WHAT IS AN REHAB?
Seldom a week goes by without articles in the Newspapers referring to some Movie/Rock star going into rehab (rehabilitation) to address their “stress related problems” - later to be revealed as their drug/alcohol, sex or pill addiction. There has been a rapid growth in the rehab industry with new centres opening in Thailand, South Africa and Portugal. These newer centres claim to offer better, more researched and evidence based treatment than the older established centres, particularly in the UK. In many cases this is true; the overall experience gained by patients being admitted is not only positive but they are returning with a much better chance of their hard won sobriety lasting longer than the journey home. In some cases however rehab in an exotic destination can be no more beneficial than a holiday and patients return ill equipped for abstinence from their drug of choice.
But what exactly is rehab and what goes on behind those formidable front doors that many addicts/alcoholics find so difficult to enter?
The Clinical Team at Nova Vida Recovery Centre, Algarve, Portugal have visited many rehabs centres around the world to try and put together a rehab programme that works. One that works for everybody - Patients, Families and Staff. They continue to update their knowledge about treatment so Nova Vida can continue to offer the best therapeutic experience available. The environment isn’t bad either. Not everybody sees the stay as a chance to recharge their flat batteries. For many it is a daunting prospect at a time when their general well-being and self-esteem/worth, are at an all-time low. Self-pity, self-loathing are the predominant emotions and suicidal thoughts are often not far away.
Not everybody who abuses alcohol or drugs needs rehab. Only the small percentage who have been diagnosed as physically and/or psychological dependant and who cannot give up without help, enter the doors of a rehabilitation centre. For some it is essential in order to be detoxed from their chemicals under medical supervision.
Who are these people?
You don’t have to be on “skid row” to be dependent on alcohol/drugs. Many alcoholics/addicts hold down good jobs, remain in a relationship and have no financial concerns. At least that is their perception of the situation but on closer scrutiny, their jobs are on the line, the relationship is about to end and sometimes there are debts.
Addiction is a chronic relapsing illness that when left untreated can lead to a pre-mature death. It is treatable and treatment is often successful but you can never return to controlled use. Alcoholism and Drug Addiction are:
Primary – We cannot treat anything else effectively until the drinking/using stops. Equally it can stand alone with no other co-occurring illnesses.
Progressive – It always gets worse.
Chronic – Once you have it, you have it.
Fatal – Heavy drinking/using over a long time can destroy the brain, heart, liver and pancreas.
A diagnosis of alcohol/drug addiction can easily be made by your Doctor or an Addictions Specialist at Nova Vida. Once this diagnosis has been made, the choice is yours. You can hold on for a little longer promising yourself that you can handle it but in reality just digging yourself deeper in the hole taking with you, your family, friends and colleagues or you can opt for treatment. Once you have taken the decision to go for treatment you can pat yourself on the back; the difficult decision has been made. The work ahead is hard but you are now heading in the right direction.
There are not many philosophical differences between the rehab centres that offer abstinence based treatment. The predominant model is based on the 12 Steps of Alcoholics Anonymous (AA) and this is the model Nova Vida uses. But before you stop reading this and say “It’s a cult” or “I don’t believe in all that God stuff” I would respectfully suggest you forget all those preconceived ideas about AA and adopt an open mind. AA is not religious nor is it a cult but we will work with you and your difficulties and if you really cannot get your head around the 12 Steps there will be help on hand to look at alternative ways of staying clean and sober.
The Early Days
Nova Vida has an assessment process to determine that you really do need admission and that we can offer you what you need. This is important; important for us so we cannot be accused of just taking patients for the money because Rehab can be expensive. [Often the staff/patient ratio is 3 to 1 and all the necessary costs of running a Centre don’t come cheap] It is also important for you to know that we can help you. We need to know that we can look after you medically. The last thing we want is for you to be admitted only to be transferred to a general hospital a few hours later because of some medical complication. The assessment is conducted by a qualified addictions specialist and is a two way exchange. You will not be judged as often the staff have been where you are now; they too are in recovery. Since then, they have trained in the field and are qualified to Masters/PhD level. They bring their own experience of addiction and a much deeper perspective of the problem.
It is not a prison sentence; you are not being punished. However, Day One can often feel that way. You will be met on arrival by a caring team of professionals whose sole aim is to make you as comfortable as possible and to settle you down quickly to the Centre. The Admissions staff will deal with all the paper work efficiently in order to meet the strict controls that the local health authorities and licensing bodies apply to us.
You won’t be left sitting around withdrawing from your drug/alcohol. At a very early stage you will have a full medical check-up and providing it is medically safe to do so, you will be started on any detoxification medicine necessary to lessen the effects of withdrawal.
You are not made to suffer the withdrawal effects of stopping. Prescribed medication is administered to a safe level and whilst this may not totally remove the effects, it makes life a lot more comfortable. Other assessments include psychiatric with a Consultant Psychiatrist specialising in the field of addiction. All in all a very comprehensive medical, psychiatric and nursing assessment with blood already on its way to the laboratory to ensure there are no hidden complications following the years of (mis)use.
During your first day you will meet one of the therapists who will walk you through the programme. Rehab programmes tend to be group based which means that most of the therapy is conducted in groups. This has been demonstrated as the most effective way of getting well. There may be issues that you find difficult to talk about in group which is when one to one therapy with an appropriate member of the therapy team will be arranged. You may also be assigned a ‘buddy’ who will be a patient who has been at the Centre for a while who will show you the ropes. This buddy is important and as most rehabs work on the principle that you need to start asking for help it is essential you ask your buddy all the questions you want answered. Welcome to Rehab.
Movies have been made over the years about rehab and the best is probably “28 Days” starring Sandra Bullock. It is a fairly accurate [Hollywood] depiction of life in treatment. The days are structured with little free time. You may have some therapeutic duties to perform such as keeping the common areas clean/tidy or being a buddy but the majority of the time you will be engaged in your own recovery process. Learning from your peers, building therapeutic relationships, listening to educational lectures, attending workshops, repairing your body/mind with nutritional meals and getting well. It is hard work but you are surrounded by others with whom you can closely identify. You also learn to laugh again. Not the type of laughter fuelled by alcohol/drugs but genuine laughter listening to someone’s jokes or even their mishaps when drinking/using. We learn to laugh at ourselves.
Treatment is a 7 day a week process with Saturdays/Sundays showing only a slight slowing of pace. The weekends often see the arrival of family members. Not just for a visit to their loved ones but also to engage in meaningful therapy to learn about the dynamics of addiction and to start to repair the damage that has been caused by the addiction. The disease of addiction is a family disease. To be able to help the addict you need to work with the family system and that includes children. It is often an emotionally charged time with patients with family members reminded of the damage they caused and similarly those without family visitors reminded by their absence. Family therapy is an important part of treatment and family members are encouraged to participate. Research shows that if family members participate in the therapy on offer, the outcomes for the patient are enhanced. In many rehabs this family participation is an ‘extra’ expense. In some it is not. At Nova Vida we recognise the importance of the family participation and do not charge for immediate members of the patient’s family taking part in our family programme. These family programmes usually run over the weekend in order to be accessible to many family members as possible.
Old style treatment concentrated on the addiction alone. If you could stop the patient drinking/using, then the other issues could be looked at later. Today the approach is different. It is meaningless to concentrate on looking at the addiction alone without also looking at the underlying issues that occur side by side with the addictive behaviour. This may be trauma, abuse, relationship issues or a co-occurring psychiatric illness such as depression.
Nova Vida has fully trained professionals to help address these issues. Sometimes treatment is prolonged in order to address all the issues but better this than to discharge with the entire relapse triggers still around. Some of this work is done in one-to-one sessions with the focal counsellor if it is deemed too sensitive for the Group. But whatever forum is used for the work done in rehab, it is all encapsulated in confidentiality and anonymity. What is said in Group and in one-to-one sessions remains there and is not divulged to anyone inside the rehab except for the Clinical Team on a need-to-know basis. The only exceptions to this are if the patient is threatening to take their own life or the life of another; there are issues of current childhood abuse or national security.
Part of the rehab process is also about learning to live again without the use of alcohol or drugs. We are lucky here on the Algarve enjoying 350 days of sunshine each year enabling us to put together a programme that also includes time for leisure and time enjoying the outdoors. Walking, swimming, chilling-out are all catered for in the programme but they all have some therapeutic benefit. After 6 hours in the Group Room it is good to be able to go for a walk along a deserted beach and watch the sun go down over the Atlantic or mountains.
During your stay in rehab you will be introduced to the Self Help Groups that exist across the world. Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Cocaine Anonymous (CA) and the other 12 Step Group meetings form the support network for millions of recovering people around the world and also provide continuity if you are travelling from place to place as part of your work or leisure. You will seldom be far from a 12 Step meeting. During rehab you will be introduced to the meetings and get a greater understanding about what they are really about rather than the unfortunate myths and misunderstandings that prevail. Going to your first meeting with your peers is a lot less daunting than leaving it until after you have discharged when you may have to do it alone.
The day has finally arrived and it’s time to discharge and go home. For some the euphoria of discharge is tempered with the fear of going back to places where temptation is going to be high. For others going home is not an option. Whatever the circumstances of discharge, all the hard work done in the Centre will be wasted if an adequate aftercare plan is not in place. The recovery process has only really just begun and there are many months ahead where recovery has to be continually worked at in order to continue. The alternative to not attending aftercare meetings, AA or NA or CA is often relapsing. If death doesn’t get you first, it’s back into rehab – an option that might not be available to you if your funds have been exhausted. At Nova Vida we will work closely with you to put a comprehensive discharge plan into place which might include one to one therapy with a therapist close to home (if this is clinically indicated); attendance at local 12 step meetings and hopefully connection with an aftercare group weekly for a year post discharge. It is a sad fact that addiction is a relapsing illness and graduates from many treatment centres statistically have only a 1:3 chance of remaining clean and sober 12 months after discharge. Those that do celebrate their 1 year clean and sober are more often than not those who have had a good aftercare plan put together and who have regularly attended 12 Step meetings and aftercare. Let us not forget that addiction is a killer illness. We owe it to ourselves and our loved ones to do all in our power to make sure we are the ones that remain clean.
CONTACT INFONova Vida Recovery Centre