Rehab
The very word conjures a flood of stereotyped images: narrow hallways, dingy bed sheets, gaunt-eyed patients sipping coffee from styrofoam cups under harsh fluorescent lights. Much of what people know about rehab they learn from television and movies—and, as a result, much of what people know about rehab is incomplete. Or distorted. Or more often than not really just plain wrong. The facts about rehab—the actual facts, the true facts—are far less stark than the illusions you find on the big screen; real-life rehab lacks the drama of the Hollywood version, which is often welcome news for potential patients and their loved ones. Indeed, understanding what exactly rehab is—and, no less importantly, what exactly rehab isn’t—is important for anyone hoping to begin a successful recovery program.
Broadly, “rehab” encompasses all those processes by which an individual confronts and conquers his or her drug addiction. “Rehab,” as the term is conventionally used, is everything: the beginning and the end, the first step and the final hurdle, the agony of the start and the triumph of the finish and the long hard work of everything in between. The goal, of course—the goal of the start and the finish and everything in between—is to help a patient stop using drugs. To help a patient get sober and stay sober, so that he or she can get back to living a healthy and meaningful life. To that end, rehab generally aims to combat the bifurcated roots of drug addiction: physical dependence on the one hand; psychological dependence on the other.
Physically, addiction works by changing the internal chemistry of the body. Prolonged periods of drug abuse literally remake the structure and function of the human brain; in time, the addict’s system comes to rely on the drug as part of its “normal” metabolic operations. This reliance, of course, is exceedingly injurious to the addict’s health—and means that any sort of recovery must begin by addressing the physical needs of the patient. In concrete terms, this means mitigating the symptoms of drug withdrawal during the detox phase of treatment and then managing the incidence of drug cravings thereafter. By providing patients with surrogates for their substance habits—like methadone for recovering heroin users, for example—rehab aims to facilitate the process of physical healing.
The psychological basis of addiction is no less firm than the physical one—and, as a result, no less central to the treatment methodology of any competent rehab program. Psychological dependence is intimately related to physical need; as the patient’s body comes to literally rely on a drug, the patient’s mind comes to register that need as a compulsive and overwhelming sense of want. In cases of prolonged abuse, the drug typically becomes a source of emotional stability for the addict—a relationship which makes the proposition of sobriety all the more daunting. In response, rehab addresses the psychological underpinnings of addiction, mostly through individual and group counseling sessions designed to help patients develop the social and emotional skills required for clean living. The key, of course, lies in freeing addicts from their psychological bondage: before patients can get healed, they need to distance themselves, emotionally, from the drugs to which they’ve become enslaved.
Although all rehab philosophies target the physical and psychological causes of addiction, different types of programs emphasize different elements of the recovery process. Medical rehab programs tend to be more strongly oriented towards the physical aspects of addiction; spiritual programs concern themselves primarily with the psychological core of abuse; social rehab aims to help patients recover in a communal environment; holistic programs explicitly address the mind-body-spirit nexus of chemical dependency.
It should also be mentioned that rehab programs are distinguished by the living arrangements of their patients. Inpatient programs run like hospitals, and are staffed by accredited nurses and physicians. Residential programs occur in a more relaxed and less overtly “treatment”-type environment, like a ranch or nature camp. Outpatient programs, finally, are designed to help individuals beat addiction without significant interruption to their daily lives, usually with the assistance of extensive support group networks. Outpatient programs are often strongly grounded in the twelve-step methodology of Alcoholics and Narcotics Anonymous.
In any of these guises—medical or spiritual, social or holistic, residential or outpatient—”rehab,” as noted above, refers to the entire extent of the recovery process. It begins with an individual’s first week in a detox facility, runs through the months spent in primary and extended treatment centers, and doesn’t end until the patient has mastered the art of clean and independent living in halfway houses, 3/4-way houses, and sober living cooperatives. It is, again, the start and the finish, the first step and the final hurdle. Studies have shown that those patients who spend at least three months in some form of rehab program are most likely to achieve a lasting victory over their addictions. Recovery, of course, is and can only be an ongoing process; recovery isn’t recovery at all if it doesn’t last. With that in mind, rehab aims to meet the needs of the patient at every step along on the road to sobriety—and to ensure, above all else, that sobriety itself becomes an enduring state of being.
