January traditionally sees a surge in rehab admission rates. And if you’re going to residential addiction treatment by choice, I completely support you. I went to rehab several years ago, at the urging of my parents but with my full consent. I agreed that I needed to get to a safe, alcohol-free place, and they knew of a prestigious rehab near my mother’s home.
In retrospect, I wish we had taken more time to explore our options. But I was not coerced. This article is primarily for those who are.
Thousands of Americans are coerced into rehab every year—by the criminal justice system, employers, professional licensing boards or family courts, as Stanton Peele has described for Filter. Too often, attending a 12-step rehab is a condition of staying out of jail, maintaining the ability to work, or keeping custody of, or contact with, your children.
If this is your situation, your best move would be to consult with an attorney (this article is not legal or medical advice). No one should be forced or threatened into rehab. And the Fourth Amendment of the US Constitution, which prohibits false imprisonment or unreasonable search or seizure, should prevent this—despite the many waivers rehab reps get you to sign during the admissions process.
But if all else fails and you are coerced into rehab, here is a short guide—based on my personal experiences and viewpoints, those of people I know, and my research—to what to expect and how to survive.
I hope this article will help. But also get a copy of Inside Rehab (2013) by Anne Fletcher and read it as fast as you can. It tells you exactly what to expect in a traditional 12-step, Minnesota Model rehab, which the vast majority of US rehabs still are. The more information you have, the better.
Be sober—but only if you safely can:
Many people understandably feel the need for one last night of getting wasted before going into rehab. The trouble is, this usually guarantees that you’ll get locked in the detox ward, which is not where you want to be. You will have no control over what medications you are given, and no family or friends there to advocate for you.
If alcohol has been your issue, for example, steering clear of it for three-to-five days prior to entering rehab will allow you to pass the urine test. Then you can be a “direct admit,” meaning you skip the detox ward and go straight to the normal floor, where you are likely to have more comfort and rights.
However, a big caveat is that if you’re drinking very heavily or using certain other substances—such as benzodiazepines, GHB or others—imposing sudden withdrawal on yourself can be dangerous and even lethal, and should not be attempted.
Again, you should always seek medical advice whenever possible. Failing that, carefully research the possible consequences of immediate sobriety from the substances you use before attempting it.
Plan for medication management:
Particularly If you have been on opioids, try to research your options as much as possible and find a facility that supports gold-standard medications like buprenorphine or methadone. These medications are often known as medication-assisted treatment (MAT) or opioid replacement therapy (ORT).
There are many more resources for this than when I was in rehab, when I watched young women go through heroin withdrawal with no medical support at all.
Rehabs may insist on taking control of your medication. Here is a place to draw a line in the sand. Many rehabs’ cookie-cutter approach to how medication should be handled (both psychiatric and physical) can put patients with complicated medication regimens in danger. Plan to demand that your own physicians continue to manage your medication, and that you be able to take your medication on schedule and at the doses you are prescribed. Inform your current doctors of this plan. Most rehabs will want to keep your medications and give them to you at “med time,” under the supervision of a nurse. This is fine as long as you get the medication you need, when you need it.
Prepare for possible pushback. For example, the rehab I went to was as vehemently opposed to Xanax as it was to heroin. I had been on Xanax for a raging panic disorder for years. I knew that this rehab’s practice was to put benzodiazepine patients on a “taper”—a patch that contained a combination of barbiturates and who knows what else, designed by their in-house psychiatrist.
I was sufficiently terrified of this mystery patch that I detoxed myself off of a major alcohol binge, using Xanax, in four days. Then I tapered myself off of Xanax… in four days.
My current psychiatrist is probably having a seizure right now realizing what high seizure risk I was at. I didn’t sleep or eat for at least six days, threw up constantly, and had strange hallucinations involving meeting Bill Wilson in a bar. Do not try this at home.
Denial of prescribed medication can incapacitate people. I remember watching a woman with severe back problems writhe in agony for hours on the couch in our rehab common room until the facility got around to giving her some medication—and even that wasn’t sufficient. Proactively plan to stand up, calmly but clearly, for your rights. Don’t let their ideology get in the way of your health.
You are walking into a situation that is unusual for most adults who have not been to jail. Most likely, your belongings and perhaps even your person will be thoroughly searched.
This is not like an airport screening. They take out all your things and search them for “contraband.” Not just alcohol or drugs, but any medications (even Advil or other over-the-counter drugs), mouthwash with alcohol in it and even some hand sanitizers! Who knew you could get drunk off of hand sanitizer?
If you find this objectionable, I agree. But this is how rehabs typically operate, and you need to be ready. In your own interests, stay as polite and professional as you can. Sadly, a key to surviving rehab without serious harms, as I and many others have found, is to never, ever lose your cool. If you do, you can make yourself a target for people who have great power over you.
I coped by pretending the search of my bags was a concierge service in a fancy resort. I thanked the young woman who searched my bags and put my things in the drawers of my little two-person room for her help unpacking.
Most facilities will send you a list of rules beforehand. Do your best to read them and make sure you pack nothing that is not allowed. If they insist on taking an object, let them. Don’t start a fight you can’t win; they will usually return it at the end.
In what is, again, a situation completely alien to most adults, most rehabs have a period of four days or longer when you are not allowed to have any contact (phone calls, visits or mail) with the outside world. This can be terrifying, but you can get through it.
In some ways, I found it a relief not to talk to my (understandably) freaking-out parents, my concerned-but-controlling boyfriend, or anyone wanting to sell me something. But the idea that another person controls to whom you can speak and when can feel horrifying.
This is another of the many moments where it’s best to just play the game if you can. It will be easier if you know this is coming and are mentally prepared. There’s no point in arguing—they’ll just mark you down as “non-compliant” and give you a harder time. Keep your cool and remember that the missed or not-so-missed people in your life will be back soon enough.
Rules, rules, rules:
Rehabs have a lot of rules. They are based on the stigmatizing idea that we “addicts” and “alcoholics” cannot control ourselves. These rules go much further than you might imagine, and there is probably a dress code. Most are much more restrictive for women than for men (surprise!).
Mine required that women wear a bra at all times when out of their room, and that all shorts or skirts be below the knee. There was a sign on the wall that actually said, “If you’re wearing yoga pants, make sure your shirt covers your BUTT!”
There are also rules about when you can eat, when you can sleep, and where you have to be when. This is both annoying and exhausting. At my rehab you had to attend meal times even if you weren’t hungry and didn’t want to socialize. Those who didn’t socialize—which at my rehab meant sitting outside with the smokers while they smoked for mandatory secondhand smoke inhalation—were accused of “isolating.” They were often watched more carefully by counselors.
My advice: Pick your battles. Control of your medication is a battle worth fighting. Many others are not.
A big exception I would make is if you are being harassed on the basis of race, religion sexual orientation, gender-identification or something else that is an essential part of your identity. You still have human rights in rehab.
My master’s in Public Health research was on the experiences of LGBTQ individuals in 12-step rehabs, and many of their stories of discrimination were harrowing. More options, tailored for different populations, are available now, but you have the right to stand up for yourself wherever you are.
The psychological damage that can be done by accepting psychological violence can be much harder to repair than addiction.
This was the hardest part for me, and for most. At my rehab and many others, people are put into small groups of eight or so, almost always gender-segregated, for what is passed off as therapy.
There is tremendous pressure in these settings to share your innermost stories, secrets and shame with complete strangers and counselors—who frequently have little more training than self-reported sobriety and time in a 12-step program.
Our group therapy was five days a week, for 90 minutes. During that time, we were not allowed to go to the bathroom or drink water. We had to read out our “First Step Prep”—a long list of all the bad things that we had done or that had happened to us while we were in active addiction. The purpose was to convince us that we were “powerless” over alcohol, drugs, whatever.
For me, the effect was to sear in shame that I still can’t shake.
When my turn came to read my long list of sins and bad events (including multiple sexual assaults) to a group of eight women I had met only two weeks before, I dutifully read it.
The women were then told, as they were with everyone, to repeat back to me everything I had said I had done. I was not allowed to speak. Even as they got the details of my story wrong. Even as they talked about my sexual assaults as though they were my fault for drinking.
Afterwards, the “counselor” asked, “How do you feel?”
For just one moment, the woman whose rehab persona had me labeled “Recovery Supergirl” for my excellent performance broke character. I said, “I can tell you how I’m supposed to feel.”
The counselor ignored this. I said little more and withdrew into my perpetual state of mild dissociation, making myself seem to be quite normal, even happy and very, very nice. But I was gone.
My personal advice would be: Do not do what I did. Share nothing you don’t wish to share. Leave out anything you’re uncomfortable talking about in that setting. Do not confess, unless it truly makes you feel better to do so.
The right to privacy in your most intimate, most painful emotional places should never be violated. But you will likely need to assert that right, discreetly, for yourself.
In most US rehabs, you have to go to 12-step meetings every day or night. Sometimes you get to go off campus for these. My advice: If you enjoy the meetings or find them helpful, go ahead. You may find that people who are at 12-step meetings by their own choice have a lot of wisdom to share, and you may find comfort in the stories of others who have been through issues with addiction.
If you find the meetings annoying, as I did, just go along and ignore what’s said. You don’t have to share. Maybe the coffee will be good, though I wouldn’t get my hopes up.
As you’re about to be discharged, the staff will want to make an “aftercare” plan for you.
I can almost guarantee that this will involve either a) suggesting you stay for another 90 days, at tremendous cost to your family or your insurance; b) suggesting you go to a “sober living home” where you are isolated from your family, education and career and effectively imprisoned in another, less costly rehab; or c) suggesting that you subscribe to some kind of first-year program that involves mandatory random drug tests, frequent phone check ins with someone from the facility, and a hefty fee.
Unless you genuinely feel that for some reason you need these things, or they are required by your licensing board or parole conditions, I can only advise that you do not spend one more dime on this process or obligate yourself to any further connection with the rehab or the rehab industry.
The aftercare plan will doubtless include attending 90 12-step meetings in 90 days, finding a sponsor, and working the Steps. You can do this if you want, but unless you are under the duress of a licensing board or court, you don’t have to. You can politely thank your counselors for their suggestions, and then forget about them once you leave rehab.
If you find meetings and a sponsor helpful, by all means, try it! But remember that there are other groups too, ones that are not necessarily based on abstinence or faith, such as SMART Recovery and HAMS (Harm Reduction, Abstinence and Moderation Support, which I personally help to run).
Once again, no one should ever be coerced into attending rehab. But if you are, the advantage to a 28-day rehab is that it gives your mind 28 days to clear out from the influence of alcohol or other drugs and make some decisions.
Your family’s emotions, threats, tears, cajoling all seemed like life-and-death when you were in crisis. You may well want to make your apologies and perhaps even amends (though that’s your choice, and yours alone). But now is the time to focus on moving on with your life.
Overcoming addiction is not about quitting a substance; it’s about finding a meaning or purpose in life that is more important than your involvement with an addictive behavior.
Most people outgrow addiction naturally, without treatment of any kind. This is called “natural recovery” and is the norm for the vast majority, not the exception.
So you played the rehab game and you survived: Congratulations! Getting your life back on track—with work, school, raising your children, or doing whatever you need or want do to have a fulfilling life—should be your priority now.
Finding the support you need, not pleasing others, is what will keep you safe, sane and maybe sober… if that is your choice.