If you're currently experiencing thoughts of hurting yourself, please call the National Suicide Hotline at 1-800-273-8255. They will listen to you, and, if desired, help you explore mental health treatment options in your area.
Rehab Survival Guide
Preparing For Drug & Alcohol Treatment
This extensive guide is for individuals seeking treatment at inpatient drug and/or alcohol treatment facilities in the USA.
Do you have a problem with, or think you might have a problem with drugs or alcohol? If so, this guide is for you.
In this guide, we’ll start by talking a little about addiction. Then you'll learn about the treatment options available, what red flags to look out for, what questions to ask, what terms get thrown around, and what a typical day looks like at a treatment facility.
There are many ways to get sober and one size does not fit all. I hope this guide will give you the tools to find the treatment option that works best for you. My goal is to make you feel comfortable and knowledgeable going into this somewhat cumbersome process. I'll be real with you and tell you the ins and outs of selecting a rehab.
You may also skip to the section on selecting a rehab, or view the guide's table of contents by clicking the button in the top menu bar.
About Me: I’m speaking from decades of personal and family experience of going through countless rehabilitation and therapy programs. Keep in mind, I'm not a doctor or a therapist. I've just been around addiction and recovery for a long time. I try to back up my statements with science, but a lot of this is based on my own experiences. I usually do my best to write unbiased articles, but some of my biases towards certain programs definitely show through in this guide. It is ultimately up to you, with the help of a treatment team, to determine what is best for you.
I'm not endorsed by any rehab centers or making money off referrals.
A Note on Alcohol
Our society treats alcohol as somehow being different from other drugs, even though it works the same as heroin and meth as far as addiction in the brain is concerned. Its effects can, in some ways, be even stronger than cocaine or heroin. For the rest of this guide, I’m going to use the terms “addict” and “drugs” to include alcoholics and alcohol, since alcohol is a drug.
Alcohol is one drug that can literally kill you if you just up and quit. You need to taper off. Do not just stop drinking alcohol if you have been drinking for a prolonged period. If you haven't had a drink and are feeling shaky or nauseous, by all means, go grab one. I'm giving you permission to drink. Hard seltzers may be a good option, as they contain a lot of water.
Do I Have a Problem? Am I an Addict?
Admitting you have some type of problem, no matter how large or small, is the first step to getting help. For this guide, I’m going to assume you recognize that you have some sort of problem with drugs. It can be anything from drinking more than you intended on the weekends or smoking too much pot to injecting a bundle of narcotics into your veins every day. Addiction is addiction. If you think you have a problem and are considering getting help, you’re doing well.
If you are involuntarily being sent to a rehab for court or being forced to go by a family member, I have a separate guide you can read on that topic before continuing on. It’s not so common, but some people that get caught using drugs or driving under the influence made a one time mistake, and do not fit the clinical definition of a substance abuser.
The term "addict” or “alcoholic” has an inherent negative connotation in our society. You’re going to hear it a lot in recovery settings. Thankfully, you don’t have to use it as a label. In fact, you shouldn't. You can choose to call yourself whatever you want. Maybe you prefer the term “substance use disorder.” Or you’d be more comfortable saying you’re a “recovering addict.” Things like “I used to be an addict” are also acceptable. The brain is neuroplastic, meaning the neurons can change their structure over time. If you condition your brain to believe you're an addict, you'll always be one.
Recognize that if you’re reading this guide, drugs have affected your life in some negative manner. The degree to which does not matter.
If you’re looking for a clinical definition of the problem. The DSM-5, a guide used by doctors to evaluate psychiatric conditions, defines substance use disorder (SUD) with 11 criteria, of which at least two must be present (I’m summarizing).
- Using more of a substance, or taking it more often than intended
- Wanting to quit or slow down, but being unable to
- Spending a lot of time looking for the substance, using it, or recovering from its effects
- Having cravings or an intense desire to use substances
- Failure to fulfill obligations to family, work, or school because of substance use
- Continuing to use despite negative consequences
- Giving up time spent on family, work, or recreational activities/hobbies to use instead
- Using the substance in risky situations where you could be physically harmed
- Continuing to use despite physical or mental problems resulting from its use (paranoia, insomnia, infections, liver failure, worsening depression, etc.)
- Developing a tolerance where you have to use more of a substance, or more often, to achieve the desired effects
- Going through physical or psychological withdrawal when the drugs aren’t present (tremors or shakes, anxiety, insomnia, etc.)
So if you meet two or more of the above (many people meet most or all) criteria, congratulations. You probably have a problem that needs to be addressed. Welcome to the club.
Am I Ready to Quit?
I’ll lead by admitting that drugs aren’t all bad. They can be a lot of fun. Some of my favorite moments happened when I was absolutely wrecked and I wouldn't trade them for the world. Drugs may help you feel less depressed, more confident, more outgoing, more (or less) energetic, and may temporarily ease or help you forget the pain in your life. They work great until you run out of supplies and money, get arrested, wake up in the ER, or your tolerance gets so high and the drugs just stop working no matter how much you take.
You may be uncertain if you’re ready to quit and may not like the idea of quitting. You may not be ready to quit for the rest of your life right now. That’s all okay. The good news is, you don’t have to be 100% ready to quit to get started (though it certainly helps). You just have to try sobriety for a little while and go from there.
I’m not recommending it, but the liquor stores, drug dealers, dark web marketplaces, and marijuana dispensaries will always be there if you decide you want to use again. If you get sober and think, “Hey, sobriety sucks. I’d rather get messed up and ride my life into the ground.” It’s probably a bad idea, but it’s always an option. If you're not done yet, you're not done yet.
Once you get sober, get past the withdrawal phase, make progress on addressing your core issues, and begin feeling like a regular human being again, you may find that you enjoy, or at least can tolerate, sobriety. I’m not a fan of Alcoholics Anonymous, but one of their mantras is “One Day At A Time.” This one holds true. You don’t have to commit to sobriety forever, you just have to decide to stay sober for now. You can always go back to the drugs tomorrow.
It often takes multiple tries before people finally commit to sobriety. I hope you get it the first time, but if you don’t, at least consider practicing some harm reduction strategies so you don’t get yourself killed when you go back out. Don't get too down on yourself, either. You can always try getting sober again like you may try using again.
Determining Your Care Level
Everyone is different. What keeps me sober might not keep you sober. The good news is there are tons of different options to try out. I’ll level with you. They often require a lot of mental and physical work.
There are hospitals, detox centers, physicians, outpatient clinics, psychiatric medications, inpatient rehabs, outpatient rehabs, support groups, addiction therapists, group therapy, AA meetings, spiritual retreats, and countless other options to help you get and stay sober. Often you’ll need to try a combination of options to determine what works best for you.
I'm going to list all the programs involved in a standard course of addiction treatment, starting from the most intensive options.
- Emergency Room or Psychiatric Hospital
- If you are currently planning on killing or injuring yourself, please call 911, go to the nearest emergency room, or have a friend or family member stay with you until you find a nearby private psychiatric hospital that accepts your insurance. They take patients 24/7 every day of the year. A social worker will help you find a rehab to go to afterwards. Get the help you deserve. I'm proud of you.
- Detox Only Centers
- These are places where you go to get sober and safely taper off drugs. They rarely focus on therapy, groups, AA, or anything else. Their sole purpose is to get rid of the drugs in your system and send you on your way. This is better than nothing, but I’d highly recommend going to a facility that offers both rehab and detox, or going directly to an inpatient rehab program after completing the detox process.
- Detox centers have 24/7 nursing staff on hand to help with the physical withdrawal phase of recovery. They use medication to help you safely come off hard drugs and alcohol, sleep, and be comfortable. If you’re addicted to alcohol or benzos, they’ll taper you down safely to prevent life-threatening withdrawal effects. They’ll also closely monitor you and be on hand in the event of an emergency, such as if you have a seizure or fall and hurt yourself. They’ll bring food and drinks to nourish you if you’re too sick to get out of bed or even function. A physician will give you an exam and make sure you don’t need to be in a hospital or something.
- Standard Private or Non-Profit Inpatient Rehab Facilities
- This is the type of facility this guide is mainly about.
- Inpatient rehabs are often the first part of getting sober, but they don’t always have to be. Not everyone can go away for a month of rehab because of financial reasons, work reasons, or family obligations. There are many supportive outpatient programs and free support groups available if you can’t go to inpatient for whatever reason.
- Inpatient rehabs are facilities which provide a drug-free environment to recuperate and mentally stabilize from your drug use. They’re “inpatient,” meaning you live and sleep there for the duration of your stay. The time you spend there largely depends on your insurance company or ability to pay, the facility you select, and, of course, how willing you are to stay there. The average stay is about one month, but it can be as short as a week or as long as several months. They’re not psych wards or jails. Unless you’re a minor, you can walk out the door whenever you choose.
- Most inpatient rehabs offer detox services.
- Luxury Rehabs
- If you're well off financially luxury rehabs may be an option.
- These typically run anywhere from $60,000 to $150,000 per month and do not accept insurance.
- They offer private rooms, internet access, first-class amenities, and the ability to work while getting treatment.
- They offer the ability to connect with other high net worth individuals struggling with addiction.
- The therapists usually hold Masters degrees or PhDs and may work around your work schedule.
- They may offer treatment programs and regimens not typical to standard rehabs, some of which are questionable.
- Be extra careful when selecting a luxury rehab and be sure to focus on finding one with a good clinical team rather than a million bells and whistles.
- State-Run or Free/Low-Cost Inpatient Rehab Facilities
- These are like the private rehabs in that you live there, but aren't typically as good. They're often structured more similarly to boot-camps. Beds may be hard to get. They often have an old-school approach to recovery that's primarily focused on attending AA meetings all day. They're certainly better than nothing, and may be better than sleeping on the streets, but I'd consider them more of a last resort.
- Partial Hospitalization Program (PHP)
- Some rehab facilities offer residential PHP programs, which are very similar to inpatient rehabs. You'll be in groups most of the day and they usually provide breakfast and lunch. The difference is inpatient rehabs have more supervision and are billed differently to insurance companies.
- PHP programs may be on the same site as the living quarters, they may have apartments down the street you can live at, or they may allow you to come during the day and go back home every night. If living at facilities provided by the PHP company, you'll likely have to pay for room and board. Usually it's pretty affordable, like $25 a day or less.
- PHP includes medical supervision or medication management, but it might not be 24/7 access. There probably won't be a nurse available 24/7 like in inpatient rehab.
- If you start off in PHP and stay sober, your insurance company will not grant you clearance to go spend a month at an inpatient facility, as that’s a step up. If you do inpatient first, you’ll have the option to pursue PHP after, thus allowing you to get more days of treatment if you believe you need the additional support. Therefore, I recommend starting with inpatient and doing PHP afterwards for the additional weeks of support.
- Included transportation is usually offered if coming from home or a recovery house.
- It usually runs about six to seven hours a day every weekday.
- Program may last anywhere from 2 to 8 weeks depending on insurance and your progress.
- They may offer remote services due to Covid, where you attend online.
- Intensive Outpatient (IOP)
- IOP is the next step down from PHP.
- It's usually 3 or 4 hours a day, 3 to 4 days a week.
- May be offered with an optional boarding component depending on the facility, but normally you commute in each day.
- Transportation is usually offered if coming from home or a recovery house
- They may offer remote services due to Covid, where you attend online.
- No medication management or medical access from the facility, you need to find your own doctors.
- Program may last anywhere from 2 to 8 weeks depending on insurance and your progress.
- General Outpatient (GOP)
- The last step in the clinical program
- Usually 1-2 hrs, once or twice a week.
- More of a maintainance program
- No medication management or medical access from the facility, you need to find your own doctors.
- Program may last anywhere from a few months to even a couple years, with some places allowing you to return indefinitely.
I’d highly recommend starting off in an inpatient facility if you are a regular drug user or experience physical withdrawal. A stable, drug free environment is ideal for early sobriety. If you stay at home, you may be highly tempted to use again. Additionally, people who stay in treatment longer tend to stay sober longer when they get out, which is why going from inpatient to PHP to IOP and so on over the course of several months is a good idea.
If you're an occasional user or can successfully quit for several days by yourself, and don't have any withdrawal symptoms, you may start at the PHP or IOP level. A therapist or doctor's consultation can help determine where you should start the process.
Work & School Considerations
If you're afraid of losing your job because of taking a month off for rehab, don't. Legally, companies may not fire you for claiming FMLA/disability during your stay since substance use is a recognized mental health issue. If you're afraid your company will make up a different reason to fire you after returning, which unfortunately happens sometimes, they're a poor company to work for in the first place and you should cut your losses. You don't owe them your loyalty. There's plenty of jobs out there. You can replace them just like they can replace you.
If you're in school you can also report this as a disability, which may allow you to get a full refund on your tuition for the semester, even if you're past the regular drop period.
Alternatives To These Options
If none of the above options sound like a good fit, you can try a spiritual based program such as Teen Challenge (which isn't just for teens). You can try finding 12 step meetings in your area and see if that works. I promise, the people don't bite. You can schedule a meeting with an individual therapist to help you determine the best course of treatment. You could give Smart Recovery a shot. If there are none in your area, you can try doing them via Zoom (video calling).
You can also try stopping on your own and practice drug aversion techniques. You may find a doctor that can prescribe you appropriate medications to help with withdrawal and cravings from home. You can even try tapering yourself off the drugs or alcohol. It requires a tremendous amount of will power, but it can be done. I'd still advise you to go to inpatient rehab and seek professional treatment over these options.
Selecting a Rehab
Not all rehabs are good. There are plenty of bad ones out there. There are many good ones too that might not suit your specific needs. I’ll tell you that absolutely none of them will be perfect. There’s always going to be something or somebody that annoys you. The admissions reps may seem like pushy car salesmen. Some may even blatantly lie to you.
I don’t want to scare you off, but do your research and ask the right questions to ensure you’ve got the best chance of success. If you know a friend or family member that has gone to rehab, contact them. Even if you haven’t talked to them in a while, they’ll probably be happy to at least give you a recommendation.
If you get to the rehab and it’s nothing like what the rep said on the phone, have a backup plan before going in and leave.
Here are some key things to consider when researching your rehab. Ask the admissions reps about these issues. Write down the answers. Compare several rehabs until you find the one that best suits your needs.
Call the behavioral/mental health or addiction number on the back of your insurance card to find rehabs in your area that take your insurance. You can also call local rehabs and have them run your insurance. Verify with the insurance company. If you do not have insurance, your options may be severely limited to state run facilities or rehabs that offer free “scholarships” to people in need. Check your deductible, see if they offer a payment plan, and ask if there're any costs due up front. Insurance companies are required by law to cover rehab, but your deductible may still apply. Self-pay options are usually several hundred dollars per day, and can easily approach and exceed a thousand dollars a day. The last thing you want is a fifty thousand dollar bill after you come out.
Look into neighbouring states for rehab as well if you don't find any good ones in your area. Many have a wide radius and will pick you up even if you're coming from several hours away.
Self Paid Rehab: If you or a family member are self paying for rehab, you can expect it to cost around $1,000 per day, or even as much as $4,000 or more per day if you're going to a luxury rehab. Some rehabs offer discounted rates for people self paying, which will still be a few hundred dollars per day on the low end.
Most rehabs have their own detox unit so you don’t have to go to a separate facility. Ask about this beforehand and learn about their detox program. It's ideal to do detox and rehab at the same facility. Do they offer comfort medications to help reduce anxiety and aid sleep, or do they just throw you in a room to sweat it out? What medications do they usually use for your type of addiction? We'll discuss more on the detox process later in this guide.
Most rehabs offer group therapy every weekday, along with individual sessions once or twice a week. This is where you can start processing your emotions and work on yourself. You’ll analyze the reason’s you’ve been using and try to develop coping strategies for dealing with cravings and the pressures of outside life. You should ask how often you’ll be with your primary therapist, what their qualifications are, and if they have any specialized groups. Many rehabs offer specific groups for people with trauma, people new to recovery, people who are chronic relapsers, people in the medical field, first responders, military, older individuals, young adults, LGBT, and more.
Do they have a staff psychiatrist? Many people suffering from addiction have what’s called co-occurring mental health disorders and they self-medicate these issues with illicit drugs. Getting sober won’t immediately fix these problems. These doctors have trained for over a decade to help people like you with mental health disorders. Take their help. If you think you may have an underlying mental health issue, talk about it and try the medication. If you leave rehab chronically depressed, you’re not going to last very long when you get out.
If you’re averse to taking psychiatric medications, keep in mind the fact that you may have been using harmful drugs to self medicate for years. Psychiatric medications can be a logical, safe alternative for treating your issues. They won’t help immediately, and you’ll have to follow up with another psychiatrist when you leave the facility. It’s a process, but I promise it’s one worth exploring. Medications also exist to help with drug cravings, which makes it much easier to stay sober, even if you don’t have other mental health issues.
What does their admissions process look like? When you get there, it’s common for them to do a strip search and go through all your supplies. Addiction is a powerful disorder, and it’s not at all uncommon for drugs to find their way into rehabs. Remember, not everyone that goes to rehab wants to be there. You may be uncomfortable stripping in front of a stranger, this is normal. But they try to do it quickly and professionally. Some only require you to strip to your underwear, but many do make you remove everything. You may even be required to bend, squat, and cough. Fun! You may find it somewhat demeaning, but it’s the price of admission and helps keep you and everyone else safe. If you’re uncomfortable stripping in front of a particular person or a technician, you can ask for a nurse.
At least half the people with substance use disorder also suffer from another mental health issue. Staff should be trained on these issues and know how to treat them. They should be able to offer CBT (Cognitive Behavioral Therapy) and other therapies to help you manage your thoughts and regulate emotions.
Many rehabs (but not all) have a strict 12-step Alcoholics/Narcotics Anonymous approach to their programs. This is not necessarily a bad thing. 12-step programs work for some people, but you might not be some people. It’s good to get some exposure to the program. It may work for you. But if your rehab makes you go to three 12-step meetings a day, you may quickly resent it and hate the program. Aim for a rehab that makes you go to one or fewer 12-step meetings a day. That way, if you don’t like them, it’s only an hour out of your day, not multiple hours of agony. You should also ask if they offer other alternatives, such as Smart Recovery, NA, or Recovery Dharma (a Buddhist approach).
Do they have a gym? Do they offer art or music therapy? Do they do meditation? Do they offer any religious services? Is there a library? How often can you watch TV? You will likely have some down time between groups. What will you be allowed to do during these times? Are there any walking trails? Some facilities make you stay in one cramped room the entire day. I would avoid those.
What is their census, or how many patients do they have on average? What’s their staff to patient ratio? It should be around 1 staff to 8 patients or better. Some rehabs are large and feel like a college campus, accommodating upwards of a hundred plus patients. Others are smaller, and may only have a couple dozen patients. Are you looking for a small, homey rehab where you get to know everyone, or a large campus with lots of activities and a wide variety of people?
Speaking from experience, newer rehabs can have outstanding facilities, but if they just opened a few months ago, you’ll likely run into a whole world of chaos you don’t want to deal with. New facilities often have issues with staff training, retaining their employees, and constantly changing policies. Rehabs can be chaotic enough to begin with. You don’t want to be there while they’re still working out the kinks. I’d recommend going to one that’s been open for at least a year or more.
Some rehabs offer art therapy, music therapy, and yoga, all of which have proven therapeutic benefits. But others offer things like “equine” therapy. Although it may be a pleasant change of pace to get out and pet some horses, the therapeutic benefits are questionable. Some rehabs offer chanting, drumming, and meditation. This may or may not be for you. I’ve even seen rehabs that offer culinary classes, gardening, acupuncture, and massages.
Can you use your cell phone? Every rehab should let you make phone calls, but there are usually heavy restrictions. It’s not uncommon for them to have a “blackout” period in which you’re not allowed to make any calls for the first week. You likely won’t be allowed to have your phone on you at all times, if you’re allowed to use it at all. They may make exceptions for paying bills, looking up phone numbers, and ordering hygiene supplies or clothes online, but other than that, you likely won’t be allowed to use your cell phone. Some rehabs also monitor all phone calls with a therapist present. You should ask about this and make sure you clearly understand their phone policy before going in. Rehabs that allow you to use your cell phones usually only allow you to access them during certain parts of the day.
Can you access a computer? If you have schoolwork or professional obligations, do they allow you to access the internet to complete these tasks? Many do not. But ask if this is important to you.
It’s understandable that some rehabs don’t permit smoking due to it being a hospital-like environment, but when you’re in recovery, almost everyone smokes. It’s actually not recommended to quit smoking while you’re in early recovery, as you have bigger fish to fry.
Many rehabs don’t allow you to bring outside vapes in, as they cannot tell if you have illicit substances in the vape such as marijuana or DMT. If the rehab is directly affiliated with a hospital, or run by a hospital, they may have extremely strict limitations on smoking, or even ban it altogether. If they allow smoking, ask if they allow you to buy cigarettes on site.
My recommendation is to bring two or three cartons if you can, and try to limit yourself to only a pack a day. You also likely won’t be allowed to bring in unopened packs, as some people try to smuggle in drugs. So make sure you keep them sealed.
What is their food like? Are there any vegetarian options? What’s the bedroom and shower arrangement? Unless you’re self-paying for a luxury rehab, you’ll likely be sharing a room with at least one or two other roommates. Unfortunately, this is unavoidable.
Many rehabs have a store that sells clothes, books, and personal hygiene items. Some also have vending machines to get soda, ice cream, candy, or snacks. Never bring too much cash (I’d limit it to $200), as things sometimes go missing.
Have them walk you through a day in the life. Ask about what they do on weekends and holidays, because usually there’s less staff around. You want to be active and have things to occupy your time while you’re stabilizing or your mental health will deteriorate.
What are their policies on razors, grooming supplies, books, clothing, etc? You likely won’t be allowed to bring any clothes that reference drugs or alcohol. You should also avoid bringing any expensive jewelery, accessories, or clothing, as it may get damaged or get stolen. They try to prevent stealing, but it does happen. Do not bring more than one suitcase of clothing and three pairs of shoes. You’re not moving in permanently and they have laundry facilities. The less you have to deal with the better. Don’t bring any delicate clothes, as they’ll have to run it all in a high heat dryer for sanitary reasons. Bring your toothbrush, unopened soap/shampoo, nail clippers, and medications. Bring a hoodie or sweatshirt even if it’s summer, as sometimes they run the buildings on the colder side.
Some rehabs operate similarly to a psych ward, confining you to a small subsection of the property. Some keep men and women in entirely separate units. Others are co-ed and allow for mingling (I’d advise against rehab romances). They may only allow you to go to the cafeteria, game room, gym, or library during specific times. Others are wide open and you’re allowed to come and go as you please during downtime. Having some freedom and control over where you’re allowed to go and when is nice. At the very least, they should allow you to go to the cafeteria for snacks and hang out in the lounge as you please during downtime.
We discussed the differences between PHP and regular rehabs in the last section. Some treatment centers do not specify if they're a PHP or a traditional inpatient center. Make sure you're not going to a PHP with boarding program when you really meant to go to inpatient rehab, as PHP is a step down from inpatient and you could be losing out on weeks of treatment.
Often times they cannot give you a straight answer on this one. Some rehabs accept your insurance and automatically guarantee you a set number of days, usually four weeks. In most cases, however, your insurance only will approve days in small chunks. For example, they may begin by approving you for 10 days of treatment. Then on day nine your rehab has to fill out paperwork on your treatment progress and request approval for more days of treatment. The insurance company can approve or deny these additional days.
On average, most people get approved for around 20 days to 30 days of inpatient treatment, though I have seen cases where they only approve as little as a week or less.
Reading Reviews & Websites
Even the best rehab centers don’t attract the best reviews online. Most people hate going there, some are forced to go there, and again, nothing is always perfect. Instead, I’d pay attention to the content of these reviews rather than the ratings.
Look at different posts reporting similar issues. If they’ve got a three star review and all the negative comments are about the food and the uncomfortable beds, but everyone likes the therapists, maybe that’s actually a pretty good rehab.
Pay extra attention to the reviews that go into specific details about why they didn’t like it. Ignore the generic one star reviews and people just saying “it sucks don’t go here.”
When looking at websites for rehabs, take it with a grain of salt. They’re only going to put their nicest areas on display. Sometimes, they showcase beautiful rooms on their website. Then you get there and find yourself in what looks like a cheap motel room and find out that the rooms on the website either don’t exist or are only for their VIP patients in a different unit.
Advertised success rates are a lie. Many rehabs claim high success rates, such as 90% remission or greater. Relapse rates vary by drug user and age, but anywhere between 37% and 91% of people who go to treatment end up relapsing. They calculate these numbers based on follow up calls to patients who answer. They're completely subjective. They ask you how you're doing and if you relapsed. Lots of people just lie and say they're doing fine even if they relapsed because they just want the random phone call to end. The last thing most relapsing people want to do is talk about their relapse on a random unsolicited phone call.
Here are some key things to watch out for. Ideally, if things don’t go as planned and you feel extremely uncomfortable at the rehab, you should have another option lined up before going in. This way, if you need to leave, they can transfer you directly to another facility, or you can quickly get admitted to the next place when a bed opens up.
They likely won’t give you a phone and a laptop while you’re in there to research other rehabs, so do this beforehand. When in rehab, they try to isolate you from the outside world as much as possible. This has therapeutic benefits. They don't want you obsessing over social media or playing on your phones the whole time. But it can make it difficult to contact a family member for a ride or find a way out.
Remember, all rehabs are uncomfortable at first, no matter how nice they are. You’ll always find something you don’t like. Don’t quit just because you didn’t like the food much, the shower wasn’t hot enough, your bed’s a little uncomfortable, or your roommate snores too much. These are all extraneous factors. You’re stronger than that. They can usually find you a different roommate, you won’t always like everything they serve you, and they can move you to a different group or therapist if someone’s really annoying you. Only drop out or transfer to another facility if you notice major red flags.
One of the key things in any rehab setting is the absence of drugs. If you feel you are at risk of relapsing in rehab because someone offers you drug, leave and go to one that provides better safety.
There should ALWAYS be a nurse and a therapist available to help in the event of an emergency. Someone should be checking on you at least once an hour to make sure you’re okay (and 2-4 times an hour in detox). With the national staff shortage, many rehabs are understaffed and have high turnover. But if it’s ridiculous and impacting your therapeutic process on a daily basis, you may want to look into other options.
If this happens repeatedly, you should find another facility that has their stuff together. It’s common for the nursing station to be overcrowded, and you may have to wait half an hour for your medications, but they shouldn’t be losing things or giving you the wrong meds.
These happen frequently at some rehab centers and often revolve around AA or a similar spiritual program. Most people have an inherent desire to fit in and be part of a group. It’s okay to be a part of a group and connect with your peers, but you should not feel extreme pressure to do so. It’s good to step out of your comfort zone and try new things. Some rehabs take these groups to an unhealthy extreme, where you feel as if you’re being indoctrinated into a cult or joining a religious group.
I went to the Caron Foundation, a high end rehab that’s been around for many years. They had a spirit walk that involved doing a chant at 12 stones spread around the campus, ringing a giant bell, passing a wooden stick (I s#it you not) to a distinguished member of the cult each week, and ended their groups with a ritual where they fist pumped and shouted “Band of Brothers” or something. It was ridiculous, and I hated it.
The thing is, some people enjoy this type of atmosphere. It makes them feel connected to the group. My primary concern with this methodology is that 1) people are being coaxed by a large group of their peers into performing senseless rituals they may not be comfortable with and 2) once they leave the group they got so connected to over the past month disappears and now they’ve got nothing to keep them sober, other than a stupid chant. I got out of there shortly after a weekend of these antics.
I can name eight people who came out of Caron exclaiming what a great experience it was and how connected they feel to AA. They’ve had a spiritual awakening and whatnot. They’ve all since relapsed or died. Everything revolved around being part of this “brotherhood” and I couldn’t focus on my recovery.
Some rehabs do this. They have one large group space and you’re in there all day. This will only serve to make you more depressed and anxious. You need open spaces, a view of the sky, and some (but not too much) alone time.
This one doesn’t always mean you need to switch rehabs, you can ask for a different therapist. Therapists are people and none of them are perfect. Some are objectively better than others, and some are good, but just might not be the right fit for you. Unfortunately, some are also just plain awful.
A good therapist will have control over the room and the direction of the conversation. They know when to put the brakes on and when to pry deeper. They encourage you to speak, but don’t force you to. They give everyone a chance to talk about their problems and provide feedback to other group members. Some individuals may need more attention than others, but they should still keep everyone involved in the discussion.
You shouldn’t feel like a fly on the wall listening to other people’s problems for hours on end. Some therapists cannot control the room and allow one or two patients to monopolize the entire discussion, which can become excruciatingly annoying after a few days. If this happens repeatedly, bring it up to the therapist directly or to their supervisor and ask for a switch.
You’ll always have one or two people in your group that you don’t particularly enjoy. If you dislike the vast majority of them, you may need to ask for a group with better dynamics. Don’t be afraid to ask if you need something to help your recovery. Be tactful, direct, and cordial when presenting your needs. Don’t just say “this group sucks” or “this therapist sucks,” as that only serves to worsen the atmosphere and raise the tension, which isn’t good for you or the treatment team.
Remember, everyone has bad days. Occasionally, mistakes happen, which will frustrate you, especially when going through detox. Everything may seem boring or stupid to you, this is normal, you're probably depressed and going through withdrawal. Try to stick it out through detox before switching facilities. What seemed so bad at the beginning might not be so bad after a few days. Only leave if multiple red flags appear repeatedly and you feel your mental health is declining rather than improving.
You may decide to leave early if you'd like. I'd give it at least 24 hours of thought before committing to the decision, and I highly suggest transferring to another facility instead of just returning home early. Check your motives and make sure you're not leaving just because you want to go use drugs.
Be assertive. It's in their financial interest to keep you there, and some places truly believe they're saving your life by convincing you to stay (which may be true, sometimes). At least hear them out.
They will not give you successful discharge papers if you're there for court related reasons. It's considered leaving "Against Medical Advice." They will probably say a lot to convince you to stay. Maybe you should stay and stick it out for another day or two, but that decision's ultimately up to you.
Tell staff you're going to leave early in the day. Make sure they know you're leaving and that they're processing the paperwork, as it usually takes several hours to discharge you. Tell several people. Make sure the nurses, therapists, and administrators know you're leaving. If you just tell one person, they might not pass the information along.
Some rehabs make it difficult to get your stuff if you're leaving early. They may say they have to hold it for 24 hours or some nonsense. If they do this, tell them you'll come back with the police for your items. Or say you need those items to get into your next rehab. Or make up some type of other medical excuse. That usually gets them to back down.
If they really don't give you your stuff. Take what you can. It may be useful to have a sheet of paper ready with your family's phone numbers written down so once you get out you can borrow someone's phone and ask for a ride. In some states, they may be legally obligated to provide you with transportation up to a certain distance (they can't just throw you out on the street). This could mean a free bus pass, taxi ride, or they may use their own in-house transport team.
Standard Admissions Process
When you first arrive you will check in. They’ll provide instructions prior to your arrival. You'll have to take a Covid test and follow Covid protocols. They’ll want your insurance card, ID, and, if you have it, vaccination card. They’ll also want your signature on a lot of different forms and ask you a hundred different questions about your drug use. They’ll likely do a strip search in a private room and examine all your belongings. Anything you’re not allowed to have should be locked up safely for you to collect on your departure. They should inventory everything and have you sign off on what they’re holding on to.
Once you’ve been admitted, they should give you a brief tour, show you where your bed is, explain the basic rules, and offer you something to eat and drink. You’ll meet with a nurse or a physician who will check your vitals and start you on some detox medications. You might not see a physician during your first day there if you arrive later in the day, but you should definitely see one on the second day. They’ll give you a full physical to make sure you’re healthy enough to remain in the facility and refer you to a hospital if you are not.
Rehab Prep Checklist
This is a link to a printable PDF containing all the rehab essentials. You may find it useful.Rehab Checklist
A Typical Day in Rehab
All rehabs are different, but the good ones follow a similar structure. I’m going to give my best approximation of what a normal day looks like at a decent rehab.
You can also check out a Sample Schedule I created based on an actual patient schedule from the Caron Foundation. Here is another sample schedule from the Recovery Village in Cherry Hill. Personally, I prefer the second one, though it does have a bit too much free time.
They wake you up around 7:00. You have your morning coffee, cigarette, and breakfast. The dining situation is normally similar to a high school cafeteria, where you form a line, get a tray, and select your food . You go to the nurse and take your morning medications. Then they might do some type of yoga, meditation exercise, or give you gym time. You should have at least an hour of free time in the morning to take care of things like showering and personal hygiene. They may have a morning meeting where everyone gathers to discuss what’s going on that day.
After getting ready for the day, they’ll usually have some type of group session or sessions. This may be your small groups with your primary therapist, or it may be a larger psychoeducational group where they discuss a certain topic about mental health and addiction. It may also be an AA meeting, or they might take you out for an activity like recreational therapy or petting horses. The order varies between rehabs, but it’s all basically “group time.”
After your morning groups, you’ll have an hour long break or more to eat lunch, mingle, smoke, and play games or read/watch tv. You may be pulled aside to have a one-on-one discussion with your therapist.
After lunch, there’s more group time, so again you’ll be with a therapist, in an AA meeting, or doing some sort of planned group activity. They’ll give you some breaks here and there.
You’ll then eat dinner and take some time for yourself.
There’s usually one more shorter hour long group in the evening, most likely an AA meeting. Then you have the rest of the night to watch TV, snack, chat, get your meds, and go to bed.
Weekends are more laid back with less staff on, so usually no small groups or individual sessions. They’ll likely have larger groups instead of the small ones and you may have more free time.
It can become monotonous after a couple weeks, but the hope is with each passing day you’ll start feeling better physically and mentally. You’ll be able to think more clearly and make better decisions. Hopefully, you’ll setup a solid plan for when you get out of rehab and can get back to enjoying your life free of drugs.
Avoid Rapid Detox
Some facilities offer a “rapid detox” for opiate users, which takes 4-6 hours rather than 1-2 weeks. They put you under anesthesia and flush opiates out of your system with naloxone (an opioid blocker). I would highly advise against this method unless it’s a last resort, and you have failed multiple traditional detox programs. It might seem like a quick fix, but it’s putting stress on your body and opening a window for unnecessary medical complications.
Detox Process & Medications
I'd like to preface this section by saying that I'm not a doctor or a medical professional. Your doctor will help you make the proper medical decisions.
Standard Detox Process
Now let’s talk about traditional detoxes as part of an inpatient program.
Detox is the first phase at inpatient rehab centers with detoxes. It’s usually a separate unit in the building where you go through withdrawal and begin waiting for the drugs to leave your system. They'll start you on taper medications to limit the effects of withdrawal and lower risk of medical complications.
Most of your time in detox will be spent sleeping, lying around, watching TV, reading, or, unfortunately, crying and feeling horrible about yourself. They usually try to be a little nicer to you in detox, check in on you more often, give you food and drinks basically whenever you want, and won’t force you to go to group sessions. Often the nurses will come to you rather than you having to go to them.
To help with withdrawal symptoms, most detoxes offer “comfort” medications such as:
- Propranolol - lowers blood pressure, may help with anxiety and headaches
- Vistaril - an antihistamine that may help you sleep and feel less anxious
- Gabapentin - prevents seizures and may help with anxiety and cravings
- Remeron - an antidepressant that makes you sleepy and hungry (may help with underweight clients)
- Trazodone - another antidepressant that makes you sleepy
- Melatonin - standard over the counter sleep aid
Those are the ones I’ve seen offered most in rehabs. They should also have all the basic over-the-counter medications such as tylenol, ibuprofen, Claritin, and Mucinex on hand in case you need them. They’ll also give you lots of vitamins.
Next we're going to talk about drug specific detoxes.
Opiate Withdrawal & Meds
Opiate withdrawal may make you extremely irritable and short-tempered. Insomnia, nauseousness, and anxiety are also common. Be prepared for a few rough days with little sleep. Try not to dwell on things and just zone out for a few days if you can.
For opiate users, they’ll likely offer you Suboxone, Subutex, or methadone. You’ll often hear them referred to as “subs.” These are opioids used to help taper you off harder drugs, like fentanyl, heroin, or opioid pills. Suboxone contains both the opiate buprenorphine and the opiate antagonist naloxone (Narcan). Combined, these help to ward off withdrawal and fight cravings at the same time without making you really feel high.
Subutex is just buprenorphine without the naloxone, so it may also give you a high. You won’t really have a choice. Your doctor will probably put you on Suboxone unless there’s a reason they cannot.
You may also choose to refuse the subs and quit “cold turkey” (quitting and going through withdrawal with no help). Some people actually prefer to quit cold turkey and go through the full effects of withdrawal as an incentive to not use again.
They usually start you off at a higher dose and lower it slightly over the course of a few days or weeks until you’re no longer on any opioids and the bulk of the physical withdrawal is over. With chronic relapsers or people with chronic pain, they may start you on a maintenance program, where you can continue to receive these drugs in the future to prevent you from returning to the harder drugs. Ideally, quit using opioids altogether.
If you cannot quit and your doctor deems it necessary, maintenance programs work well for many people. Keep in mind that these drugs are still addictive and have similar side effects to other opioids. They’re just less euphoric and less likely to cause an overdose. They likely won’t make you feel high if you’ve been doing opioids for a while, but when people who don’t do opioids take them, they get a moderate high off them.
Alcohol or Benzodiazepine Withdrawal & Meds
Alcohol and benzos (Xanax and such) both depress the central nervous system. Quitting them suddenly after prolonged use can cause severe withdrawal symptoms such as seizures, delusions, insomnia, and even death.
To make the detox process as comfortable as possible and reduce risk of seizures, they’ll likely start you on a benzo taper to prevent seizures and delirium. If you’re not familiar with them, their effects are very similar to alcohol. I’ve seen Librium used the most, though it’s not uncommon for them to use Lorazepam (Ativan) or Diazepam (Valium). The doctor will decide what’s best for you.
They’ll start you on a high dosage and monitor how you progress with withdrawal symptoms. Once they notice the symptoms (shaky hands and such) subsiding, they’ll start lowering the dose. For mild-to-moderate users, the tapering process can take as little as a few days to a week. For heavy users, it may take possibly two or even three weeks to get out of detox. I would highly recommend taking the sleep medications and trying to sleep through most of it if you can.
I won’t sugarcoat this, alcohol detox can be hellish. People respond to benzos differently. If you were already depressed to begin with, the benzodiazepine taper compounded with the fact that you’re in rehab may worsen your depression. It may feel like being miserably drunk in rehab. Self harm and suicide are associated with benzos. If you feel suicidal or like hurting yourself, tell someone on staff.
Stimulant Withdrawal & Meds
They mainly try to treat the symptoms of anxiety, depression, agitation, and psychosis with other medications, such as the comfort meds listed above. With psychotic symptoms, which most often occur if you were doing a lot of meth, they’ll likely put you on an antipsychotic drug such as Seroquel.
They’re researching drugs to help with stimulant addiction, but unfortunately there aren’t any approved medications out at the moment specifically for it. Because of its fast acting nature, they can’t exactly give you a bump of coke every day and taper you down.
Some medications exist which are prescribed off-label to help with the cravings. Topamax (another anti seizure med) has been shown to help with cocaine cravings, so they may offer that if you find yourself constantly fiending for more stimulants.
If you’ve been taking stimulants to self medicate your ADHD, the doctor may have you try non-stimulant ADHD medication such as Strattera.
Marijuana Withdrawal & Meds
Though weed is becoming increasingly socially acceptable, it’s still a drug like any other. You can become dependent on it and use it as a crutch the same way alcoholics guzzle alcohol or heroin users jab themselves every time something good or bad happens. Over time, with chronic use, you may start getting depressed and find that weed isn’t really making you happy anymore. If you’re here for marijuana, I’m proud of you for admitting you have a problem, even if 99% of weed smokers deny that it’s addictive.
The withdrawal symptoms for marijuana include irritability, cravings, and heightened anxiety. Thankfully, they’re less severe than the other withdrawal symptoms in this guide. Still, I don’t want to discount your feelings. You may have trouble sleeping, experience weird dreams, feel kind of depressed or flat, and get annoyed easily. There're no drugs for marijuana withdrawal or cravings, but you can treat the symptoms if they’re bothering you. Marijuana, like alcohol, is commonly used to self medicate for depression and anxiety. So you may benefit from psychotherapy and medications that treat these underlying issues.
If you regularly use other drugs not covered above you may still experience some withdrawal effects. Hallucinogens such as LSD really only work well when your tolerance is low, so it's difficult to really become addicted to them. If you do use them often, you could be psychologically addicted to them. This means your withdrawal symptoms will involve anxiety, cravings, and poor concentration.
If you're addicted to a different class of drug or research chemical, your doctor will determine the best course of treatment and help with any symptoms.
Getting Through Groups & Social Interaction
It’s normal to be a little anxious during your first group meetings, even if you’ve been to rehab before. You’re coming off drugs, your anxiety’s heightened, and your thoughts may be scrambled. You may be extremely anxious, that's okay too. Here are some tips to help you get through:
- Take all advice given to you as a suggestion. Remember, no one can force you to do anything and everyone’s different. There’s no straight road to recovery.
- Step out of your comfort zone. Don’t go crazy and throw yourself to the wolves, but look at yourself and try to make slight improvements. Try new things. Talk to someone you wouldn’t normally talk to. Look at the bigger picture. Watch out for others and be kind to yourself.
- Share what’s important, but try not to go off on tangents.
- Advocate for yourself. I’m not saying demand filet mignon and lobster, but stand up for yourself and your recovery. If something’s not working, talk about it and work on a solution with staff. Don’t let anyone walk all over you. If your therapist’s not working out, ask for a different one. If your meds aren’t working right, ask to see a doctor.
- Don’t be afraid to talk to people or share in group. You’re all in there together, facing the problem of addiction. You might as well get to know the people you’re in there with. It’s not like you have somewhere else important to be. You will find people that can relate to your experiences and are going through similar problems. Maybe you’ll give advice to someone and realize you need to start taking your own advice. If you really are having problems in the group setting, talk about it in individual sessions with your therapist.
- Be ready to take a breather. If you need to get up and leave the room so you don’t flip out on people, do it. If they’re trying to get you to do something that makes you feel extremely uncomfortable, tell them you’re not going to. Go for a walk. Go talk to one of the staff members somewhere away from the group. If you need some you time, take it, within reason.
- Forgive people who are rude or ignorant. Not everyone’s functioning at 100% in rehab, and some are so far gone after years or decades of drug use, they’re literally learning basic life skills. Not everyone was raised in healthy environments. Some people have gone through a lot of trauma. It’s okay to not like everyone. Offer constructive criticism if you can, or step away and try to ignore them. If they’re directly interfering with you on a regular basis, tell staff. Don’t take things personally in rehab. You may get frustrated, but you need to let it go.
- Don’t lie to your counselors or your peers. It’s absolutely pointless. Chances are, you’ll never see most of these people again after rehab. Everything is bound by confidentiality (unless you’re homicidal, which is another issue entirely). If you’re lying, you’re doing yourself a disservice and wasting time.
- You will run into many chronic liars. Most people, especially other addicts, can see right through lies and will think less of people for it. It’s a nasty habit and if you catch someone in a lie, call them out on it or question them further and wait for their story to derail. Don’t intentionally belittle them, but give them a reality check. You’re really doing them a favor.
- There’s no need to show off, exaggerate, or glamorize your life. No one cares how much money you made, how “gangster” you are, or how many people you had sex with. It’s not a competition to see who’s the biggest, baddest drug addict in rehab. Just be yourself.
- Do not date anyone in rehab. We call them rehab romances, and they're a horrible idea. It does not end well and leads to relapse 99% of the time. You are not the special 1%. You need to learn to stand on your own two feet without leaning on someone else for emotional support. Relationships are difficult enough for "normal" people. If you're in rehab, you're in no condition to be dating.
Next Steps After Rehab
As you near the end of your time in rehab the clinical team should assist with your aftercare plan. They’ll likely recommend therapy, an outpatient program (PHP or IOP), going to support groups or 12-step meetings, and seeing a psychiatrist or individual therapist.
They may also recommend you move to a recovery/halfway/sober-living home. It’s uncomfortable living and sharing rooms with other people, but I’d highly recommend giving it a shot if you don’t have a family to go back to, or you feel like going home will trigger a quick relapse. If you have anyone on the outside who can tour recovery homes in your area for you and call outpatient centers to get information, that would be advisable. Some treatment centers are selective about where they send their patients afterwards, but others could care less. Do your own research if you can.
Whatever you do, do not let them send you to Florida. They're improving, but the rehab industry down there is still rampant with corruption due to years of lax regulation and you're more likely to come home dead than return sober. There are some good rehabs down there, but seriously, I would just rule it out entirely. I've had extremely negative experiences down there.
Regardless of which path you choose to get sober, I hope things work out well for you. Figure out why you use drugs and what you can do to work on your core issues. Be kind to yourself. Surround yourself with healthy people and build a life worth staying sober for.
I hope you found this guide helpful. Feel free to log in via social and post comments below if you have any questions. I will try to address them.
Thanks for reading and take care,Kevin Olson
Here are a few other things you might find helpful in your recovery journey.
- John Oliver - Rehabs (YouTube) - A good video overview of the problems with the rehab industry, with some key things to watch out for.
- Rehab Packing Checklist - A list of some essential items you'll probably need in rehab.
- Sample Schedule - Recovery Village - A sample of what the daily schedule could look like
- Sample Schedule - Caron - Another sample schedule with a heavy focus on spiritual programs
- Intro Image - Sad Teen, LightField Studios, Shutterstock #1502227286 - Licensed Do Not Copy
- Header Graphic - RGT Youth Leader Conference (Has nothing to do with addiction) - Andrianna Geo Free Unsplash License
- Alcohol is a drug. Experts say it's stronger than cocaine or heroin. (WebMD)
- Alcohol withdrawal can lead to death. Complications of Alcohol Withdrawal (Trevisan, MD, et al. 1998)
- Do not label yourself as an addict or an alcoholic. If you keep calling yourself an addict, you'll always be an addict. The brain is neuroplastic and to change your thinking you should identify yourself in a more positive manner. Neuroplasticity in Addictive Disorders (Charles P. O'Brien, MD PhD, 2009), Never Call Someone an Addict (Adi Jaffe Ph.D. 2018)
- 11 Criteria for Addiction (Elizabeth Hartney PhD), Substance Use Disorders, (Diagnostic and Statistical Manual of Mental Disorders, 5th edition, American Psychiatric Association, pp. 483,585)
- See Addictions & Stages of Change (W. Henry Gregory, Jr. Ph.D. 2015
- The longer you stay in treatment, the higher your chances of long term sobriety. Does retention matter? Treatment duration and improvement in drug use (Zhiwei Zhang PhD, et. al 2003, paper is behind a paywall)
- 29 CFR § 825.119 - Leave for treatment of substance abuse. (Cornell Law School)
- Lapse and relapse following inpatient treatment of opiate dependence (B P Smyth et. al, 2010), Abstinence and drug abuse treatment (McKeganey et. al, 2009), Relapse after inpatient substance use treatment: A prospective cohort study among users of illicit substances (Andersson et. al, 2019)