And I say no, no, no.
October 20, 2011 10:07 AM   Subscribe

My sister might end up in rehab. What happens there?

My 19 year old sister might go to rehab for drugs. I believe she primarily uses cocaine and pot (as in: I know she uses those two daily, but she might also be using other drugs); she also drinks (but probably not enough for it to be a problem) and smokes (half a pack a day). This would be her first time in rehab, and it would be a one month inpatient program.

So what happens there, in general? My knowledge is limited to tv. She usually sleeps through most of the day, what happens if she tries to do that there? What is a day like, an evening, the weekend? Will they deal with other issues as well (theft, say, to buy stuff -- mostly but not exclusively drugs)? What is allowed when family visits? All her friends are also drug users or dealers -- how do they help her make a new support network when she gets out?

(This is for my personal knowledge and is not being used for any decision making or even to tell my sister about what she might expect. My parents will get appropriate counselling for themselves and be speaking to the clinic to ask questions about their specific policies. I am looking for general answers. I am probably not asking the right questions, so please answer the ones I should be asking.)

Throwaway email:
posted by anonymous to Health & Fitness (19 answers total) 1 user marked this as a favorite
'Rehab' is like 'Diet' - there are tons of different styles and types, and some people fit better with one than the other, and some never fit at all. Some are set up very boot-camp like, some are almost a posh resort stay. Like TheBones said, the only place that can answer your specific questions is the rehab facility in question
posted by pupdog at 10:30 AM on October 20, 2011 [1 favorite]

I don't know your sister and how ingrained the addiction is, but I really hope this will be her only time in rehab. Be prepared for the fact that it may not be.

If it's a good rehab, yeah, they definitely deal with other issues like stealing (which, after all, mostly occurs because of the need for drugs). They are well-trained in making sure that she will not have access to drugs, and well-trained in all the excuses that addicts will try to use to get out of treatment.

The first few days will be spent helping her detox, if that's an issue. After that, I believe it's just a rigidly structured day of group meetings and one-on-one meetings, with rest periods in between. During these sessions, all the issues you mention are addressed, including how to avoid "triggers" (people or places or thought patters that make the person want to use).

In the rehab my loved one was at, they had a family weekend after the third week, where we went to group and one-on-one meetings with him. We had meals with him on the campus; there were no foods or drinks at all that contained any sugar (the soda machine was all diet soda). The patients were allowed to smoke in a designated area. We were allowed one evening off campus with him, where we went out to dinner and he did not attempt anything sinister during that evening. I don't know if they'd allowed him off if they thought he was at risk for slipping.

If your sister complains about the rehab and how they're being mean to her, don't believe her for one second. If she comes up with an elaborate scheme as to why she needs to leave and how she's definitely going to be able to kick her habits without professional help, don't believe her for one second. If she is kicked out of the rehab for not following rules (this varies, depending on the rehab) and then tries to blame it on the facility, don't believe her for one second. In fact, don't believe her for one second about anything until she's been sober for at least a year.

Best of luck to you.
posted by Melismata at 10:33 AM on October 20, 2011 [3 favorites]

No, she probably won't be allowed to sleep through the day. Generally there are therapy sessions (group and individual), meetings, activities, and chores to be done. Weekend are usually a bit less scheduled and usually include a day or afternoon devoted to visiting hours. This is based on the people I know who have been in rehab.
posted by otherwordlyglow at 10:33 AM on October 20, 2011

Usually rehab (assuming your standard, 12-step based program) is a mixture of group therapy and individual sessions with a counselor, 12-step meetings, and down time. She will probably not be allowed to talk to anyone from home for at least the first few days. After that, there will probably be specific times set during which she can have visitors. After rehab she will probably be encouraged to go to some kind of outpatient program for a while, or at the very least attend 12-step meetings every day for three months ("90 in 90"). She will be encouraged to completely cut off contact with her drug-using social circle, and make new friends within the recovery community.

However - like the posters before me are saying, this is going to vary based on the facility. If you know where she might be going, there is probably some information available on their website about what a typical day might be like.

If you're looking for what you can do to support your sister during and after her treatment, I strongly recommend seeking out a Nar-Anon or Al-Anon meeting. The people there have had more than their share of experience with this stuff and will be able to answer a lot of your questions, particularly ones related to specific facilities in your area.
posted by something something at 10:35 AM on October 20, 2011

Here is what happens at most rehab places (and I have been in several although they were all run on state funding, I can't speak to what happens at private rehab facilities):

What they do is structure the patients day for them so that between wake up time (usually 6am or so) until lights out (11pm or so) they are constantly in some type of group where counselors lead discussions about different strategies for fighting off urges to use. That is the crux of most classes and the most important thing about trying to get off of drugs, IMHO, fighting the urge. That urge does not go away, ever, remember addiction is a disease that can't be cured. There will also be classes on life skills, budgeting, managing time, human relations, etc. For the most part the classes are boring and an addict sitting there does not pay attention or care, at least I didn't. They will do physical activities and eventually will do group activities outside the facility (movies, bowling, etc) and they may also have to work, i.e. picking up trash, working at a local goodwill, things like that. They will definitely be assigned chores to do at the facility.

Normally, rehabs have a snitching system in place where, essentially, patients are rewarded for ratting out there fellow patients. Its one of the parts of rehab that I just do not understand.

Normally patients will be denied access to phone or any outside contact for two weeks and then they will start being allowed phone calls and visitors on the weekends. The visitations are limited to an hour or two at first, and the longer you are at the facility the longer your visitations are. Eventually they will be allowed to go offsite for a couple of hours at a time. But just like everywhere else, there will be people there breaking the rules. From people with cell phones that will allow another patient to use it to circumvent the phone rules to people with drugs for sale.

Here's the important thing to remember, if they go there voluntarily (i.e. not court ordered) they don't have to stay there. They can get up and walk out anytime they want and no once can stop them. A lot of places won't even try to talk them down, they just let them walk. The patient has to be ready.

It's also important to note that unless the drug of choice is alcohol or an opiate like heroin, there is no detox period at the beginning, so they are thrown into classes the moment they walk in the door. The first days are the hardest.

At MOST places, boys and girls are separated and there are penalties for contact, even verbal, outside of classes, but that will not stop anyone from doing it. It's called 13th Stepping. I met my future wife that way (getting married on Saturday), but it is really a dangerous prospect. One thing to remember is that when someone goes to rehab they are meeting dozens of other addicts, the majority of which are there because someone else wants them to be and what they really want to do is get out of there and get high and being with like minded people makes that easier (kind of like criminals in jail meeting other criminals).

So this was all pretty disjointed, sorry about that. And even though you didn't ask for it, I will give you some advice about addictions and addicts in general. When I was using (meth was my drug, btw) no one could tell me what to do, anyone who tried to help me was my enemy and really trying to hurt and control me, I always knew what was best, always knew that I could stop whenever I wanted (which was never), never hurt anyone by my drug use and EVERYONE JUST MIND YOUR FUCKING BUSINESS AND STOP TRYING TO RUN MY LIFE!!

I went to rehab three times, staying from two weeks to three months. After I left my last rehab of 90 days, I started using the day I got out and kept using for three years after that. One day, when everything was gone, my family, my job, my money, my kids, my girlfriend that I had met in rehab, I finally decided that I wanted to stop. I didn't go back to rehab or any meetings. I just stopped. And it was hard. HARD. It's been since February 26th 2010 and I haven't used, but God I have wanted to. It's weird how the disease works. I think about it daily, but know that I don;t want to do it, not a big deal, I have partial custody of my kids and am getting married this weekend, have a steady job and am on good terms with my family again. But, every time I have a little extra money that I could buy an eight ball with and still pay my bills, I will dream about shooting up meth. It's the strangest thing.
posted by holdkris99 at 10:47 AM on October 20, 2011 [17 favorites]

Make sure the demographics of this inpatient facility are at least somewhat similar to your sister. It will be very important for her to see other people like her (age, SES, life situation) to be able to benefit from the group sessions. If she, for example, were mixed in with middle age yuppies trying to combat their addiction, she may feel isolated and may feel no one shares her plight.
posted by teg4rvn at 11:01 AM on October 20, 2011 [1 favorite]

holdkris99: "That is the crux of most classes and the most important thing about trying to get off of drugs, IMHO, fighting the urge. That urge does not go away, ever, remember addiction is a disease that can't be cured. "

I don't wish to belittle your experience, holdkriss99, but this is not always true. The entire point of 12 step programs is to have that urge removed. It doesn't work for everyone, but I haven't had a compulsion to drink or use for 23 years and go years between even fleeting thoughts of using.

It is damned hard to stop, active addicts (including alcoholics) are some of the most manipulative, heartbreaking people around, but it isn't hopeless.

For folks dealing with us, I highly recommend not doing it alone. Nar-anon, Al-Anon, a good therapist, something. You'll need the reality check of people used to spotting bull shit.
posted by QIbHom at 11:05 AM on October 20, 2011 [1 favorite]

QIbHom, that's awesome and rare to hear. It's very encouraging in fact. Hopefully I will get to that point someday. Like I said, I am only a year and a half clean so I still deal with the urges daily, not in a real should I or shouldn't I way, just with the thought crossing my mind or, like I said, when I dream at night.

Also, seconding the OP going to Al-Anon or something similar to getting their bs detector finely honed. Not only that, but once I got clean it meant the world to me that my sister went to those classes, that she made that sacrifice.
posted by holdkris99 at 11:10 AM on October 20, 2011

If the rehab allows it, you may want to make one concession: cigarettes. And if allowed, there may be limits on how much can be brought in a one time. Getting through detox/rehab is bad enough. Trying to go cold turkey on smokes at the same time can make a person want to leave just when they are getting the immediate help they need. Maybe a nicotine patch is an option, but that would absolutely have to be cleared with the facility first.

Nthing all the Al-Anon suggestions. It really is more than her problem at this point and everyone needs some help. If in the least, go to learn how to deal with a post-rehab addict and their likely ensuing behavior. Maybe you don't feel that you want to do those type of meetings for the rest of your life, but getting yourself acquainted with the addiction world and how it has affected you is a valuable education.

If she agrees to go, knowing exactly what goes on in a detox/rehab is less important at that point than how you deal with her when she gets out. She will have professionals that will tend to her and know what to do. Let them do their job and you do yours - get yourself well. No matter what exactly goes on there, you will be of a far greater help to her after she gets out if you make a few changes yourself.

Good luck!
posted by lampshade at 12:08 PM on October 20, 2011

If the rehab allows it, you may want to make one concession: cigarettes.

Great great point. Cigarettes are a life blood in rehab!
posted by holdkris99 at 12:19 PM on October 20, 2011

My brother was in rehab over a decade ago, and his experience was much the same as others here: Very structured day, with therapy sessions, meals, and down time all planned out.

He also had no problem getting drugs there, brought in by various employees. And when he got out, his network of druggie friends has increased 10-fold.

The question is, "What happens AFTER rehab?" In my experience, if it's in any way forced (like because of a DUI, or whatever) then it's just a short vacation between addictions. Rehab doesn't change those who aren't absolutely sure they want to change.
posted by coolguymichael at 12:37 PM on October 20, 2011 [1 favorite]

DarlingBri and netbros both provide thoughtful perspectives on their rehab experiences, although their drug of choice (alcohol) was different than your sister's.

One thing to remember is that when someone goes to rehab they are meeting dozens of other addicts, the majority of which are there because someone else wants them to be and what they really want to do is get out of there and get high and being with like minded people makes that easier (kind of like criminals in jail meeting other criminals).

DarlingBri addresses this concern in the comment I linked above:

>Also, I have this (possibly ridiculous) fear that rehab is somewhat like I imagine prison to be, in that you can come out ‘worse’ than when you went in, and that mixing with other addicts constantly just makes you even more obsessed with drinking.

Worth noting: you're mixing with other addicts at a bar pretty constantly. How's that working out for you?
posted by virago at 12:59 PM on October 20, 2011

At the partial hospitalization program I was in (for bipolar depression & anxiety,) a few people had been in rehab and talked about it. They said it was a lot like what we were doing (loads of CBT) but with less freedom (rehab had more freedom than what the inpatient people had, but not a lot more.) The emphasis appeared to be on keeping busy not being high/whatever, though they also said it was really boring (and I have no idea how AA is even supposed to work where everyone's brand-new at the concept and half the people are there because they have to be.) I was told that not participating (just being in the room) was pretty common, but that they try a lot harder to get you to at least sort of make an effort than they do in inpatient hospitalization.

In the partial program they really started pushing for participation in therapy after two or three days. I can't imagine they'd be OK with staying in your bed all day, but I suspect it'd result in cajoling and turning lights on and stuff rather than force. I also very much doubt the staff lets you truly alone for very long (if at all) during the day. Therapy people seem to have a real thing for sitting quietly and watching you be miserable if you don't cooperate with programming (or are freaking out,) from my limited experience.

I was not at all impressed with the actual success rate of the rehab programs I was told about. Though admittedly, every single person I met was dealing with serious mental illness too, it seemed like the aftercare was not really at the level necessary to ensure success. Most of them said they were using again within days or weeks - it was all alcohol, which I would imagine is really hard to fight since the stuff is available everywhere and most adults have it in their homes and use it pretty regularly. Then again I've also been assured that it's ridiculously easy to get hold of illegal drugs in the community, so.

No one said rehab fixed anything for them - usually they talked about AA meetings and sponsors out in the real world being the key. And lots and lots of being really sick of being addicted. And really committing to therapy and taking their prescribed medications. The recovering addicts in my program were evangelists for sobriety and following external advice, actually. I think you can't get to that point without wanting to be there first. On the other hand, a few people did say rehab was their first successful attempt at "waking up" - that it was a necessary but not sufficient part of their journey from being mindlessly addicted to being someone trying not to be addicted.

(But again, every single person I've talked about this to was sent to a partial hospitalization program - and most were there after stepping down from a recent inpatient stay - for serious mental illness, mostly bipolar disorder, schizophrenia, or borderline personality. Then again, lots of addicts are self-medicating, so.)

Oh, and maybe it's just a local thing, but forbidding smoking appears to be the new "thing" in mental health programs. They gave the inpatient people fake cigarettes and at least one person had used them in rehab - a few others got put on the patch or got the gum instead. At the partial program anyone who wanted to smoke had to leave the hospital property to do it. This was cited as something that made everything much harder than it needed to be, by those who smoked.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 2:41 PM on October 20, 2011

I spent time in rehab, and found that they kept us busy. Meetings, group, activities, etc. Smoking was allowed only 3 times per day, and the staff kept all your cigs, then doled them out (Yeah, I don't get that either). The demographics were interestingly varied - young teens and twentys, middle agers like me, and some older folk. All of us living on the unit together. And we were all different in our reasons for being there - the folks my age were in for booze/pot/coke, the younger ones were all about pills (I learned everything I ever need to know about scripts and benzos from them). Not trying to generalize by age - it was fascinating to see people from all classes and age groups together (in hindsight, of course).

The main thing that I took away from the experience was that you really do have to be ready to kick if you're going to go in. There were so many repeaters there that had been in and out of all the rehabs in the area. It made me happy for myself that I went when I was ready, and I got so much out of it. There is a big difference between really being ready to change and being forced in. If your sister is really ready, what she experiences while she's in will hopefully give her the strength to fight her disease. And it's hard. Real hard.

Follow up is critical. I had to attend IOP (intensive outpatient group therapy) for a month afterward. And I went to meetings. Tons of them. Outside support is key. Definitely get yourself to Al-Anon/Nar-Anon - you will need support as well.

My experience was at a private rehab in CT. YMMV.
posted by sundrop at 5:45 PM on October 20, 2011

On the other hand, a few people did say rehab was their first successful attempt at "waking up" - that it was a necessary but not sufficient part of their journey from being mindlessly addicted to being someone trying not to be addicted.

Rehab is the start of a journey, not the whole journey. Recovery is a process. I decided to drink again 8 months after rehab. However, it was what I needed to do to accept my addiction and move forward. I've been sober since. If my support system dumped me after that slip, things might not have turned out so well. If your sister can afford individual therapy after rehab, I highly recommend it in addition to any other resources (AA, Rational Recovery &c.) that she has at her disposal.
posted by kamikazegopher at 8:14 PM on October 20, 2011

Mod note: From the OP:
Thank you so much for all your answers. They have been really helpful.

Al-anon! It never even occurred to me, but this is a really good idea. Nar-anon meetings are all an hour away from me, so will I be okay with al-anon even given that she doesn't have a drinking problem? There may also be programs at the rehab facility, I will find out about those as well. But figuring out how to deal with my anger at her lying to me and stealing my stuff etc will be good, as will determining when I might be willing to let her come to my place for dinner. Right now I don't trust her enough to have her over (I would prefer not to see her than to have to call the cops on her again), and I think that hurts both of us. I know we're very different people, with a big age gap, but we both wish we had more of a relationship.

I know she wants to get off drugs (mostly), and is willing to get help but resistant to inpatient stuff. But my parents will kick her out (she's actually 18, typo, so it wasn't a good option before this) otherwise, and I think she's more okay with going to rehab and then being allowed back home to being set up in a crappy apartment and not being allowed to visit except on a schedule. But again, these are decisions that I am not making. In any case, she's for the first time actually agreeing to do stuff to try to get off drugs, so this isn't court-ordered. She will have the financial means to get further therapeutic support on an ongoing basis, assuming she is willing to continue.

I will find out more about the rehab program she will be entering (there's nothing on their webpage).
posted by jessamyn (staff) at 11:49 AM on October 21, 2011

>Al-anon! It never even occurred to me, but this is a really good idea. Nar-anon meetings are all an hour away from me, so will I be okay with al-anon even given that she doesn't have a drinking problem?

OP, I think you'll definitely be on the right track with Al-Anon meetings. The 12-step program and the issues that an addict's friends and family members are dealing with are basically the same, no matter what substance the addict is abusing. A good meeting will help give you the tools to address what's going on.

"You didn't cause it, you can't control it, and you can't cure it." -- An Al-Anon saying that my friend who's in recovery tells families of people on the psychiatric unit where she works (the patients are often dealing with addiction issues as well as mental health ones)

Finally, I ran across this discussion in an online discussion group for addicts' friends and families and thought you might find it useful: How Al-Anon or Nar-Anon Works.

OP, you're a good sibling, you have a good heart, and I wish you and your family well.
posted by virago at 12:19 PM on October 21, 2011

Yes, all the best to you!

and is willing to get help but resistant to inpatient stuff

Addicts are always willing to get help...until the help actually is there to be offered. She's resistant to inpatient stuff? That's this week. Next week she'll be resistant because it's a full moon, or raining, or because it's a Tuesday. Good for you and your parents for setting boundaries and demonstrating that you're not willing to put up with her bullshit.
posted by Melismata at 1:18 PM on October 21, 2011

AA meetings will be very helpful, even for you. Just be sure it's an open meeting (closed meetings are exclusively for alcoholics). The folks at AA know addiction and what it's like living with it.

I'm going to recommend a book for you.

In the Realm of Hungry Ghosts goes into details of how the brain works with regard to addiction. It has personal stories too but the meat of the book is all about the brain. It's an accessible read too. If you can wrap your head around it, you'll have a better idea of how challenging addiction is. You'll also learn that addiction lurks in almost everyone in one form or another.

There is also the "The Big Book" as the AA people call it. You're best off buying a copy at an AA meeting. They're cheap and the online/free versions are out of date. It's a bit harder to recommend this. It's heavily focused on alcohol, men, and the "spiritual recovery for an illness" model that seems weird these days. The writing is pretty solid but has anachronistic chapters, most notably the "To Wives" chapter. The reason it's still a good read is that this is The Book of Genesis for the modern recovery movement.

Relapses happen. Don't be a sucker but don't give up either.

Best of luck to you and her.
posted by chairface at 8:01 PM on October 23, 2011

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