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What’s A Day Like In Drug Rehab?

A lawyer who represented drug pushers became a drug addict himself. How did this happen? His success in getting clients acquitted by finding loopholes in the system was partly to blame. Confident he could get himself out of scrapes as he did criminals, smugness over his legal skills beat fear of consequence. After hitting rock bottom and completing drug rehab, he was able to recover. Now, he represents clients from the treatment centre he attended.

One can only wonder what went on in that facility that not only healed the lawyer but prompted him to help those within its circle. If you’re curious, read on.

When we started with this article, we thought about interviewing just one person to present a ‘micro view’ of what goes on in a rehabilitation centre. But the first one we spoke with griped about just being cooped up in one boring meeting after another where the facilitator droned on about long-term sobriety and change. He did not like being “lectured at,” referring to presentations as “sermons.” Another was an introvert who did not appreciate the forced participation in group sessions and community-based activities. He despised the socializing part of his program.

Understandably, not every program or attendee is the same. A few get more out of sessions than others, not because they’re more disciplined or committed than their contemporaries, but because they found the right fit. That’s why it’s important to find the appropriate program for one’s personality and circumstances.

So rather than featuring a single resident in one facility, which gives a one-dimensional view of rehabilitation, we cast a wider net to present a more diverse perspective. We included treatment centres outside of North America to show the contrast between government-sponsored and private facilities, as well as court-mandated and voluntary attendance.

Southeast Asia: Drug War Casualties

Court-ordered attendance, for example, involves signing a statement vowing to refrain from illegal drug use. This is not just a piece of paper. The addict has to keep his promise under threat of severe punishment, lengthy incarceration, even death.

In countries like the Philippines with its full-blown drug war, rehab attendance connected to arrests means assigned programs are mandatory. They are run military-style, and residents are monitored by armed guards.

Most who seek rehab are ‘surrenderees’ from the drug war. They usually give themselves up to avoid or shorten prison sentences. The Department of Health (DOH), however, estimated that only 1-10% are eligible to be admitted.

Their Dangerous Drugs Board (DDB) puts a drug user through the Drug Dependency Examination (DDE). Through this exam, an accredited medical practitioner determines a user’s level: (1) experimenter, (2) social recreational user, (3) habitual user, (4) drug abuser, and (5) drug dependent. The drug dependency level dictates the appropriate intervention.

Users on levels one to three can be treated through intensive outpatient programs (IOPs), while level four and five users are admitted in residential treatment and rehabilitation centres (TRCs).

If you think this is harsh, consider the plight of those arrested for drug possession or trafficking in other Southeast Asian countries. Automatic incarceration, often without due process—and the death sentence—await them.

One Day In A Private TRC

In one privately managed Asian inpatient program, facilities for men and women are separate. The age range of attendees is 15 to 65. The centre can take in 20 patients at any given time. Treatment usually follows detoxification in an affiliate hospital.

A typical day for residents begins with exercise at 6 am. After showering, they dress up even if they’re just staying in the facility. This reinforces the value of caring for oneself. Other values the centre instils in residents are responsibility, humility, and accountability. The last two are difficult for older residents, as they sometimes take orders from younger ones. In Asia, where educational status is highly regarded in social hierarchies, the pride of the highly educated is often hurt in the process.

After a healthy breakfast, residents meet to discuss the day’s agenda. They’re assigned to divisions where they do chores to keep them busy, so they won’t think about using drugs or alcohol. This TRC prohibits chocolate, all forms of nicotine, drugs, and alcohol, phone/Internet use, and engaging in sex to prevent triggers, cravings, and temptations. Consequences of noncompliance include being given more difficult tasks, sanctions, or extended stay in rehab.

Departments include inventory, appliance/furniture repair, maintenance, cleaning, laundry, and food preparation. Staff monitor residents assigned to the kitchen to prevent them from using tools as weapons or instruments of self-harm.

After lunch comes group therapy, where residents discuss interaction among themselves. This includes resolving altercations and disagreements. They take this opportunity to civilly express their feelings, negative or positive, toward their fellow addicts. Complaints, filed through cases, are addressed in therapy sessions.

Individual counselling and therapy sessions follow. These include cognitive behavioural therapy (CBT), among others. Extra activities involve journaling, Bible study, art and dance therapy. Recent additions to prison drug rehab programs include Zumba and karaoke. Residents find it hard to comply with daily routines in the beginning, but they eventually adopt regimens.

Residents get to relax during weekends. They wake up later to leisure time, which involves reading, writing, engaging in sports, and evenings watching selected TV shows/movies. Sundays are for family visits and worship. Depending on the centre’s budget, services on various religions are held simultaneously in separate facilities, or one after the other in one room. The role of families is an important part of the recovery process, so residents are allowed to interact with them during the treatment process (unlike in many rehab programs).

Family therapy and participation, though, depends on the patient’s pre-admission interview with the station director. Management determines if family members are supportive, agree to the rehabilitation, and are committed to an aftercare plan upon the addicted loved one’s discharge. Counsellors emphasize that the centre isn’t a place to dump addicts in. They educate families on handling life after program completion.

Residents often have a tough time returning to the regular schedule. The addicted brain thrives on pleasure, so if rewards stop, it has difficulty adjusting. But that’s the reason for routine: to instil discipline and bring about normalcy. Counsellors, social workers, and doctors are on-site, though, to assist in dealing with upsetting feelings or maladjustment.

Program duration depends on a patient’s progress, but treatment typically runs from six months to one year. A Philippine private rehab centre costs between PHP50,000-100,000 (USD $1,000-$2000). Medication costs extra. Public rehab costs from USD $100-$200. The monthly fee covers the patient’s stay and the rehabilitation program. Government funding covers daily necessities in public TRCs, while private centres usually charge extra for personal allowance. Private fees sound unbelievably cheap to the average North American, but they’re beyond the reach of his Filipino counterpart.

At luxury centres, patients have their own nutritionists who monitor food intake. They have shared air-conditioned rooms, as they’re not permitted to be alone to minimize risk. One luxury TRC, in addition to offering patients activities like mountain climbing and trail biking, also allows trips abroad that are related to treatment. Another has an open enrolment program that offers a partial subsidy.

Government-owned drug rehab centres offer free services, but there aren’t enough of them, and most are riddled with budget and logistics problems. The DOH has since raised the 2020 budget for the DDB to PHP616 million, with a focus on rehabilitation [1]. Eleven constructions with a 6,000-bed capacity are expected to be completed next year. The Armed Forces have also opened their military camps to take in overflow. Bills have been proposed to have medical insurance cover drug rehabilitation.

California: The Rise Of Luxury Rehab

In the US, drug and alcohol-related deaths in the 25-64 age range have overtaken those from automobile accidents. A 2009 study by the Substance Abuse and Mental Health Services Administration revealed that, of the 23.5 million people nationwide over the age of 12 who need treatment for substance abuse disorders, only 2.6 million actually receive it.

This has paved the way for drug and alcohol-related rehabilitation to grow into a $35 billion industry with about 15,000 facilities nationwide [2]. Non-hospital residential treatment serves only 10% of US substance dependents, but the high cost makes it lucrative. Celebrities, who make up most of this treatment model’s clientele, have contributed to it becoming the gold standard. But this has also spawned unscrupulous operators preying on the downtrodden.

Dr. Lance Dodes, addiction specialist and former director of substance abuse treatment at Harvard University’s McLean Hospital, explains. “To justify the huge rehab charges ($30,000-$90,000 a month), rehab centres have become like spas. They couldn’t just give patients the same things you can get from a church basement, and operators are competing against each other. So they added treatments to their programs without any evidence to show these are effective.”

Dr. Drew Pinsky, celebrity addiction specialist, says, “Poor (addicts) are better off than rich ones because (the wealthy) choose BS programs offering special care. This is not about being special. It’s about shutting up and stopping the BS. You get special treatment, you end up not with good outcomes. Michael Jackson got special treatment. Rehab is hard work. It shouldn’t be gratifying.”

United Kingdom: Drug Rehab In A High-Dependency Psychiatric Hospital

At Broadmoor, the best known high-security psychiatric hospital in England, all-male inmates in the strictest wards are caged and only allowed out one by one on schedule. Though difficult to believe that these men could ever progress, each ward is a staging post to their recovery.

Dr. Amlan Basu, Broadmoor Clinical Director, claims, “One of the misconceptions about Broadmoor is that those with severe mental illnesses (and addiction) are destined to be unwell forever. That isn’t true. The mental health disorders we treat are very amenable to treatment.”

Cranfield is the hospital’s ward with the most acute mentally ill patients. They are violent and unpredictable, so the simple act of serving meals is done by several staff members and tailored carefully to the individual. Food is slid through small openings built into doors, and all staff deliver food with gloves on and keys chained to their bodies.

At Epson, another Broadmoor high-dependency psychiatric ward, patients are allowed to associate with each other but accompanied by attendants. When low-risk patients are allowed to cook, careful account has to be kept of everyday household items, especially those that could be used as weapons. Most utensils are made of plastic.

Broadmoor’s 800 staff have been with the hospital for years despite the daily risk of assault. Clinicians, not prison officers, run the wards. Nursing staff wield specific equipment and undergo specialized training to deal with anything from administering medications to managing full-scale riots. Teams are deployed 30 times a year, disarming patients with weapons.

Australia: Detox Without Meds

Peter Lyndon-James, a former addict, gun runner, and convict runs possibly the strictest drug rehab in the country, Shalom House. All patients are required to quit cold turkey without medications (though medical practitioners monitor them). Residents do manual labour within the centre or are sent to help in external ministries.

The centre requires residents to sport crewcuts, and it prohibits facial hair to hone the importance of appearance to even out how the outside world views addicts. This helps patients reintegrate into society after discharge.

This TRC follows 12-Step programs like Alcoholics Anonymous. The curriculum is Christianity-based. This is not for everyone, as evidenced by those who quit after a short period. One of them, a computer analyst, didn’t appreciate the religious aspect imposed on him. The founder counters that attendees are not forced to accept this, but claims that most of those who quit the program have difficulty with its rigorousness, not its spiritual side.

New Hampshire: Prison Detox

New Hampshire has the highest rate of opioid abuse among young adults in the USA*. The state has the second to the lowest budget nationwide for substance abuse programs, and can only support 4-6% of young adults in need of care because of its small tax base. The number of people in need far outweighs the capacity of state-funded rehab facilities. Even across the US, for the past 50 years, only 10% of those who need drug treatment get it.

This means that addicts without funds for private in/outpatient care are in danger of drug overdose deaths while on month-long waiting lists for treatment programs. It has gotten so bad that one desperate addict faked his intention to commit suicide just to get into a program (state-sponsored rehab facilities cannot turn away patients in danger of killing themselves or others).

In contrast, substance abuse treatment is readily available in prisons courtesy of the state’s Department of Corrections. So some addicts are getting themselves incarcerated just to get treatment.

What the ‘fakers’ don’t count on is the fact that prison detox is much more difficult than ‘external’ detox. Counsellors challenge inmates to feel their pain and other negative emotions without tapering drugs. Lack of structure and boredom are the top reasons for relapse. So routines and daily schedules are mandatory and rigid. Withdrawal symptoms in detoxification render inmates physically and emotionally sick. But the strictness helps in long-term recovery.

The system enjoys higher rates of success than fancy private treatment programs. But drug rehab plans in prisons should only be a last resort, not a band-aid.

Lack Of Regulation

Drug rehab should be the first step in addiction recovery, not the only one, because numerous oversight problems in addiction treatment abound in the US medical system. No federal standards exist for counselling practices or rehab programs [3]. Lots of private rehab facilities make suspiciously impressive claims. The mean success rate is 80%. According to their 2018 National Quality Assurance meet, the National Association of Addiction Treatment Providers found that “the operation of addiction treatment in some sectors is out of control.”

It’s easy to open drug rehab centres in certain states. For example, in Idaho, as long as your residential program is not for adolescents, you don’t need a licence. In California, anyone can open an intensive outpatient treatment and rehab centre if clients pay privately. In Florida, ordinary people can start a sober living home or transition house.

Most experts agree that there should be consistent access to other newer treatments like certain behavioural therapies or medications like naltrexone, buprenorphine, methadone. But rehabs are not required to offer these. Proprietors can frame anything as part of a treatment plan. For example, Cliffside Malibu (whose treatment program costs $73,000 monthly) offers equine therapy through a third party, Stand In Balance. Each hour-long session costs $265. But there is no empirical evidence that this works as an addiction treatment. So “the vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care [4].”

DIY Research

Those who want to investigate rehab centres can file a public records request from their state or province’s Healthcare Services. This takes months, though.

Dodes recommends not starting with rehab centres, which will push their services. Instead, find a board-certified doctor in addiction medicine by visiting the American Board of Preventive Medicine’s website: certification.theabpm.org/physician-lookup. If preferred physicians are not listed as certified, they may be so by the American Board of Medical Specialties. Check certificationmatters.org to see if these doctors are certified elsewhere.

Expense Unjustified?

The price of a program doesn’t guarantee 100% success, no matter what the proprietors of fancy TRCs say (or sell). Private companies may have better facilities and higher-end equipment, but this doesn’t mean they’re the best. Many public TRCs have visiting or volunteer local and international specialists. Sometimes, barebones, strict, no-nonsense methods work better than comfortable environments that coddle patients.

Despite their differences, TRCs have the same objective: to simulate a structured daily life within their facilities to aid clients in early recovery. Most drug rehab organisations aim for all clients to recover. Numerous testimonies prove this is possible. Many former addicts even go beyond recovery. Some became sponsors, counsellors, and employees in the centres they attended, giving back to the community. Others have found jobs, gone back to school, reunited with their families, and are now living drug-free lifestyles. If they can do it, so can you.

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Sources:

[1] Dangerous Drug Abuse Prevention and Treatment Program. Department of Health. And The Philippine News Agency. September 2018.

[2] “Principles of Drug Addiction Treatment: A Research-Based Guide”. National Institute on Drug Abuse. January 2018.

[3] “What science says to do if your loved one has an opioid addiction”. FiveThirtyEight. July 2016.

[4] “Addiction Medicine: Closing the Gap between Science and Practice”. Casa Columbia. June 2012.

[*] VICE News. February 2016.

Photo credit: Find Rehab Centers. This picture has a Creative Commons attribution license.