What Happens In Treatment

Mitchell E. Wallick PhD CAP CAGC

The first step to getting help for any addiction is to agree to get it. In my forty + (yes I am getting old) years of practice, I have discovered that two reasons for this are:

1. An illness whose hallmark is the feeling that we are doing well when we are not.

2. Fear of the unknown. The idea of treatment is scary.

The purpose of this article is to help the prospective client address both these issues.

The first area that I feel is important for us to understand is that the disease of addiction is one that affects our thinking process. Because we rationalize that we don’t have a problem, we cannot think our way out of the problem. In fact, we rationalize the fact that treatment is not only unnecessary but also is not worth the interruption it will cause in our lives. By the time an addict is ready for treatment, the pain of their illness has finally become greater than the pain of their disease. None the less, their rationalizations will interfere with their attempts at recovery. For that reason I tell my patients that:

1. If they think they need an opinion, just ask and we will tell them exactly what it should be.

2. We give a full warranty stating that if they don’t like what is turned out at the end of the rehab experience, we will return every bit of misery that they have given up.

The second part of the patient’s reluctance to enter rehab is twofold.

1. The first is their fear of what will happen when they come into the rehab. Television dramatizations, horror stories from friends and acquaintances, and not knowing what to expect makes them fearful.

2. The second part of their unwillingness is the fear of giving up their best friend, the drug. Understand that there is a grieving process related to entering into recovery. The addiction has been their friend and constant companion for many years. In a very real sense the addict is going to grieve the loss of their safety net against feelings, their fear of change,
and their reluctance to giving up the control which is so necessary for successful treatment to occur.

In order to allay some of these fears, this next section will deal with “What to expect in Treatment”.

The first part of treatment is usually intake. While the intake process may vary from program to program; the following will be pretty consistent in all programs:

1. Paper work. Mountains and mountains of paperwork. These will include, but not be limited to:

a. Consent to treat. This is a document that is signed giving the program permission to treat the patient.

b. Releases of information. This will allow you to tell the program with whom they are permitted to communicate. Understand that you are protected by confidentiality statutes and that without the release; no information about you may be given. You may revoke this release in writing at any time. Understand, that even if you revoke this release, the program cannot be responsible for information that they have released prior to your revocation. If you are court ordered to the program, they will be required to notify the court and/or their representative that you have revoked this release. The same applies if you have left the program. (Just a word to the wise, unless you are particularly fond of jail cells, this would not be a good idea.)

c. Orientation packet: Here you will be asked to sign a paper that says you have been oriented to the program.

d. Patient Rights Packet: This paper will outline your rights as a patient. You will be asked to sign the paper attesting to the fact that you have received this packet. This paper will also more than likely include a grievance procedure.

e. Financial agreements and payment. If there are any financial responsibilities you will be asked to sign papers indicating your understanding of the programs policies regarding payment schedules and/or your obligation for amounts not covered by your insurance.

f. Other paper work as determined by the program and/or therequirements of the state in which the program is located.

g. Many programs will have additional papers for you to sign.

Try to remember that these papers are legal requirements. They are no different
from the papers you would be asked to sign if you went into the hospital.

2. Generally speaking, the next steps in your program would be:

a. Assignment of a therapist.

b. Initial assessment. This initial assessment is designed to make sure you are eligible and appropriate for the level of care that the program is able to offer you. For example, if you have been drinking heavily and the program you are attending does not provide detoxification, you may be sent to another program for this step of your treatment.

c. After your initial assessment, you and your therapist, and others involved in your treatment will develop an individualized treatment plan. This plan is basically a contract, an agreement between you, your therapist and the treatment program that specifies the areas that you will be working on and the steps you will need to take to complete your treatment. You need to remember that as you progress through treatment, this is a flexible agreement. It is going to change as your treatment unfolds. You will in all likelihood begin to uncover problems about which you never recognized and/or were refusing to look at.

d. You will be attending groups, have individual sessions and an opportunity to share strengths, hopes and experiences with your peers.

3. The purpose of treatment is to assist you in attacking your and resolving the issues that you must face in order to return to a quality life. These issues may include but will not be limited to:

a. Psychiatric problems. Many of these problems such as depression can be treated with medication. These medications help to adjust the physiological causes that you may be attempting to self medicate. (Incidentally, what I tell my patients is, because you did not study medicine you are prescribing the wrong drugs for yourself.) For those who require these medications, the results are generally seen very quickly.

b. Rationalizations: Rationalizations are what 12 step programs refer to as “stinking thinking”. This means that the thinking process of the addict is “broken”. Through therapy, you will learn to examine your thought process and change your way of looking at things.
Here is an example of rationalization: An alcoholic walks into a bar and says to the bar tender, “set up five beers”. The alcoholic picks up the second and downs it. He does the same with beer three through five. He then says “set up five more please.” The bar tender
replies, gladly, but you still have not drank the first one. “Responds the alcoholic, “but you don’t understand, I am in AA and my sponsor told me never to pick up that first drink”.

c. Mistaken beliefs: These are an extension of rationalization. Mistaken beliefs include such things as:

i. I am worthless.
ii. I am invincible.
iii. I am unique. (Most addicts incidentally die from terminal
uniqueness.)
iv. I am entitled.
v. It is really ok to use drugs.
vi. It is really ok to use alcohol.
vii. I can control my use.
viii. If you lived like me, you would use drugs to.
ix. Marijuana is legal and used for medicine, so it should be ok.
x. I am not an addict because all of my “medications” come from Drs.

d. The pain of facing my past. In treatment you will learn about facing the fact that you probably did many stupid and not good things during your addiction. What you will learn is that you are a good person with a bad disease. Treatment will help you forgive yourself by:

i. Facing the fact that you did not choose to be addicted. Think about it. Did you plan it? Did you do anything to cause it? The answer is of course NO so how can you be held responsible.
ii. That does not mean that you get off scot free. While you may not be responsible for your illness, you certainly are responsible for managing it.

1. You are responsible for not picking up that first drink or drug.

2. You are responsible for making amends. Understand, amends are not just saying you are sorry. Amends are about changing your behaviors. You cannot undo what has already
happened, but you can change your future reactions.

e. Recognize that yours is a disease of the thinking process. This means that you cannot think your way out it. Instead you have to build a support system that you can rely on to think for you, till you learn to think for yourself. (If you think you need an opinion, just ask your sponsor and/or counselor and they will tell you what it needs to be.

4. Ok, so what does all this mean in terms of what is going to happen. How do I succeed in treatment?

a. The first step is surrendering your will. You are going to have to accept the fact that your best thinking has gotten you to where you are –and it plain does not work.

b. Expect to feel emotion. It is not going to be comfortable. For many years you have probably been burying your emotions with drugs or alcohol.

c. Expect to be restricted. No you are definitely not going to have the freedom that you had when you were living on your own. Sorry, structure and following directions is a real part of getting better.

Yes you may not have your cell phone, carry money, not have access to your computer, etc. Tough! This is all part of shaping the new and improved quality you.

5. What if the court ordered me to treatment? Well, I understand that treatment is better than jail. Besides the fact that it is more comfortable, if you work at it and attain your recovery, you will never have to come back and do it again. Remember the very fact that you were arrested for drugs and/or alcohol, by definition you have a problem. You need
help… and it is a far better deal to spend your time productively in treatment than waste time in jail.

In short, three steps in treatment are:
1. Sick and tired of being sick and tired. The pain of your disease becomes greater than your fear of changing.

2. Recognizing that you need to surrender your will and follow good orderly direction. This means looking at yourself and changing the things that create problems for you.

3. Acceptance of your disease and your responsibility to manage it. If you do all these things, I can offer you my iron clad guarantee. In the event that you don’t like what we turn out, go back to doing that which you have been doing prior to treatment and we will refund every single bit of misery that you gave up.

In closing, if you are fortunate enough to get into treatment, make the most of it!

Mitchell E. Wallick PhD CAP CAGC is Executive Director of C.A.R.E.
Addiction Recovery.