Inside Rehab, by Anne M Fletcher

Old 08-14-2018, 05:54 AM
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Inside Rehab, by Anne M Fletcher

I read this book when it was published in 2013, and found it to be very informative.
So I’m reading it again.
Now five years old, so really doesn’t go into the fentenyl stuff.
What strikes me now, as it did then, is how invested rehabs are in 12 step programs.
Nothing against 12 step, but they are not for everyone.
I also have become interested in the Community Reinforcement and Family Training program, or CRAFT.
Intrigued because I have always been true blue Al-Anon, and CRAFT takes a different approach.
Would like to hear thoughts from anyone with knowledge of or experience with this program.
Have a great day, all.
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Old 08-14-2018, 07:56 AM
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while it doesn't get a lot of action, you will find discussions about other methods in the F&F Secular Forum.
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Old 08-14-2018, 09:08 AM
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I haven't read this book but I do know there is a drastic difference in the 12 step approach to addiction/recovery vs. other methods per the experience of our family. Recovery programs seemed to begin with what was already in existence - the 12 step approach. Rehabs came about as a way to house people and walk them through the 12 step program then release them back to the 12 step community.

When my husband first went into rehab, one picked out by his mom. It was based on the 12 step. Their philosophy was based solely on this, ideas were based solely on this. I was written off as a codependent and needed my own recovery. I was not to be part of his treatment because I couldn't understand etc.

Move forward to a time when he left that rehab and found treatment that was evidence based and not focused on 12 step. Totally different. It was about motivation, family oriented, cognitive behavioral therapies, medical approaches, no labels, no concepts that revolved around this is an addict, and this is what you are. Nope it was an individual approach where he was looked at and his specific needs were met. I was a participant in the recovery process. we did joint therapy. I was no longer called a codependent, but instead was called a wife who loved her husband and who didn't know how to handle the situation and had endured stress, trauma, and needed counseling to deal with my emotions. And we needed to work together to rebuild our marriage because family is the strongest support system if its healthy.

Big difference. Treatments and methods are advancing and becoming more successful in my opinion as new approaches are taken and tailored to the specific patient and family.

I do know a lot of rehabs now offer alternatives to 12 step, or make them optional part of the program which is based on more therapeutic approaches. I think its what is recommended by the medical community these days .
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Old 08-14-2018, 10:00 AM
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What you state, alicia, is also what Fletcher states in her book.
There are many paths to recovery. The tricky part is finding the one that works best for the individual.
Often there is a lot of stress and time constraints when people are making rehab decisions. Making the wrong choice can be a costly mistake.
Anvill, thank you. I will check out the F and F Secular Forum.
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Old 08-14-2018, 10:34 AM
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My daughter's counsellor had an interesting perspective on inpatient rehabs (regardless of philosophical orientation). She said the rehab peer influence is really important - some people go into rehab, look around at the other people, especially those who are further along in their disease, and say "OMG I do not want to become like THEM, I need to get my act together and work seriously at abstinence". Others look around and say "Well, I'm not nearly as badly off as THEY are, because I haven't lost my job/been to jail/lost my liver/lived on the streets, so I don't really have a problem and can go back to doing whatever I was doing before I went to rehab".

She also mentioned that rehab can have the unintended consequence of giving the addict a whole new peer group - other addicts - whose behaviors and experiences are not those of normal people. In this peer group, having criminal records, engaging in violence, getting fired from jobs, getting evicted etc are just another day in the life. The addicts ratchets down their own expectations accordingly and loses sight of the fact that normal people don't get DUIs or lose their jobs because they're too hungover to work, or end up in psych wards repeatedly with withdrawals. They learn to not see these behaviors as problematic - just baseline.
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Old 08-14-2018, 01:44 PM
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giving the addict a whole new peer group - other addicts - whose behaviors and experiences are not those of normal people.

seriously? do you see how elitist and derogatory that sounds? ewwww, other ADDICTS? god no. not that. not the unwashed proletariat who haven't had the best go in life.

how else is an addict going to recover unless they are in touch with other addicts at some level?
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Old 08-14-2018, 02:02 PM
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There are references in the book about people going to rehab and learning about new ways to abuse., but I thnk that is not a common occurrence.
Okay, so I checked out the secular F and F forum, and, praise be, there were a couple of posts about CRAFT.
But the posts were two years old and the posters’ names weren’t familiar, so couldn’t really have a discussion about it.
Color me intrigued, though.
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Old 08-14-2018, 02:17 PM
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Originally Posted by AnvilheadII View Post
giving the addict a whole new peer group - other addicts - whose behaviors and experiences are not those of normal people.

seriously? do you see how elitist and derogatory that sounds? ewwww, other ADDICTS? god no. not that. not the unwashed proletariat who haven't had the best go in life.

how else is an addict going to recover unless they are in touch with other addicts at some level?
It's not a matter of whether they're in touch with other addicts but what kind of relationship they have with other addicts. If it's "there but for the grace of God" and mutual support, that's great. If it's "wow, now I have a whole bunch of new friends to relapse with, and a whole new [lower] standard to hold myself to", that's not great.

I don't look down on addicts. But I also know that a lot of people by the time they get to inpatient rehab have done things which are outside the range of healthy and socially acceptable behaviors - trashed relationships with family members, been arrested, wrecked finances and bodily health, etc. I think if an inpatient program isn't managed carefully, these things can be excessively normalized because hey, doesn't everybody drive here when they're drunk or high?

My ex now considers arrests and 911 calls no big deal, because his peer group has shifted away from friends from his former life and towards people who drink and use to excess and create all sorts of chaos - and live in craziness. If he were working some kind of program like AA or Smart Recovery or whatever, he'd meet different people and his attitude might be different, but in his case he came out of rehab worse than when he went in.
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Old 08-14-2018, 02:18 PM
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Originally Posted by Maudcat View Post
What you state, alicia, is also what Fletcher states in her book.
There are many paths to recovery. The tricky part is finding the one that works best for the individual.
Often there is a lot of stress and time constraints when people are making rehab decisions. Making the wrong choice can be a costly mistake.
Anvill, thank you. I will check out the F and F Secular Forum.
That's what happened and why my husband ended up in that first rehab. There was not proper research done and to be honest my mother in law only really knew of 12 step approaches because of her relationship with the alanon program. I had been doing research but they rushed him in there. And then of course there is this myth that it doesn't matter what kind of treatment a person obtains, anything will work if the person wants it bad enough. I just don't think that's the case.

My MIL has really struggled. I was just posting that one of the things that's helped her is seeing that movie called pleasure unwoven where it gently explains how substances affect the regions of the brain, and why people behave the way they do / have the symptoms they do. Its helped her realize that as a man his character isn't tied to the symptoms of the illness. But he does have deeper emotional issues and needs specialized care, along with the addition counseling to keep him safe in the future.
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Old 08-14-2018, 02:44 PM
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It is a complex issue, for sure.
And not to belabor the book, but another thing that I found interesting is the to detox or not to detox question.
Many rehabs won’t admit without the patient having spent time in detox.
Though there are cases of the patient having stopped drinking for a period of time prior to entering rehab, so should they have to go through detox?
Fact is, detox adds to the bottom line for the facility, but it is also a way to ensure that the patient is starting the process clean.
There is a case cited of a woman in a detox facility who was was in an unlockable room and across the hall from men, also in unlockable rooms.
That would be way too scary for me.
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Old 08-14-2018, 04:56 PM
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Originally Posted by Sasha1972 View Post
My daughter's counsellor had an interesting perspective on inpatient rehabs (regardless of philosophical orientation). She said the rehab peer influence is really important - some people go into rehab, look around at the other people, especially those who are further along in their disease, and say "OMG I do not want to become like THEM, I need to get my act together and work seriously at abstinence". Others look around and say "Well, I'm not nearly as badly off as THEY are, because I haven't lost my job/been to jail/lost my liver/lived on the streets, so I don't really have a problem and can go back to doing whatever I was doing before I went to rehab".
The therapist we used links this to - the concept that all addicts are alike, and idea of 'the addict' or 'the alcoholic. Being told your paths and recoveries are all alike.

It brings about the need to compare to others, instead of looking at ones own life, goals, and how their 'use disorder is affecting the person as an individual. When instead - it doesn't matter the depth of another persons addiction/mental health issues, doesn't matter what they are doing to recover. Treatment for me' wont be like treatment that someone else goes through necessarily. And it can highlight the importance of early treatment and the difference it makes to get things under control early on.

She also mentioned that rehab can have the unintended consequence of giving the addict a whole new peer group - other addicts - whose behaviors and experiences are not those of normal people. In this peer group, having criminal records, engaging in violence, getting fired from jobs, getting evicted etc are just another day in the life. The addicts ratchets down their own expectations accordingly and loses sight of the fact that normal people don't get DUIs or lose their jobs because they're too hungover to work, or end up in psych wards repeatedly with withdrawals. They learn to not see these behaviors as problematic - just baseline.
Our therapist said the same type of thing. I mean lets be honest here, its a dangerous dynamic to have people who are in addiction, struggling with addiction, along with many dysfunctional patterns of behavior, dysfunctional families, relationships, work/career, financial issues, legal problems. Again it goes to comparison. For some I don't know it may be a rise up' from their baseline. But for others, and for young people it may trap them in an environment where they feel only other addicts/alcoholics can understand or help them - so they need each other. This can displace other relationships with friends, coworkers, family, meeting new people through other activities. Recovery can provide a 'new world' where there is constant struggle with chaos., acceptance they are broken and need fixing. This can bring about a lower expectation and baseline of normal.

I have seen this tv show called 'MOM' this summer. And its about a group of female alcoholics and addicts who go to AA together and work with the same sponsor. Its funny and they do try and support each other, but yeah their baseline is off as to normal and its complete dysfunction.

The other issue my therapist talked about is recovery work varies. Dealing with the addiction, being abstinent is only one thing. Many people also suffer from multiple mental and emotional health issues and have varying degrees of treatment for these issues. We were told a real danger is people who feel like since they have their addiction under control they are ok. They may have never been treated for other issues and may be in denial there even are other issues. Rehabs generally only last 30 days and then how many people continue on with therapy? And most programs are only designed to support quitting drugs and alcohol. they are not designed to deal with other issues at all. to me that is scary.

My husband has no friends in recovery, or in active addiction. His good friends (normies) from work have stuck by him, and we have made friends as a couple' and as parents' now that we have our son.

I think about how hard it would be to have the majority of my friends being in constant struggle, or life being all about one point in time when active addiction was in our lives, or I was in this bad place emotionally. I think I would feel stuck in that place emotionally, if not physically. I don't like that feeling.
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Old 08-14-2018, 05:16 PM
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I like “Mom”.
I didn’t at first, but I have come to enjoy both Alison Janney and Anna Faris.
I don’t find the AA meetings super believable, but it gets the job done.
And I like the overall premise of both women having done damage to themselves and their families, but are now sober and accept what they did.
Treating addiction in a humorous way is a fine line, but I would say that Chuck Lorre (The Big Bang Theory) and writers do a pretty good job.
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Old 08-14-2018, 05:49 PM
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While every person has an individual personality....the disease of alcoholism/addiction is very predictable...…
Having worked with many alcoholics, over the years, I can say that addiction is no respecter of socioeconomic levels...…
When people are gathered together with one central purpose....all of the other social strata drops away, in importance. It is like people being in battlefield, together.....basic humanity becomes the common denominator. (I hate war, by the way, but it is the example that comes to mind)…..
Not wanting to be associated with "those others" is sort of like wanting to go to church where the sinners have been prescreened out.....

I see rehab as presenting the individual with the Opportunity to grab hold of the ring of sobriety....if they want it....
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Old 08-14-2018, 05:52 PM
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Originally Posted by aliciagr View Post
They may have never been treated for other issues and may be in denial there even are other issues. Rehabs generally only last 30 days and then how many people continue on with therapy? And most programs are only designed to support quitting drugs and alcohol. they are not designed to deal with other issues at all. to me that is scary.
Not getting the correct tools for recovery is scary. The truth is there are:

Adults (ages 18+):

According to the 2015 NSDUH, 15.1 million adults ages 18 and older (6.2 percent of this age group4) had AUD.

About 6.7 percent of adults who had AUD in the past year received treatment.

There are also approximately just over 600k youth that are addicted.

Many people don't want help - that's their choice but I'm going to hazard a guess that there are many more that can't afford therapy, can't afford thousands of dollars for rehab, can't afford to take time off work for rehab (if they even have any type of benefit that would cover it).

The fact that AA exists and welcomes anyone who is even thinking about quitting is amazing and commendable. Most people that go to AA probably have the best of intentions, they stick around to help others. I have no scientific data to back this up but it's still around so I think that's pretty safe to say.

Dual diagnosis, the wrong approach at rehab. For many that is just a pipe dream that's totally unreachable (rehab). While in some ways it might be ideal for each addict to go through a psychological analysis before identifying the best treatment, it's not realistic.

I am grateful that AA exists and that so many have helped so many others.
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Old 08-14-2018, 11:18 PM
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Aliciagr, what program is this? Is it only offered in certain places?

Originally Posted by aliciagr View Post
I haven't read this book but I do know there is a drastic difference in the 12 step approach to addiction/recovery vs. other methods per the experience of our family. Recovery programs seemed to begin with what was already in existence - the 12 step approach. Rehabs came about as a way to house people and walk them through the 12 step program then release them back to the 12 step community.

When my husband first went into rehab, one picked out by his mom. It was based on the 12 step. Their philosophy was based solely on this, ideas were based solely on this. I was written off as a codependent and needed my own recovery. I was not to be part of his treatment because I couldn't understand etc.

Move forward to a time when he left that rehab and found treatment that was evidence based and not focused on 12 step. Totally different. It was about motivation, family oriented, cognitive behavioral therapies, medical approaches, no labels, no concepts that revolved around this is an addict, and this is what you are. Nope it was an individual approach where he was looked at and his specific needs were met. I was a participant in the recovery process. we did joint therapy. I was no longer called a codependent, but instead was called a wife who loved her husband and who didn't know how to handle the situation and had endured stress, trauma, and needed counseling to deal with my emotions. And we needed to work together to rebuild our marriage because family is the strongest support system if its healthy.

Big difference. Treatments and methods are advancing and becoming more successful in my opinion as new approaches are taken and tailored to the specific patient and family.

I do know a lot of rehabs now offer alternatives to 12 step, or make them optional part of the program which is based on more therapeutic approaches. I think its what is recommended by the medical community these days .
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Old 08-15-2018, 02:19 AM
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I have seen this tv show called 'MOM' this summer. And its about a group of female alcoholics and addicts who go to AA together and work with the same sponsor. Its funny and they do try and support each other, but yeah their baseline is off as to normal and its complete dysfunction. (QUOTE)


Alicia...…..I don't see where the "baseline is off and complete dysfunction"……
The characters are all in treatment and committed to sobriety....As much as I can remember....one is an ER nurse, another is a rich lady--but does charity work....another is an apartment manager...and her daughter is going to law school and works as a waitress..... All the characters work and, as per program...endeavor to behave honestly in all of their affairs.....
I don't see where the characters are people that one would recoil at...and fear having association with them.....
Even the most perfect appearing, among us, including us, have imperfections...or struggles...or some difficult challenges in our past.....
That is one of the core messages of the show, as I see it....but, that does not prevent us from seeking and attaining recovery.....

Why would you not want to associate with these people...in a recovery group?
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Old 08-15-2018, 04:23 AM
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‘Mom’ is in reruns where I live so we have managed to catch older episodes back to back. The characters are a hot mess in earlier seasons. The most intriguing thing is we do not always laugh at the same points in the show. I’m not sure how hard the writers tried to do build humor in for As and the poor suckers who love them, but it is refreshing to laugh about it.
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Old 08-15-2018, 06:35 AM
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Originally Posted by Maudcat View Post
It is a complex issue, for sure.
And not to belabor the book, but another thing that I found interesting is the to detox or not to detox question.
Many rehabs won’t admit without the patient having spent time in detox.
Though there are cases of the patient having stopped drinking for a period of time prior to entering rehab, so should they have to go through detox?
Fact is, detox adds to the bottom line for the facility, but it is also a way to ensure that the patient is starting the process clean.
There is a case cited of a woman in a detox facility who was was in an unlockable room and across the hall from men, also in unlockable rooms.
That would be way too scary for me.
My husband didn't have to go to a special detox before the rehab. Everything happened so fast those last few days before he went in. He was using both drugs and alcohol. His alcohol use was not to the point where he had tremors or any physical/medical concerns. And his drug was powder cocaine which has more of an emotional/mental impact than say opiates or benzo where there can be severe physical symptoms of wd.

But I do feel money is a big issue in rehabs. I think its also one factor in what services are offered, what types of professionals are employed. It obviously cost more money to have the staff in place to provide evidence based care and meet, the medical guidelines for treating alcohol/substance use disorder.
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Old 08-15-2018, 07:12 AM
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Originally Posted by dandylion View Post
I have seen this tv show called 'MOM' this summer. And its about a group of female alcoholics and addicts who go to AA together and work with the same sponsor. Its funny and they do try and support each other, but yeah their baseline is off as to normal and its complete dysfunction. (QUOTE)


Alicia...…..I don't see where the "baseline is off and complete dysfunction"……
The characters are all in treatment and committed to sobriety....As much as I can remember....one is an ER nurse, another is a rich lady--but does charity work....another is an apartment manager...and her daughter is going to law school and works as a waitress..... All the characters work and, as per program...endeavor to behave honestly in all of their affairs.....
I don't see where the characters are people that one would recoil at...and fear having association with them.....
Even the most perfect appearing, among us, including us, have imperfections...or struggles...or some difficult challenges in our past.....
That is one of the core messages of the show, as I see it....but, that does not prevent us from seeking and attaining recovery.....

Why would you not want to associate with these people...in a recovery group?
Well to me the show is funny but dysfunctional.

We each have our own baseline as to what is normal... and we each get to decide if these are the type of people we would look to as role models, to have as close friends, or would even want to associate with, IF THEY WERE REAL PEOPLE AND NOT JUST TV CHARACTERS.

For example, its funny but not honorable or honest to lie on a resume and pretend to have education, skills, references that you don't have. Not a good situation to be in when you have to jump out of the window during an interview.

Its funny, but crazy to be so in love with your ex, and despise his current wife so much that you would steal his ashes from her home, replace them with kitty litter and need to have the whole situation rectified by your daughter who feels guilty her dad is now living in a cookie tin under moms pillow.

Its funny when Jill the rich girl comes to a meeting drunk and cursing, and sweet when they all rally around to support her and get her sober. But I wouldn't want my husband in recovery to take on this responsibility if they were friends in a group.

Also interesting when Bonnie relapsed, and was arrested while driving, to see the group rally round to offer her support and promise to help her get back on track and minimize pain and suffering - but to see Christy the daughter angry and saying oh yeah we don't want her to feel any pain. And then she had to deal with her disappointment and such.

Then there are the relationship quests, Bonnie the apartment manager almost being fired and worrying about the tenant reviews because she knows she hasn't been doing her job and caring for the tenants, etc.

There is reality involved. Christy wanting to be a lawyer but not having completed any college - so she has a goal which is great. Jill seeks to adopt a child through foster care, the groups mentor struggles with cancer. They have friends come and stay at their home who end up drunk and on the floor, and they reminisce about those days and how happy they are not to be doing that anymore. But then of course the drunk guy wakes up and wanders into Christys bed, and it turns out there was some sexual escapade in the past between the group which ends up with Bonnies current man punching the other guy in the face. And that man crying its not his fault, hes an alcoholic. And the wife saying oh, he always says that when he screws up but by tomorrow he will change his mind !

I can see the characters to some extent in real life. I might could handle a friend like Christy ( although last nights show had she had her son changing his underpants in the store aisle because he had none at home and she honorably wanted him to wear a pair to school, and the store worker wouldn't let the kid use the bathroom. It was interesting hearing the kid be like no mom I don't think you got this situation under control and seeing that look on his face) But to be honest I would not want to be near Bonnie. I think she's a little scary. She uses foul language, lies, is loud, brazen, doesn't seem to have self control, or proper boundaries - and as the show has progressed she's still a laughable hot mess.
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Old 08-15-2018, 07:51 AM
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Originally Posted by Wamama48 View Post
Aliciagr, what program is this? Is it only offered in certain places?
If you do a google search on: treatment for substance use disorder then it should pop up with the current medical guidelines for treatment. The medical community has reached a consensus on best practices. It goes over things like early treatment, evidence based treatments, family therapy, support of family. Which I think is tied back to what maudcat has been talking about in this thread and another recent one. As a family member how do we handle all this ?

I don't know if its a program per say, but more like concepts of how does the family member navigate, find support, deal with emotions, and yes even support our partner just as we would if this was another medical illness like cancer, MS, depression. My guess is there are programs / support systems for family members being built around this premise.

I didn't use a program, just therapy. Did individual and family therapy and got hooked up with the addiction doctors through the local medical center in the state we used to live in. I do know its important to check credentials of therapists and to see what their own knowledge base consists of. Sounds like you met a whacky one recently so you already know they are not all alike!
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