What to Expect When Going To Treatment
From My Own Personal Experience
In this post Covid 19 era of living where we are facing the challenge of going back to work and sending our children back to school and leaving our masks behind, some of us have come to realize that we have developed a dependence upon alcohol or other substances to help us manage our anxiety, depression, fear, etc. Being isolated in our homes has presented us with a great deal of unwanted time to ruminate upon thoughts and memories and past traumas that we happily distracted ourselves from with our occupations.
While most people will transition back to their lives with a sense of relief, some of us are left struggling with an aftermath of maladaptive coping we learned to use from a very early age. Think about it. When we were sick as little children, mom gave us medicine and we felt better. Now we do the same as adults. We should not be ashamed for following the same path to seek relief. The problem with medicating our woes is that sometimes the human brain wires itself to become addicted and when it does, you will need help to prevent a lifetime of problems.
Do I need to go to treatment?
If you wake up every day and plan your day around getting and using your substance, you can be sure that you will need to seek treatment. When you get to this point, your brain has developed neuropathways that bypass the prefrontal cortex where judgement takes place and has established a fast track directly to the midbrain – the part of the brain that tells your body to breath, eat, etc. It is at this point that the disease of addiction has manifested. Addiction takes the ability to control usage out of your hands and trying to stop on your own is rarely successful.
To further complicate the matter, daily use evolves from a mental addiction to a physical addiction and stopping use “cold turkey” can be harmful and even deadly. Detoxification can, at best, cause a great deal of discomfort, sickness, and mood swings. In many cases, it must be managed medically to monitor you and treat you as symptoms present themselves.
It is a scary moment in time when you realize that it has gotten this far.
You will experience denial. You will try and bargain your way out by saying this will be the last time you will drink or use this much. You will provide yourself with excuses, such as your job, your duties to your home and family, money, time. You may even try and quit on your own - several times.
Then at some point you come to accept that you need help.
You will most likely try to use “one last time” before you have to stop forever. Please do not fall victim to this thinking error. The mere thought of the finality of your decision to stop using may trigger you to overdose accidentally.
Are you ready to make that call?
Before you do, there are a few things that you may want to think about first.
1. How are you going to pay for it?
a. Do you have health insurance?
i. How much is my deductible?
ii. Which providers are in my network?
iii. How much is my maximum out of pocket?
iv. Does my plan cover Substance Use Treatment?
1. Does my plan cover in-patient treatment?
b. Do you have cash on hand to self-pay?
i. I will need to keep track for tax purposes
2. Can I get time away from work to go to treatment?
a. Do I qualify for a Family Medical Leave (FMLA)? FMLA is a FEDERAL provision that requires employers to allow employees to take leave of their position to care for themselves or for a qualifying family member. ***SPECIAL NOTE*** If your employer provides Short Term Disability insurance, see if you are covered. This is a financial benefit not a time away from work benefit.
i. If your employer has more than 50 employees at your location you would be eligible for FMLA if you have worked for more than 12 months and more than 1250 hours
ii. FMLA only covers you for up to 12 weeks in a 12 month period and can be taken all at once or intermittently if you are taking it for your own illness
b. Do I qualify for a leave specified in the company’s employee handbook if my employer does not meet the Federal requirement for FMLA?
c. Do I even care if I keep the job I currently work at?
i. This brings up a question of whether you will have insurance if you lose your job. The simple answer is maybe. If your employer is large enough, they must offer you COBRA continuation coverage, which you will have to pay the full cost for, plus an administration fee. But having lost your job you now also qualify for a special enrollment period to enroll in other health coverage but you only have a limited time to do so – usually 30 days from the date you lose coverage, and this new coverage is effective the date that you lost coverage so you will have no gap.
1. Do you qualify on your spouse’s insurance?
2. Do you live in an area that offers you plans from the Health Marketplace that can be found at www.healthcare.gov ?
3. Are your income levels low enough that you might qualify for Medicaid?
3. Who should I tell? This is very personal to you and your circumstances. Who will take care of your home, your car, your pets, your bills?
a. Family – Definitely tell close family who will worry if you fail to communicate or respond. You will also want to include those who will be supporting you in your recovery and who would be open to learning more about how to help you get better. You may be wrangling about whether or not to tell your children. Your absence from them will leave many questions and may make them feel insecure. But make no mistake, however well you think you have hidden your addiction from them, they know. If you do decide to tell them that you are going to get help, they may be relieved and hopeful for better days. Secrets keep us sick. Your journey to recovery may actually be teaching them that they can also have the courage to ask for help for what they need one day.
b. Friends – Same as family members, but friends are those who may have even more knowledge about your struggles and are willing to help. Still, there are some that you may want to consider keeping “out of the loop” for now such as using friends who will want to see your recovery as a threat.
c. Co-workers/Boss – You will need to report that you won’t be at work. Human nature will prompt them to try and get more details and all you really need to say is that you have a medical issue that needs to be attended to. Get in touch with your human resource representative and request leave documents for both FMLA/Leave of Absence, and Short Term Disability – if you have it available.
Time to pack a bag!
You will need to take enough clothes to last you for at least 5 days. Your first stop will be detox. This usually starts in the emergency room so having your bag won’t matter so much.
Once you have been detoxed, you will spend approximately 30 to 45 days in residential treatment with little access to stores so it is best to bring what you will want. In some cases, you may be able to order items that you need or want online but you should plan ahead.
Identification, Debit/Credit Card, and Insurance Card
Cell phone and charger (cell phone will be placed in storage while you are in residential, but you will have access to it to get numbers that you may need)
7 outfits (make sure that clothing does not depict images of using)
Clothing for working out/yoga
Sleeping attire suitable to wear around others
Underwear and socks
Comfortable shoes for walking and hiking
Swimwear (even in the winter, in case you go to a gym)
Shaving Cream/Razer (razer will most likely be stored and you will need to request to use it)
Non aerosol hair products
Make Up/nail polish/remover (will need to be stored and requested when you want to use it)
Favorite lounging blanket/Book/Pillow
MP3 Player that does not connect to the internet/with headphones (headphones can be Bluetooth)
List of all the names and phone numbers of people you may want to call while you are in treatment
Your favorite gum/candy/tea in a sealed package
If your treatment facility allows smoking, you should bring enough product/lighter to get you through at least a week. Treatment centers will work with you if you want to quit using tobacco, but you cannot usually use both tobacco and smoking cessation methods such as a patch or gum. You may be able to taper with a prescription. Treatment centers who allow smoking will have designated areas and sometimes will even regulate how much and when you will be able to smoke. Treatment centers will often take you to specific shops that have a decreased risk of triggering their clients or they will take an order for your product and charge a credit/debit card. YOU SHOULD FIND OUT BEFORE YOU SELECT A TREATMENT CENTER HOW SMOKING IS HANDLED BEFORE MAKING YOUR CHOICE.
DO NOT BRING:
Drugs or alcohol (I shouldn’t have to tell you that, but you’d be surprised)
Aerosol containers of any kind
Any substance containing alcohol, CBD, Kratum, pre-workout powder
Camera (cell phone will be stored until you are discharged and you may need it for therapy so bring it)
Large amounts of cash
Time to go!
Have a friend or family member drive you or call for an Uber to take you to the Emergency Room or call for an ambulance to take you if you do not have the resources.
What to expect when you get there
If your journey begins in detox,
• You will be put into a hospital gown.
• An IV will be placed so that they could administer fluids – this may be done in the ambulance if you called them instead of having someone take you to the ER.
• They will take blood and urine samples to establish a baseline, what they are dealing with, and how to best proceed with treatment. Tests are sent to the lab so you will be there for a while.
• Once it is known what your levels are and how your body is reacting to them, the ER staff will administer medications and fluids to treat you for withdrawal
You will then be moved to the detox unit. Plan on at least 3 days. **SPECIAL NOTE** Since many addictions are cooccurring with mental health issues, your journey may be a little different. If you presented to the emergency room in a mental health crisis (ie. Suicide attempt, psychosis, self-harm, etc.) your detoxification may take place in the psychiatric ward which is set up to prevent patients from causing further harm to themselves and can be much more restrictive and may take longer to be released
• You will answer a lot of questions and sign many forms. You may not be coherent during this process and will most likely feel overwhelmed and just want to sleep
• You will be given information about what to expect, your patient bill of rights, how to reach your loved ones, a code to give out so that people can contact you, etc. and you will most likely not be prepared to understand any of it when you get it
• Your belongings will be catalogued and stored – including your cell phone!!
• You will be taken to your room
• You may start getting nauseous – ask for medication to help with this
• You will be expected to eat – even when you don’t feel like it (psychiatric patients may not be given utensils with points such as knives or forks or even straws)
o *Special note about hospital food while in detox* If you want something specific, you need to say so. Most of the time, your food is brought to you. If you pre-order it, put down that you want salt x2, milk x2, ketchup, a straw, sugar x6 etc. and make sure that your writing is legible. Nutrition will be increasingly important during your stay!
• Stay hydrated!! Water/fluids will help flush substances out of your system
o Some detox centers do not allow you to have caffeine as it will mask your responses to detoxification. If this is the case, BE TOLORANT and polite. Don’t kill the messenger!
• You will have your vitals taken regularly (and at the most ungodly times of the night)
• You will have a nurse check or technician check on you every 15 minutes
• If you feel strange, dizzy, have unusual sensations happening – TELL SOMEONE IMMEDIATELY!
• Take a shower as soon as you can. You will feel better! Hospitals will usually give you a care package containing a trial size bottle of baby shampoo (it has a safety seal under the cap that is almost impossible to get off with wet hands so take it off before you get in), a cheap toothbrush, a bottle of roll-on deodorant, possibly a trial sized bottle of lotion and a comb.
o If you have your own clothes wear them
o If you brought a comb or bush, ask to use it
o If you need to shave, ask if you can use a razer (psychiatric patients may need to be observed while they shaved or they may be denied access for safety)
o If you need lotion, ask for it
o If you need chap stick, ask for some
o If you brought make up, ask for it if you feel like wearing some (psychiatric patients may not have access to certain make up containers due to safety concerns)
• You will see a doctor daily
• You will attend group/education and you will be expected to participate – even if you are tired
• You will have a discussion with hospital staff about aftercare
o It is at this point where you decide if you want to go to residential or if you want to try Day Treatment (Partial Hospitalization) or Intensive Outpatient (IOP)
Making the most of your experience
If you detoxed in a hospital setting and you have decided to go to residential treatment, the hospital will bring a representative in from one of the treatment centers you have chosen, or if you are not sure, they will arrange to have you meet with one that is available to you. Whether you medically detoxed or did it on your own, you need to go straight to the treatment center. This is to prevent you from going out and getting more substance before you go in. You will be nervous and anxious. This is normal and they are aware that you feel this way. Though treatment is usually not a lock down facility, you are not free to come and go as you please. Once you agree to become part of the treatment program, you may not leave without the presence of staff. This is done as a prevention to keep you from acting on the impulse to find your substance. *****If you leave treatment before being discharged, you will be considered as doing so against medical advice (AMA) and your insurance company may have the option to refuse to pay for any services that have been rendered.
• You will go or be taken directly to the residential facility. If you need to stop for a carton of cigarettes or a treat before you go, now is the time. You may also want to use this time to clear out any messages you have gotten on your cell phone and change your voice mail to a message that says that you will not be available to get messages for an extended time
• You will have your belongings searched
• You will fill out more forms and answer more questions
• You will be introduced to your fellow house members
• You will be given a tour of the facility
o Note what bathroom policy is – if a client can only use their own or if there is one everyone can use
o Note how to use the laundry machines and where the supplies are
o Note where to get towels
o Note where items are the kitchen and what the rules are, ie.;
Tell staff right away about any dietary constraints so they can plan for them
Many facilities will not allow food outside of kitchen/dining area
Where are the plates, cups, silverware, snacks
Where are the cleaning/paper supplies
Drinks must have lids
Only water in bedroom area
Do not put personal food in chef refrigerator
Dates must be put on a label with leftover name
Do not eat other client’s food without permission
Clean up after yourself – put your dishes in the dishwasher
If you are assigned a clean up chore, make sure you do it
• You will be assigned your room
o Keep your room clean!!
o If you have a roommate, respect their space and belongings
o Put your belongings away
o Be courteous!!
Don’t leave lights on (night light is ok)
Don’t play music loudly – even if you have a headset
Don’t use roommate’s stuff unless they give you permission
Don’t leave towels or clothing on the bathroom floor
If you make a mess in the toilette, clean up after yourself
If you use the last of the toilette paper, be sure to replace the roll
Do not leave your make up, hair styling products or appliances all over the countertop or sink. Put them away or store them neatly to one side
If you can’t sleep, don’t wake your roommate. Go talk to the night staff
Be mindful of yourself – your speaking volume, tapping when anxious, stomping while you walk across the room, slamming drawers or cupboards, or any other ways that might be an annoyance to others
• You will be given a schedule of programming, activities, and breaks
o Follow it!
o Set your alarm in the morning and make a point to get up when it goes off
o Familiarize yourself with the location of the clocks around the house
o Be on time and prepared to interact – You will be tired and unmotivated. Push through your resistance to the pressure you will now be under to be present
o Resist the urge to distract yourself from programming by sleeping, being late, going to the restroom during groups, creating conflicts to deflect attention from yourself
Focus on yourself and turn inward. This is your chance to take a time out and examine what is causing you to numb out. Many who enter treatment try and reach out to loved ones extensively and vocalize that they are there to “prove” to them that they are really trying in an effort to receive approval for their efforts. This mindset is not helpful for you because you are here for yourself – not for them! It’s time to give your loved ones a break from the pain of your addiction and the weight of obligation to be patient and understanding and let the professionals help you now. Your therapist will bring them in when you have had a chance to wrap your head around healing and it is more beneficial. Definitely call them and stay in touch. But resist the urge to engage them in your treatment until your therapist can facilitate the conversation and help them better understand addiction as a disease.
In residential you will have therapy several times per week during your stay. Your therapist is there to help you help yourself. He or she can only work as hard as you are willing to. If you have the expectation that just being in a treatment program is going to “fix” you then you are not going to be successful. You will need to be vulnerable. Open yourself up and talk about the things that you have kept hidden. The sooner you bring these out into the light of day, the sooner you can begin the healing and recovery process. Recovery takes hard work.
You will also participate in therapy groups and psycho-education. You may learn about skills to manage your triggers such as Cognitive Behavior Therapy, Dialectical Behavioral Therapy, Mindfulness, Gratitude, Meditation, Post Acute Withdrawal Syndrome, and more. Keep an open mind. Some of the material can be simplistic and its lesson will require your patience. Just like the lessons taught in the movie “Karate Kid”, Daniel did not understand that he was learning Karate while Mr. Miagi was teaching him “Wax on! Wax off!” did he. It’s the context, not the content that matters. Be patient and it will come to make sense for you.
Where do I go now??
At this point, you need to make a choice. Is going back to my home going to be the best environment for me or will I be setting myself up with too many triggers to handle by myself? Your Treatment Center may have options for you to go into a short-term transitional housing or sober living. In Sober Living you will develop skills to be successful on your own by:
• Paying monthly rent on time
• Being tested for substances
• Having curfews
• Keeping your space clean and doing your part in house chores
• Having to follow community rules and guidelines around sobriety and treatment
• Being held accountable by the community as well as the staff
• Being involved with sober social communities and networking
• Learning how to enjoy yourself without self-medicating
This option is a good first step to bridge you back to managing a sober lifestyle on your own.
PARTIAL HOSPITALIZATION PROGRAM
Once you have been discharged from residential, the next stop in your voyage is day treatment, also known as PHP. Here you will continue to acquire the skills you were beginning to learn while in residential. The main difference is that you do not sleep where you are receiving treatment.
• You will be responsible for getting to the facility on time and for taking your medications as prescribed without direction.
• You will be encouraged to engage in activities involving sober communities, such as Alcoholics Anonymous (AA), SMART Recovery, DHARMA, USARA, Yoga, sober softball, etc. so that you can find new connections to spend time with who understand what you are going through
• You will be tested for substances!
• You will be held accountable if you slip
o You will not be allowed to be present while you are under the influence
o You may have a set number of days before you will be allowed to return
o You may have an accountability assignment or requirement to complete. This is NOT to SHAME YOU IN ANY WAY!! This is meant to cement a boundary and reassign a thinking error. Please do not let your pride prevent you from progressing in treatment.
o You will be welcomed back with arms open wide and with loving acceptance if you slip!!
Relapse is always going to be a possibility for any person in recovery. No one is immune!
Relapse does not mean starting over! It means you start again with the skills you learned from this cycle and now you know what did not work. Next time can be different!
Intensive Outpatient (IOP)
After you have completed day treatment, you will transition to Intensive Outpatient. This usually means that you will attend programming for several hours per day for three days per week.
• You will still be tested for substances
• You will continue to learn about tools to use to prevent relapses and manage triggers
• You will be encouraged to find a sober social network to get involved with
• You will be encouraged to resume work
• You will continue to see a therapist
• You will be encouraged to set boundaries and abide by them
• You will be ready to hold yourself accountable and adjust yourself accordingly
My best advice about how to get the most out of going to treatment is that you always remember that you get out of it what you put into it. If you poke holes in your bucket, you have nothing left to throw on the fire! Do not go into this expecting that these people are there to “fix” you. You are there to get guidance on how to fix yourself. But that only works if you open yourself up and accept that help. If you go in wanting them to bend the rules for you, or if you try and sneak around and get away with the things that you have been told are not supposed to happen, then you are not ready! You don’t want to change. You still want to play the game with the demon, and you still think you can win. Good luck with that Jack.
Also, this is not a popularity contest. You don’t get to go in there and say you’re different than anyone else in there because nobody could possibly have had it worse than you did. Trust me, they have. Everyone’s story is different, personal, and important to them and you don’t get to choose whether it was bad enough for them to deserve their addiction. Just like they don’t get to judge you for yours. Therein lies the beauty of going to treatment my friend. EVERYONE IN TREATMENT HAS WALKED IN YOUR SHOES!!
You come in and let yourself be vulnerable with the expectation that no one is going to work harder for your sobriety than you are willing to work for yourself, then you may just make this the last time you go through treatment. The people you meet and the stories you hear will change the trajectory of your life.
About the author
I am a young old soul with a great deal of experience and wisdom and a heart as big as Texas. I am passionate about helping people and seeing the life spark in them when they are brought into the spotlight.