which are too good to be true. This is not condoned practice in the health industry. If you sense a “too pushy” sales effort, or lack of ethical behaviour, then look at other centres before deciding. A trustworthy rehab centre will respond in a transparent and honest manner.
The skeptics: Rehab centres exaggerate the dangers of addiction to scare you into signing in.
The facts: Addiction risks are scary by their nature and this can be abused to create anxiety to attract admissions, but common sense allows us to spot distortions and modern technology allows us to easily check the information. Crude tactics are unsavoury, so simply avoid such places. However, media platforms are aimed at a broad audience and have to reasonably include the severe dangers. Also, some centres do a more thorough job by listing all relevant items – efficient reference lists should not be tagged as sales stunts.
The skeptics: Rehab centres promise special treatment, but do not deliver it.
The facts: Yes, some centres advertise excellence, but then act like bureaucracies, with counsellors engaged in administrative duties or attending staff meetings, while patients sit around idly, or only attend occasional humdrum activities. Others use outdated therapies. Avoid them – you need dynamic, up-to-date treatment. Look for guarantees of modern techniques and at least one personal consultation per day, plus other daily treatment-related activities.
The skeptics: Rehab centres entice you with promises of safety and luxury “rewards”.
The facts: For all rehab patients, just like for those in a hospital, a safe and comfortable environment is essential for recovery. The luxury establishments specifically provide for patients in the higher income bracket. Patients who can afford luxury, need to know what is available. Rehab centres declare their features, in the way that all other establishments do, to inform patients when they look for suitable facilities.
The skeptics: Rehab centres never guarantee abstinence.
The facts: Nobody on earth can guarantee abstinence. People and life in general are complex entities and the recovery process involves numerous unpredictable factors. Rehab centres strengthen patients’ coping skills, but they can not control all facets of their lives after they leave the centre. Some need several repeat-treatments before reaching stability, while others achieve it with a single treatment.
The skeptics: After treatment, addictions are replaced with other bad habits.
The facts: It happens, though not in all cases. It is similar to a relapse involving the original abuse, except that the patient rationalises that a different addiction will have a better outcome. Coping skills are improved during treatment, but it can not be infinite. Some patients inadvertently need repeat-treatment and/or adjustments to provide for new factors.
The skeptics: A relapse indicates that repeat treatment will not work.
The facts: Addicts exploit this idea to avoid treatment, as it seems logical (though it is actually a fallacy). A relapse does not mean treatment is ineffective. Recovery is a growth process and the risk of relapse decreases with each treatment. Some addicts only master parts of their first treatment elements and fill the gaps during repeat treatments. Sometimes adjustments are also needed to compensate for new factors that emerge on the outside.
The skeptics: Patients are safe in the centre, but not when they return to daily life.
The facts: The transition is difficult. Patients are prepared for it, but not all potential pitfalls of humanity can be covered. There are usually extended problems that accumulated during the active phase of addiction. When faced with these, on top of the normal adjustments, it can be overwhelming without support. Good rehab centres provide out-patient groups – This, as well as family, friends and other support groups, are options that patients should employ.
The skeptics: Rehab treatment attaches a stigma to the person.
The facts: In the past, people distrusted recovering addicts due to ignorance or lack of awareness. Some still do, but today most people are informed and tolerant or forgiving. In an ideal world, we would prevent addiction and treatment, but practising addicts lose that option and inevitably get into trouble – Going for treatment is their only option to regain credibility, not lose it.
The skeptics: A treatment record makes it difficult to find employment.
The facts: This problem has diminished, but still exists. It is not a treatment fault – it is a workplace problem and a trade-off that outweighs the much greater problem that further, ongoing abuse will inevitably cause. (Reputable centres have comprehensive security measures to keep patient information confidential.)
The skeptics: Success rates claimed by rehab centers are over-optimistic.
The facts: Success rates can be misleading, as there are different ways to determine it. It depends on the timing and duration of the survey (it could cover just the first month after treatment, or stretch over several years). Also, some deem it disputable due to the potential for dishonest responses. As in any industry, some centres manipulate data for sales reasons. However, uncertainty about success is not evidence of failure. Some centres are, in fact, more successful than others. If a centre has a clear, convincing reason for a high success rate, then they may well have a winning system.
The skeptics: Patients can fix the addiction and damage by themselves.
The facts: Some addicts do achieve abstinence with willpower. This is rare and seldom begets long term stability. It is logical that emotional triggers will remain, even in sobriety, unless the underlying disorders are clinically healed. Therapy is difficult for the untrained to apply and willpower does not heal emotions.
As recently as 70 years ago, alcoholics were persecuted and horribly punished, yet it did not deter the problem, as addicts were unable to change themselves and there were no institutions to help them. This is why the rehab industry came into being and why they have become a beacon of social security.
Summary of rehab centre efficacy
Therapeutic treatment in a residential rehabilitation facility remains the most viable option for long-term recovery from addiction, subject to reasonable enquiry to ensure the facility’s integrity and suitability. Recovery Direct’s Cape Town addiction counsellors treat all types of common drug addictions including, amphetamines, alcohol, benzodiazepines, dagga, tik tik, cocaine, ecstasy, heroin, mandrax, prescription medications, poly-substance process and behaviour addictions such as eating disorders, gambling and sexual addictions.