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rehab- how to choose

Jabberwocky

Frumious Bandersnatch
Joined
Nov 3, 1999
Messages
84,999
i'm half being pushed half jumping into rehab for crack and heroin addiction and am going to start looking at facilities soon. i have spent a long time reading the resources in the sticky on here but they didn't really answer my questions....

i'm in the privileged position of being able go privately so have a choice about where to go, how long for, whether to go. i will be able to detox at my parents before going. i've suffered eating disorders, anxiety, severe depression and have been diagnosed as possibly bipolar (the sort with mixed states) in addition to addiction.

  • what should i look for when looking around places?
  • the clinical outcomes of UK places are not available- is there any way to judge them? I've read that the outcomes of some places are the same as doing nothing.
  • is there any way I can tell I'm actually ready and this isn't a huge waste of money?
  • how long is it necessary to stay?
  • are there any rehabs that aren't complete abstinence based- i know i can have a g & t without being desperate for a pipe and would find it difficult to engage if i was being told i can't
  • can i have a g & t without being desperate for a pipe?
  • what is it actually like?

my life has deteriorated from having my dream job, and the world as my oyster, to no matter how many hundreds i make in a day, it never being enough, and i'm not even enjoying myself. but i also crave both b & w so so so badly, i've been addicted to gear for 5 years but the white is what made life unmanageable.

any advice at all would be really really gratefully received, or just a 'good luck' would be nice.
 
chinup said:
what should i look for when looking around places?
I've been in rehab multiple times and if there's one thing I've discovered, your conception of the ideal rehab likely doesn't exist. You just have to be an informed consumer and find the one that best fits your needs. There's no reason not to shop around.

chinup said:
the clinical outcomes of UK places are not available- is there any way to judge them? I've read that the outcomes of some places are the same as doing nothing.
Visit any prospective rehabs and go with your gut. You can't always go by reviews because even the best rehabs will have some pissed off clients, and the worst rehabs will have clients that can't be obsequious enough. I know this isn't always practical, but I live in Florida, the crooked rehab capital of America, maybe the world. Visiting in person will let you know if the nice, glossy pictures are a lie, or if the place is just "off."

chinup said:
is there any way I can tell I'm actually ready and this isn't a huge waste of money?

Only you can answer that, but one thing to consider is that you say you're half "being pushed" into it.

chinup said:
how long is it necessary to stay?

That's between you and the medical and counseling staff.

chinup said:
are there any rehabs that aren't complete abstinence based- i know i can have a g & t without being desperate for a pipe and would find it difficult to engage if i was being told I can't
I can't speak about the UK, but I've never heard of a non-abstinence based rehab in the USA.

chinup said:
can i have a g & t without being desperate for a pipe?

Only you can answer that. But something you might want to consider is will alcohol disinhibit you to a point where you will become desperate for a pipe? My primary DOC was alcohol. But I also quit weed because I will likely become disinhibited and consume alcohol. But it may not have that effect on another alcoholic who can smoke weed every now and then without their use escalating into a problem. I guess the question to ask is, "Will this substance cause me to be an irresponsible fuckup?" I've had rehab doctors who were horrified that the psychiatrist I've been seeing for years prescribes me Ativan, Ambien and Adderall, just because I'm an addict, but I can take those medications therapeutically without it escalating into abuse. We're all wired differently so that's something you have to figure out for yourself.

chinup said:
what is it actually like?

Impossible to say. That's why ideally you should visit in person. I've
been in places where you're not allowed to watch or read anything other than news or recovery related stuff, places where there is no internet access, where phone access and visitors are severely restricted, to places that have generous TV and phone privileges and places where business-related or living situation-related internet access is allowed. I've also been in places where little to no meaningful therapy takes place and everyone just sits around smoking or watching Netflix (I can smoke and watch Netflix without paying to be at rehab), to places that beat you to death with boring-as-shit process groups and mandatory 12 step meeting attendance (at least your day is structured that way).
 
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thanks so much for taking the time to reply and sharing your experience.

i intend to look around in person- I will visit 2 facilities tomorrow. All places in the UK offer 12 steps as far as I can see (so abstinence only, ugh) and because of my comorbid problems I am only looking at places that offer more than that.

I'm sorry you're stuck in the 'crooked rehab capital of America' that's gotta be frustrating.

I am imagining it to be similar to the inpatient place for anorexia- restricted phone, internet, lots of different types of therapy. but with one big difference- they used clonazepam to control behaviour in there and funnily enough anorexics do not tolerate treatment well so i often got several of the up to 3 extra doses daily (on top of the 3 standard). that sparked problematic bento usage i've never got over. i'm partly relieved partly petrified, there will be nothing like that on offer.

i'm not actively being pushed, but my parents refuse to continue the way things are, and they've been paying my bills. if i don't want to end up homeless, and make it impossible to renew my mortgages etc, i need to make it stop. i can't just hang around their house, where i don't use and don't crave to, i can have a g & t and not crave cos i know now that smoking light there just causes paranoia, forever and i can't see myself being an independent adult without serious changes, rehab feels like the only option.

so essentially- i need to look in person, they vary wildly, and i should get an idea of what the time structure is, and what 'freedoms' i'm granted?

also- what about the supported housing/aftercare? any idea whats worth doing/not doing?
 
Aftercare is a good idea. I should have gone after one of my residential rehabs but their partial hospitalization program was full so I didn't follow up and was drinking again within two weeks. Any respectable rehab will also assist you in finding a sober living community if you wish to go that route. Most US rehabs follow these steps:

Residential rehab -> Partial Hospitalization (usually six hours five days a week) -> Intensive Outpatient (usually three hours three days a week) -> Sober Living

A respectable rehab will also provide individual therapy and psychiatric services as part of their PHP and IOP as well. It's a good idea to ask what the terms of their PHP and IOP are as well. One IOP I was in kicked me out because I tested positive for benzos two times in a row. They knew benzos were prescribed to me and I asked them would they rather I drink, because that was what was going to happen if I had a full-on panic attack and didn't have benzos available to me, but they kicked me out anyway.

Definitely ask how the day is structured and what freedoms you have. I was whisked away to a detox and rehab by my old AA sponsor in the middle of a bender and once I got there found out I couldn't make or take any phone calls in the first week and after that you were limited to 20 minutes per week. And no internet period. That royally sucked and I ended up leaving against medical advice. Many places also have beautiful pictures of their grounds and recreation areas in their brochures and websites, but what use are they if you don't have time to enjoy the grounds, or take a swim or use the gym?
 
wow that is a lot of steps!! but i guess it makes sense. i really really want to go into supported housing after its almost a must for me cos i've known for more than a decade that i can't be trusted alone. i'm impossible with partners too cos i can't do all the batshit crazy shit i need to be alone to do.

it really does sound like you got a bit screwed by yours- i think its unfair to take you if they don't have space in the aftercare.

well i'm going to see my first 2 facilities tomorrow. i feel really nervous. its an hour and a half drive so i'm going to write down a billion questions in the car (i'm not driving!!). if there's anything else you think is worth asking please do let me know.

i'll probably have a load more questions after i've been.

this is properly making my addiction go nuts though. i literally decided earlier that i can't quit heroin at the start of winter cos i'll fell the cold. like a normal person. my anorexia stepped up hugely before inpatient but i only got 3 days notice. i've promised myself one last huge binge before i go in, to say goodbye. but that's just an excuse to use more i know.
 
this is properly making my addiction go nuts though. i literally decided earlier that i can't quit heroin at the start of winter cos i'll fell the cold. like a normal person. my anorexia stepped up hugely before inpatient but i only got 3 days notice. i've promised myself one last huge binge before i go in, to say goodbye. but that's just an excuse to use more i know.
No judgment from me. I chugged a pint of whiskey before going into my first medical detox. I'll be happy to answer any other questions I can.
 
So I'll start off by saying a lot of these questions will be answered/decided by you and the staff at whatever place you decide to go. The biggest thing I would screen for is a well staffed, professional and clean environment. Go and visit the place before, see where you will be staying and what not. Get a feel before you go, maybe talk to some of the staff there. A lot of it will be personal preference as well.

Also, if you are wanting help for some of the things you mention beside substance use disorder, then you will need to screen for that as well. These places will be called "dual-diagnosis" or "co-occurring disorder" capable. If you want to see a counselor/therapist, a nutritionist, or a doctor then you will have to make sure to express this desire and find a place that is fitting. And to be completely honest, you probably should address those deeper issues if you really want to have the greatest chance at a successful recovery.

what should i look for when looking around places?
Clean, professional, well-staffed. Capable of dealing with your specific disorders.

the clinical outcomes of UK places are not available- is there any way to judge them? I've read that the outcomes of some places are the same as doing nothing.
Unfortunately, not that I am aware of. But visiting the place and talking to some of the staff should give you a feel for each place. Maybe talk to some of the people who are there. Ultimately though your going to have to make a judgement call and hope for the best. In the end you need to focus on yourself. If you succeed it will be because of the work you put into your recovery. Likewise, it's important to own your failures and not try and shift blame. Even if it's not the best facility, it's up to you not them.

is there any way I can tell I'm actually ready and this isn't a huge waste of money?
That's a difficult question to answer. Rehabs and treatment facilities aren't 100% necessary in that people recover on their own or without the help of a rehab. I tend to look at it like I would going to college. Usually it is a very expensive decision that many will spend a long time paying off. A college degree isn't necessary to get a job most of the time and a lot of times people will find work in a completely unrelated field. But that doesn't make college a waste of time and money. Even if you are to find work in an unrelated field you still take with you the knowledge, personal growth, and some social wealth(friends and acquaintance)

how long is it necessary to stay?
That's dependent on you, your financial situation, and the facility you will be staying at. Personally, I wouldn't recommend inpatient longer than 60-90 days and probably no less than 30. But all that will be dependent largely upon you. If you can find a facility that has staff trained to work with your other disorders, a longer stay in the area of 90 days might be beneficial. Either way, the transition out of inpatient is probably more important than how many days you stay for. Having a solid plan and sticking to it after inpatient is what really determines how effective treatment will be long term in my opinion.

are there any rehabs that aren't complete abstinence based- i know i can have a g & t without being desperate for a pipe and would find it difficult to engage if i was being told i can't
can i have a g & t without being desperate for a pipe?
I'm guessing you're talking about gin and tonic? There are some places that allow cigarettes and coffee but you'd be wasting your money if they are allowing you to drink any amount of alcohol. The point is to learn new ways to cope that does not involve psychoactive substances. It's going to be painful and difficult but the brain can adapt to nearly anything. You'll learn a lot about yourself through not satisfying your drug cravings.

what is it actually like?

Pretty boring to be honest. Hopefully you can find a counselor that doesn't take everything too seriously. A lot of the exercises feel elementary and if youre anything like me talking about yoru feelings isn't something you enjoy. But hopefully you'll learn a lot and gain some insight on yourself and the disease of addiction.
 
thanks. i probably can't reply properly now cos i'm just in flood of tears but i just wanted to say the place i went to is confident they can deal with my dual diagnosis, i.e. addiction + ed.

i had an in depth conversation before NA with someone at the other place i was going to look at and they said they might not even accept me and offered barely any one to one, which i need. wanting to look at multiple facilities was a delaying tactic so i could have extra time to indulge my addiction.

that group makes me cut through the bullshit so i came home and said i want to go in a fortnight on monday- i need to sort my house out and get my cat to my parents. i'm leaving myself a 2.5 day window in the place i can use.

i felt serene at the time, but now i just feel grief for what i'm losing and grief for what i've lost and i don't know if i can do what i have to. i've always felt i was born to suffer. i was named after someone who nearly died twice in Bergen-Belsen concentration camp.

one condition of my parents paying and preventing me defaulting on my bills is me giving them power of attorney over my finances and i found out technically i'm not mentally fit to even grant it to them in my current state and it set me off.

they have an art room and i've wanted to learn to draw for ages too. so i can draw the places i go. but in my state of mind it feels futile. i'm worried i might really attempt suicide when i go home.

Mafioso- your points were useful but i'm not in a frame of mind to respond right now sorry i'll try to get back to you later i'm just in tears drinking and munching benzos.
 
Not to be a downer but rehab never got me clean.

Go with something reasonably priced and make sure you do it for yourself first and foremost.

I mean might as well try to make the most of it. I cannot say I ever voluntarily admitted myself to one though.

Being in recovery right now is my choice so perhaps it might be different if I chose to go to rehab by my own volition?
 
Sorry to go off topic but is there a doctor in rehab incase you need something to relax you or help with acute withdrawal symptoms?
 
i'm gonna go to one of the ones i saw yesterday. its fucking 15k a month but i've been spending 10k a month on drugs so i don't know why i'm worried, i don't have that money but my parents don't want me to die and hope i'll pay their retirement savings back.

there is a doctor there and i'll be taking my diaz and zopi in the boxes. i will detox for a week at my parents first, not wasting a week there lying in bed sweating, kicking and shitting.

argh i don't know though. i feel like going to norwich and changing my phone number, fucking everyone off and just going for it.

Save- i'm going because even though i am so so desperate just to smoke myself to death, i know there's more to life...

even the beautiful countryside half an hour from my home, is out of reach:

even this, half an hour from my home, is out of reach:

uI5N5ci.jpg


definitely this:

OuDWCaq.jpg
or this
lfXFmhH.jpg


i can't believe that my brain even thinks there's a decision between being able to take trips like that and sit at home on my own smoking till i die. argh feeling so bleak. i thought i really wanted rehab but now i want death more.

i torture myself like this looking at what i've lost and for what? to sit alone in my room smoking crack and putting my health at risk to do so.
 
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Sorry to go off topic but is there a doctor in rehab incase you need something to relax you or help with acute withdrawal symptoms?
Not off topic at all. I can't imagine it would be any different outside the USA, but all the rehabs I've been to have a psychiatrist and a GP on call if not on site, and there is always a nurse practitioner who can diagnose medical problems and dispense medication on site.
 
I know this is gonna sound preachy but you have to want to do it for YOU not for mum or dad or kids or anyone because other people will all go one day but you are left with yourself.

Be kind to yourself don't expect huge things at first just one day at a time.

Also sleep on it, I good night sleep and a fresh head to look at your problems is a good idea, don't be rash.
 
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Also, if you are wanting help for some of the things you mention beside substance use disorder, then you will need to screen for that as well. These places will be called "dual-diagnosis" or "co-occurring disorder" capable. If you want to see a counselor/therapist, a nutritionist, or a doctor then you will have to make sure to express this desire and find a place that is fitting. And to be completely honest, you probably should address those deeper issues if you really want to have the greatest chance at a successful recovery.

.....
Likewise, it's important to own your failures and not try and shift blame.

I'm guessing you're talking about gin and tonic?

thanks so much for your in-depth answers. most places in UK don't do dual diagnosis and i get back into the anorexia as soon as i stop the drugs so its a biggie. the place i looked at yesterday does do dual diagnosis and has a chef and controls your food so thats part of why i have decided to go for it. i see no point in going somewhere that doesn't address both.

as a research scientist i knew professionally that i was wrong all of the time so i'm better than average at owning failures, also means cos i'm used to it, i forget people outside of academia aren't used to it and i offend them a lot.

and yeah i fid mean gin and tonic, i'm drinking one now actually. they don't allow booze in there but am happy given alcohol isn't the reason that i'm going in, that they're not going to tell me i can never drink again. i did actually used to be a problematic alcohol user but cos i was drinking on an empty stomach i burned a hole in it and now can't drink much at all, so it really never will be an issue for me, but not being allowed boozed at select times would be a huge issue.

its interesting you don't recommend longer than 90 days- i wasn't planning to, more like 60, but why would you advise against longer?

i think i definitely do need rehab to get better cos i've tried to quit heroin since 2014 though with no help and my best is 4 months with only one usage. the fact that i've been in a supportive environment at my parents and still had the obsession to use just shows me i need something serious. i wouldn't have recovered from anorexia without going into hospital.
i'm hoping to go to a recovery house after.

i got through this post without crying. fucking hell thats a big one for me even up to the eyeballs on benzos i've been such a state since i said i wanted to just get on with it.

i've got 2.5 days left to do what i've been doing cos in a fit of madness yeserday i engineered it as such and now fuck fuck fuck

oh and there is a GP on site.

i still don't really wanna not smoke light and dark, i just wanna be able to do other stuff too (if you open the links to my picture attempts you'll see places i've been happy, i should also probably address why i can't be happy most of the time in mundane life rather than fantastic trips) but as soon as i start smoking i want nothing but smoking. i can earn enough for a holiday i badly badly wanted to go on in 2 days and still not be able to afford food. so though i want to use so so badly i recognise that i can't have the life i want whilst using, or whilst using light at least and i've hated myself for being on the dark for years.

if just not wanting the consequences isn't enough, then i'm fucked cos i fucking love hard drugs.
 
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chinup said:
its interesting you don't recommend longer than 90 days- i wasn't planning to, more like 60, but why would you advise against longer?
I wouldn't fixate on numbers at this point. Stay as long as your treatment team, and more importantly, you, feel you need to stay. In hindsight, it might have been good for me to do 90 or more days somewhere. I might have gotten sober sooner, but I can't discount the effect of all the negative reinforcement in the form of chronic relapses, either. I do understand why some folks might feel that at 90 days there is a diminishing return on investment, since rehab is a nice protective bubble. But you can't stay in that bubble forever and a lot of people (myself included) crash and burn after leaving that bubble. That's why I stressed the importance of aftercare in my first response to you. But remember it's not a prison sentence, so don't count days and focus so much on the temporal aspect of your treatment, but rather what you and your treatment team think is the best.

Did you have a chance to talk to anyone on the medical staff about your dual-diagnosis issues? One place I went to (the place where I said I stayed sober maybe two weeks after discharge) claimed to be dual diagnosis, but really wasn't. They did have people there dealing with legitimate mental health problems, but on the chemical dependency side, it was like sitting in AA meetings for four hours day. The psychiatrist there did me no favors at all. He diagnosed me with PTSD (which neuro-psych testing ruled out) but didn't catch my ADHD and depression. It was a godsend when a psychiatrist and clinical psychologist at another rehab six months later did the neuro-psych testing and caught those issues and prescribed the appropriate medications. Turns out when you don't feel like complete ass about yourself, and the world around you, you don't really have a good reason to use. At least I didn't.
 
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eople have said that relapse is often a major part of their long term recovery. but my parents ain't gonna find another 30k + so i really can't risk it.

you were right to stress aftercare. there are recovery houses near my parents and i really need to get into one as a stepping stone towards independent living.

this place really is dual diagnosis as far as i can tell. they have a chef and after what i've told them i will not be able to use food as a means of control. i won't be allowed any of what i describe as the crackhead diet foods- i.e. as close to pure sugar as possible. it only offers an initial 28 day stay and in week 3 the clinician decide on whether you need longer. i'm encouraged that they're ethical- not just wanting your money as long as possible. i'm wondering about doing 28 days, taking time out at my parents to consolidate, then going back in.

i didn't feel like a complete ass when i started using. i've just been depressed forever and had some really ingrained stuff in my psyche- being put in the bin as a child, bullied, and later on being raped multiple times, that made me feel unable to value myself at the best of times and actively self destructive at the best of times so that's what i need to work through.

they have 6 people max, loads of 1-1 group work too, it seems like the creme de la creme, they even have an art room and i've long wanted to learn to draw,

---------------------------
so more questions

  • Does doing a month in, a month somewhere safe, then another month, sound productive or wouldit be better to do the whole thing?
  • any tips on mentally preparing?
  • what should i bring? i'm allowed phone + computer 1 hour a day, want to bring lots of books, pictures to decorate my room... should i not being any of these, have i missed anything?
  • I've been losing my shit ad getting as battered as I can given I'm at my parents since saying to them I wanna go in soon. I know its normal to setp things up a notch but might this mean I'm not actually ready?
  • i can do acute detox at my parents- after this how long should i loeave it before going? straight away or as long as possible? does it make any difference?
  • i already know since i said i want to go in a fortnight tomorrow that this has made me really panicky- i'm worried i might just fuck off and block my parents numbers to avoid going. any idea how real this threat is and what ican to to mitigate it?
  • is it normal to feel suicidal at this point? i' genuinely worried that in my current state of mind i


i want the chance of this beck in my life:

ARwXI9a.jpg


not a grubby bedroom, grubby men, not daring to get an HIV test and almost never getting the satisfaction i need from the pipe

sorry for the long post

any input not related to my questions is also gratefully received
 
Hey chinup, I'm going to do my best to address some of your concerns:

chinup said:
i'm wondering about doing 28 days, taking time out at my parents to consolidate, then going back in.
If it's a good facility and you trust your treatment team, they will recommend what they see as being best for you. If they're only suggesting an initial four week stay, it doesn't sound like a place that wants to squeeze every last penny from you. As I alluded to in my first post, strong-arming you into extending your stay is a common tactic among Florida rehabs.

chinup said:
Does doing a month in, a month somewhere safe, then another month, sound productive or wouldit be better to do the whole thing?

Can't really answer that question. Rehab is definitely "safer" than being on your own, but it's not foolproof. People can get drugs into rehab, but it's more difficult (but not impossible) to cover your tracks when in a program.

chinup said:
what should i bring? i'm allowed phone + computer 1 hour a day, want to bring lots of books, pictures to decorate my room... should i not being any of these, have i missed anything?
Does the facility have a computer you can use because I wouldn't recommend bringing one. I don't know what this particular facility is like, but I'm guessing patient quarters are not secure because of the potential for self-harm and something like a computer would be enticing for a potential thief. At least you can sleep with a phone. If the facility places no limits on reading material, then by all means bring books, because as Mafioso said, a lot of rehab is pretty boring. And I can't imagine pictures would be an issue either, as long as they're not explicitly triggering.

chinup said:
I've been losing my shit ad getting as battered as I can given I'm at my parents since saying to them I wanna go in soon. I know its normal to setp things up a notch but might this mean I'm not actually ready?

Unfortunately we're not telepaths, at least I'm not. Only you can answer that.

chinup said:
i can do acute detox at my parents- after this how long should i loeave it before going? straight away or as long as possible? does it make any difference?

I would go as soon as possible. The mind is amazing at coming up with excuses if given the time - like me with that PHP program. Since I was going to have to wait a few weeks until space opened up, rather than looking into alternatives, which is what I should have done, I just figured I'd make it until then (after all I had just done four weeks inpatient) and ended up drinking before a slot opened up.

I agree with you about the detox. Stims usually don't pose any medical withdrawal complications and opiate WD, while unpleasant, doesn't have the same potential to be fatal like alcohol, benzo or barbiturate WDs. Save the money.

chinup said:
i already know since i said i want to go in a fortnight tomorrow that this has made me really panicky- i'm worried i might just fuck off and block my parents numbers to avoid going. any idea how real this threat is and what ican to to mitigate it?

Any
chance of going sooner? People make a commitment to rehab and then run from it all time time. If you can't go sooner, put yourself in a situation where running is as difficult as possible: give other people control over your phone, your money, your vehicle keys if you have one, etc.

chinup said:
is it normal to feel suicidal at this point?

Another good reason to go sooner rather than later. Feeling suicidal is never normal under any circumstances.
 
smoke crack and heroin till they kill me but without the consequences of missing out on what life has to offer

is that what you meant?

i feel suicidal.

i will reply to the longer responses, which i really really appreciate, tomorrow whey i can actually see
 
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