So, you have spent the last month getting a fresh start at the rehab center. It’s a new beginning. You feel good. You’re cautiously optimistic and ready to get on with your new sober life. But you know battles will come. In fact, deep down you know they will come hot and heavy the first week. Dealing with your GF or BF or difficult marriage. Your well-meaning but dysfunctional parents. Your crazy finances. Chronic physical pain, your boss, that 12-year old car that needs a transmission. The list of potential triggers for stress, frustration, and discouragement is endless. And it’s a big part of why some people wipe out within 24 hours, days, weeks or months of coming home. Coming from the protected environment of rehab back into your very real world is a shock to the system. Reality can come at you slow, steady and relentless or it can be like a sledgehammer, just whacking away at your sobriety the minute you walk out the door of the rehab center. Either way, relapsing sucks. You need to be uber-prepared for your first day home, those first weeks, and the whole first year back home. This blog is about coming home prepared for what’s ahead.
The main relapse prevention principle of this blog is this: Stay in Treatment When You Get Back Home!
This is the #1 overarching principle to follow for a successful first year after rehab. In my experience, people who relapse quickly, come home greatly overestimating how much they can handle and greatly underestimating how much ongoing support, time and effort will be required to keep their recovery going strong.
Of course, “staying in treatment” will look different for different people. Here are a six preparation questions you and your recovery team should strongly consider before you come home. Then, periodically reevaluate these with the input of your professional and non-professional supports.
1) Do I need a sober or transitional living arrangements before I go home?
For some folks, going straight home from rehab is a great option. They are coming back to a relatively protected environment with healthy and supportive family members. But for others, going home is absolutely a monster trigger, nearly guaranteeing relapse. There may be other people abusing substances in the home, or even using substances legitimately, but it might still trigger you to use. There may be a worried sibling or parent that hovers and micro-manages. An abusive partner, or some other dynamic that makes coming home extremely stressful and counter-supportive. If this is your situation, be careful not to skip over this question. Yes, transitional living will mean more expense and it might upset your family. But with a little research though, there are often many affordable options. Be sure to thoroughly research your options. Ask knowledgeable people about reputable sober housing or transitional living services. While some are extremely well-staffed and run, there are also many that are unsupervised, house ongoing substance abusers, and lack the overall positive environment that can really be key to your first few months home. If you will be living in the Central Ohio area and would like to talk about specific options, please call us.
2) Will I need an Intensive Outpatient Program?
IOP can be a godsend for many people coming home from a 30 to 45-day inpatient program. It typically involves three, 3-hour group meetings a week with a substance abuse professional facilitating the group. Here, you can develop comradery, continue to work on your key recovery issues that surfaced at inpatient rehab, and be regularly drug or alcohol tested. The beauty of IOP is that it provides a good support base while you are learning to deal with the very real triggers and cues of being back home. It’s a logical step down from the intensity of an inpatient rehab stay. IOP lasts for 12 to 18 weeks in most cases and is usually very affordable. That may seem like a huge commitment but in the larger scheme of achieving lifelong sobriety, it is a relatively short period of time that will fly by once you get going. I highly recommend IOP for most individuals coming home from rehab. Speak with the substance abuse professional who knows you best at your rehab program as you consider this aspect of staying in treatment when you get home.
3) Do I REALLY need a Support Group & Sponsor?
This is often a very sore subject for people coming home from rehab. It is human nature to want to be independent, strong and able to do life without a support group. There may come a time for that, but the first 6 to 12 months home from rehab is not the time to skip the benefits of a strong support network. Your support group, sponsor, and mentors who have been in successful recovery for some time can be your backbone when the going gets tough. They know better than anyone how difficult coming home is, facing a landslide of old people, places, and things all at once, but they got through it. It’s humbling to need people but the sooner you embrace your need for the input of others the sooner you will get on with a strong recovery.
Also, if you are having a hard time with the overall philosophy of traditional support groups you should be aware that more alternatives are beginning to appear. Check out SmartRecovery.org, CelebrateRecovery.com, or go online and look for support group options in your area.
What about a sponsor or mentor? Choosing a sponsor is a topic worthy of its own blog post but suffice it to say here, the right sponsor can really be critical support when you are on the edge, have a momentary lapse, or if you have had a complete relapse. People who have been there will understand you and bend over backward to help you get back up.
4) Do I need to work with a physician to oversee various medications? (anti-depressants, anti-anxiety, opioid antagonists like Vivitrol, pain management alternatives, etc.)
Each person is unique as is their recovery program, but it's very common to struggle with depression, anxiety, insomnia and other mental health symptoms; especially, if you have just lost your main coping mechanism. Your body and brain is in a major process of reordering many of its physiological and psychological processes that include sleep, cognitive function, self-esteem, etc. Until you reach a new normal, you might feel out of sorts for months after rehab. While doctors don’t have a crystal ball, in many cases their experienced insight coupled with current medications can be a lifesaver to your recovery in the first 6 months of transition. As with the rest of recovery, you need to work at this. Ask questions, read, talk to different medical professionals and get good at listening to your body.
People often feel frustrated with conflicting medical advice, and sometimes it can feel like you are human guinea pig. Here is some advice. No two people are the same. Successful people often have been through numerous failed attempts to accomplish a goal but trial and error eventually helped them find a winning game plan. If you are not succeeding after multiple attempts at sobriety without the use of potentially appropriate medications, it is probably time to consider investigating potential medications. Where do you start though?
Ideally, I would recommend a psychiatrist who is an addiction specialist. And if you recently detoxed from opioids, you may want to consider a physician who can prescribe opioid antagonists (Vivitrol, Suboxone, etc.) but carefully check reviews as well as their practice philosophy. Is their sole practice prescribing opiate antagonists like Suboxone? In my opinion, many of these practitioners are practicing good medicine, but unfortunately there are some that are unscrupulous in their fee structure, don’t spend adequate time in the initial assessment, or rarely consider weaning their patients off medication. Keep in mind these medications work well for some but not for others, depending on a variety of complex factors. Do your homework thoroughly before you choose a doctor who prescribes opioid antagonists.
5) Do I need a therapist or life coach and how often should I meet with them?
One of the most overlooked ways to “stay in treatment” is neglecting to find a good therapist and/or life coach. A good therapist, knowledgeable about addiction and with years of experience, can be an amazing weapon in your battle to stay clean. I say this because individual outpatient counseling gives you an opportunity to be open about any and every aspect of your life, things which might fuel your addiction or otherwise block your best recovery efforts. For example, many people have significant traumatic experiences that underlie and drive their addiction – childhood abuse, neglect, a parent’s or your own divorce, a death in the family, an injury, and many others can be the fertile ground from which addiction sprouts or that prevents lasting recovery. The good news is that therapists have come a long way in being able to assess and treat traumatic experiences and complex stress.
For those who don’t have identifiable traumas, you may use your therapist more as a life coach; someone to help you define and reach specific goals which until now have eluded your grasp and fueled your addiction. For example, if you have not been able to follow through with education or job training you need to move ahead in your career and strengthen your financial standing, a good therapist or life coach can help you. They are trained to identify your obstacles, help you surface fresh motivation, find available and affordable self-improvement resources, and get your life plan in gear again. For others, intimate relationships are the thing that consistently derails recovery. Couples-based therapy has a strong track record of bringing the existing strength of your relationship to your recovery. It may take a little time to find the right therapist but once you have found one, you should get much more than recovery support. You actually get someone who to help you reach your goals and live well in relationships, health, finances and more. It’s an investment and money well spent that provides dividends for years.
6. Do I Need Drug or Alcohol Testing?
Addiction thrives in secrecy. Drug and/or alcohol testing is a fantastic form of accountability because it works in the back of your mind 24/7. Speak with your physician or therapist about your options for testing. Most people don’t need this tool for extended periods of time but it can play a particularly important role in you first several months of recovery or for discreet periods such as traveling for work or brief time away from social supports.
Last thought: Do what it takes to have a good plan to “stay in treatment” your first year or longer if needed. You might need only two of the items from this list, you might need them all, or more. What is sobriety worth to you? Once you can answer that question honestly you will be well on your way to knowing how to answer the above questions and define what it means for you to “stay in treatment”.