Why do we keep sending our loved ones away for addiction treatment?

I totally get it, "THEY WON'T STOP USING" -

• They are hanging around with all the wrong people
• If they just get away from all the drugs they will stop
• I'm afraid they are going to die unless we get them out of here
• They won't leave us alone; they are stealing from us; they are embarrassing us;
• I called Betty Ford-Crossroads-Cirque Lodge they are well-known and well-respected.

It is incredibly difficult to help someone stop using or drinking who is a serious addict/alcoholic. For friends and family members of the serious addict, it can seem impossible. (I hope you don't mind I'm going to use addict in this post to include alcoholics) Additionally, to maintain confidentiality we use the pronoun "they" for gender neutrality.

Our team is currently working with a young person who has been to over 30 rehabs over the last 15 years and yet continues to use drugs. Here is a little background, from their teenage years until now they have been to wilderness programs and rehabs in almost every conceivable setting including the mountains, desert, an island, the east, and west coasts, the beach, southeast, northeast, and south.

Our Client said, "in the early years, I wasn't really addicted to drugs. I was experimenting. My home life was difficult, my parents divorced and I was left with my mom who seemed very overwhelmed. On a regular basis, she would scream and yell, change her mind repeatedly, say "no", then "yes", then "no" again. At 15, I was hanging out with the cool kids, we'd drink, smoke pot, take hallucinogenics, fool around, and stay out late. It all seemed incredibly fun. I didn't see a need to stop using drugs and I didn't think I had a problem. In the middle of the night, I was woken up by a couple of strange men who came into my room and told me I was being taken to wilderness camp. I called for my Mom but she didn't answer.

After I got to the wilderness camp, I was physically and emotionally abused, made to disrobe in front of counselors, sit in a closet for hours with water but no food. I would tell my Mom but she did not believe me. Many years later, my camp was written about in the Atlantic https://www.theatlantic.com/health/archive/2014/08/when-wilderness-boot-camps-take-tough-love-too-far/375582/.

But as the years progressed so did their addictions. With the number of rehabs, our Client has been to, they could publish a Zagat guide on where and where not to go. They said a few of the centers were fantastic, many of them were mediocre, and there were a few really awful ones. Unfortunately, one of the wilderness camps they went to was closed for physical and sexual abuse of their clients.

The first question we need to ask is why are there so many rehabs on islands, in the desert, or in the mountains? Clearly, most people live in urban communities but instead of people going to their local rehab, they are being sent away to remote locations? Here are a few guesses on why large rehabs were built in remote areas of the country.

• It seems like there was this belief that by getting a person out of town, away from their bad influences, removed from their dealers, that they would be less likely to get drugs or be triggered to use drugs.
• That people wanted to get away from people who know them to reduce the shame associated with going to treatment.
• They needed a serene and beautiful place to get away from it all.

Let's see why the three reasons to send someone away to treatment isn't effective:

• Anywhere many addicts congregate there will be drugs, even if, the treatment center is in a remote place like an island, mountain, or desert.
• If I had a magic wand I'd wipe away any of the stigmas associated with having an addiction as having any other illness. Since my magic wand is broken...Having a private and confidential treatment experience is possible even in your local community, if the operator has the expertise and experience to protect your privacy.
• It is amazing to go to a serene and beautiful place for a vacation, recharge your energy, or get a fresh perspective. Unfortunately, effective treatment of addiction for many people takes a very long time and a good percentage of individuals the condition is chronic. Regaining impulse control and reducing the frequency of relapses can take a year or longer. Therefore, going away to treatment for periods under 90 days is of limited effectiveness and building a supportive environment in one location and then having to abandon that support to return home can be very challenging and possibly harmful.

If you ask our Clients why rehabs aren't working for them they will give you a number of reasons including:

Rehabs don't help prepare me for real life.

I've been to so many groups in treatment I can teach them.

I'm exposed to drug use in treatment just like I was when I was at home.

As soon as I "completed" treatment I wanted to use drugs or alcohol.

When I've asked clinicians and treatment center staff why that person relapsed they tell me that the "person just didn't want to stop." This statement has always confused me? From what I've learned from reading the research reports from NIDA, SAMHSA, CASA, is that addiction impairs the impulse control centers of the brain. Therefore, an addicted person's brain does not have the same capacity to stop as people without an addictive disorder. The person wants to stop using or drinking but can't stop themselves. It takes time for the brain to heal. Most of the time after 12 to 24 months people regain their ability to reduce their impulsivity to a place where relapse on substances is less likely.

Addiction treatment is not a car wash, we don't put addicts in one end and they come out the other end clean and sober. I don't care how many MDs, PhDs, PsyD, NPs, LMFTs, LCSWs, DOs...they have on staff, how many experiential therapies, trauma egg groups, witch doctors, or leeches, if you spent $10 or $1 million, it doesn't really matter.

How long does it take to repair attachment issues, trauma, and years of addiction and its accompanying lifestyle? What happens when a client in treatment begins to heal with the support of great clinicians and the fellowship of the community at the treatment center and then "completes" treatment after 30, 60, 90 days? Isn't it harmful to the client to leave the healing support of the treatment center? What types of harm does leaving the connection to the clinicians and the community do to the client?

Any person with a serious addiction-mental health issue's brain will slowly regain impulse control, develop better self-soothing skills, begin to build a connection over 12 to 24 months with effective treatment. Therefore, the rehab, which the person went to and "graduated" from or "discharged from" after 30, 60, or 90 days, is one more form of broken attachment and abandonment.

What good are rehabs? Are they a complete waste of time? No, if they do the following things:

• Intervene on active using and help the person through a physical detox
• Get the person a complete physical that will include blood sugar, endocrine system, allergies, autoimmune disease, heart, liver, and kidney function, or any other test that can make recovery more challenging
• Help a person connect to a fellowship of recovery
• Help a person connect to a psychiatrist, internist, psychotherapist, client advocate (sometimes referred to as a case manager), a mentor (sometimes referred to a sponsor), sober companions, recovery specialists, life coaches, etc. Help the person set up regular treatment team - recovery team meetings.
• Start building healthy habits of meditation, yoga, exercise, nutritional eating, mindfulness, helping others, etc.
• Take a timeout, see things from a different perspective, chill, kill time, immerse yourself in recovery, etc.

Findings from studies using follow-up periods of up to 2 years indicate that participation in formal treatment (e.g., Anglin & Hser, 1992; Hubbard et al., 1989; Prendergast et al., 1994) and longer time in treatment (e.g., Fiorentine and Hillhouse, 2000a; Simpson et al., 1999) are consistently associated with better outcomes.

Shhh, don't tell anyone! It is time to make treatment centers (rehabs) more effective by throwing out these antiquated models and bringing in something that works. In tech, we would say, it's time to disrupt the industry.