Understanding Long-Term Rehab

Winston Churchill once said, “We shape our dwellings, and afterwards our dwellings shape us.” For addicts in recovery, fresh from inpatient rehabilitation programs, this quote has special meaning. These people may have homes full of treasured possessions and people whom they love, but when they last lived at home, their addictions truly took hold and began to blossom. The home environment may have helped to shape that addiction.

Long-term rehabilitation programs are designed to help these addicts strengthen their sobriety skills before they return to their homes. Here, they will learn more about how to control their cravings and stay ahead of their disease, and they will have the opportunity to live with others who are going through the same process. It can be a powerful way to strengthen an addict’s resolve and allow meaningful change to take place.

A General Description of Long Term Rehab

According to the National Institute on Drug Abuse, long-term rehabilitation facilities are usually not staffed by medical personnel. Where an inpatient program for addiction is typically run by a doctor, a therapist or a series of nurses, a long-term rehab facility is often run by a few non-medical staff members and the residents who live there. While it’s true that the addict will be living with other recovering addicts, this is far from a frivolous environment.

People who live in these facilities are expected to abide by a strict set of rules regarding behavior, substance abuse, addiction services and employment. Punishment for breaking the rules can include expulsion from the facility. Most residents are highly motivated to obey the rules, so they won’t be asked to leave, and they work hard to ensure that other residents follow the rules as well.

During the first 30 days of care, the resident is typically introduced to the facility and the other people who live there, and the rules are carefully explained.

At this stage of treatment, the addict may be asked to:

• Stay on the grounds at all times, unless heading to work or therapy
• Submit to periodic urine screenings
• Perform a series of household chores
• Participate in addiction meetings held in the facility’s common area
• Check in with an in-house mentor, multiple times per day

As time passes, the addict may be granted greater freedom. Some facilities allow long-time residents to leave for overnight visits with family, for example, while others allow long-time members to perform fewer chores. This can vary dramatically from facility to facility, however.

As long as the addict lives in the facility, he or she is continuing to work on addiction issues. The addict might meet with his or her counselor on a regular basis, take medications to keep cravings at bay and attend support group meetings both in the facility and in the community. The work begun in the inpatient facility continues in this long-term rehab facility.

Successes in the System

Living in a community like this can be beneficial for addicts who feel isolated due to their addiction. In a long-term rehab facility, they’re surrounded by other people who are going through the same issue, at the same time, so they always have someone they can talk to who will understand the feelings they’re struggling with. For addicts who have poor support systems at home, this can be an immense help.

In addition, the structure provided by a long-term addiction facility can be beneficial for some people. Each moment of their day is tightly accounted for, leaving little time for them to indulge in temptation or seek the substances they crave. Instead, they’re learning to connect with others and achieve their goals.

They’re living in a community full of other people, just like them, and they must learn to get along within that system and act in a manner that isn’t contrary to the needs of the group. If the addict’s behavior is appropriate, rewards are provided. If the addict’s behavior is not appropriate, punishments can be meted out. Soon, the addict learns to regulate behavior without these incentives.

Addiction doesn’t spring from just one source, and long-term facilities work to help the addict find triggers for addiction and root them out. For example, some people haven’t completed their education due to their addictions. Others can’t find meaningful work. Long-term facilities are particularly adept at helping addicts overcome these challenges.

For example, a study in the journal Addiction found that people who lived in long-term residential facilities for addiction tended to perform better in drug-use scores in follow-up surveys, compared to those who did not enter these facilities, and researchers suggest that improvements in housing and job skills were partially behind those gains. Since these addicts received complete care in their long-term facilities, they were able to manage their disease a bit better in the long term.

Limitations of the Model

Living in a long-term facility means leaving loved ones, work and beloved pets behind for a sustained period of time, and some people can’t seem to manage this idea. Long-term care facilities aren’t hospitals and the people who live there aren’t required to stay. Some people choose to drop out of the programs before they’ve completed them.

Difficulty Being Away from Families

A study in the journal Substance Abuse and Misuse found that many addicts who dropped out of treatment programs scored higher on scales of depression. It could be that their depression deepened while they were away from their families, and they chose to leave instead of sticking with their treatment.

Delay in Getting Treatment

A study in the journal Addiction found that some people experienced long delays between when they expressed a desire for treatment and when they entered that treatment program. In some parts of the country, it’s difficult to find open spaces in both short- and long-term facilities for addiction, and these delays can have serious consequences. In this study, people who endured treatment delays didn’t receive as much benefit from a long-term program as people who did not experience delays. It’s a serious issue.

Strict Rules

In addition, the rules in a long-term care facility can be quite restrictive. Changing these rules is not an option, either, and some people tend to simply resist the idea of bowing to authority. For people who know they will not be able to abide by a strict set of rules, no matter how much they might want to, it might be best to choose another form of care.

Inspiring Changes

Some people are forced to enter a long-term residential program because they’ve faced criminal charges due to their addictions. They may not want to be in the programs, but they must stay there or face the prospect of jail.

In other words, people really must want to change in order to connect with their peers and see a benefit from these programs. This is true whether or not the person is facing the prospect of criminal charges. In order to inspire these resistant people, therapists can turn to a tool called motivational interviewing. Underlying this model is the theory of stages of change.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), people walk through a series of predictable steps before they make meaningful changes in their life:

• Step one: Avoidance
• Step two: Contemplation
• Step three: Preparation
• Step four: Action
• Step five: Maintenance

A therapist using motivational interviewing will determine where the addict is on this scale, and then use a form of questioning to try to push the addict to the next level. If the addict is preparing to change, but hasn’t yet committed to doing so, the therapist might ask, “What would happen if you, for one day, listened closely in your group meetings and tried to respond thoughtfully when you were talked to?”

The idea is to encourage the addict to take the model seriously, and gain the most benefit from the techniques provided. This may help some addicts see why a long-term facility is helpful, and some addicts may choose to stay in their long-term facilities as they work through this technique with their therapists.

Questions to Ask

According to SAMHSA, there are well over 11,000 treatment facilities for addiction in the United States. Some provide only short-term care, while many others provide care for longer periods of time. Choosing the right facility means asking questions. The addict will need to live in this facility, and be comfortable there, so it pays to do homework ahead of time.

Good questions to ask include:

• What is the monthly fee?
• Does this fee include food? Utilities?
• Are there professional staff members on site? What are their qualifications?
• What are the posted rules for the facility?
• Are family visits allowed? Phone calls?
• Can a work schedule be accommodated?
• What if a relapse occurs?