Why Does Addiction Rehab Fail for Some People?
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There’s an old saying that goes, "First you take a drink, then the drink takes a drink, then the drink takes you." Addiction is a term we’ve all heard and seen the effects of — if we haven’t struggled with it ourselves, most of us have known someone who has. It can be devastating to watch a loved one lose everything — their job, family, health, personality, and sometimes even their life — by doing something that might seem easily controllable to an outsider.
When someone is struggling with addiction, rehab might emerge as a potential solution. Many of us remember Amy Winehouse singing in her trademark husky voice, “They tried to make me go to rehab, but I said ‘No, no, no.’” This is not an uncommon response — if you have ever faced the prospect of going to rehab or tried to convince a loved one to go, you know it can be a difficult step to take.
Unfortunately, even if we do decide to attend rehab, it’s not guaranteed to work. Tragically, Winehouse herself died from alcohol poisoning in spite of several attempts at recovery. At the same time, you may have heard stories of miraculous recoveries and how life-changing rehab can be.
So why does addiction rehab seem so hit or miss? Why do people go to rehab in the first place? And what can you do if rehab doesn’t work for you? Let’s find out more.
Before we get into the details of rehab, let's quickly understand why someone might end up there in the first place. Scientifically, addiction is a complex condition marked by an overwhelming urge to use a substance in spite of its harmful consequences. At the neurological level, it arises in the reward system located in the primitive, subconscious part of the brain. This system evolved to motivate us to form patterns around behaviors that feel good and ensure our survival, such as eating and reproduction.
Unfortunately, the same mechanism that evolved to keep us alive can get hijacked by unhealthy behaviors such as substance use, gambling, and other activities associated with the release of dopamine — the “feel-good” neurotransmitter that’s released in response to healthy and unhealthy pleasures alike.
When we feed our brain a constant supply of “free” dopamine, it develops a growing dependency on the substance or activity and starts adjusting to its “new normal.” This shift sets in motion a cycle that can be challenging to break. The hijacked brain’s dopamine-driven habit system drives us toward the perceived reward at any cost: it's disorienting, challenging, and can be very slippery since the subconscious brain doesn’t listen to reason. Often, even if we realize we’re trapped, it’s not a matter of “just stopping,” since continuing the habit literally feels like a matter of survival — even if it’s quickly driving us toward a metaphorical cliff.
Many people have found themselves at this challenging point: addiction is taking over their lives, families, careers, finances, and sense of self, and yet they don’t know how to stop. It’s a terrible trap to be stuck in. Fortunately, there are ways to break the cycle.
Addiction goes way back, but a scientific approach to treatment is relatively new. Up until very recently, addiction was often seen as a moral failing or a lack of willpower. Treatments, if any, were crude and largely ineffective. As our understanding of psychology and neuroscience expanded, so did our approach to rehabilitation. Addiction is generally no longer viewed as a purely moral or social issue — we now understand it as a complex interplay of genetics, environment, and brain chemistry.
Today, there's a spectrum of treatment options available, from traditional 12-step programs and medication-assisted treatments to cognitive behavioral therapy and holistic approaches. We’re also finally seeing change when it comes to challenging the stereotypes and stigma around addiction and advocating for compassionate, evidence-based care.
In recent years, technology has revolutionized the world of addiction recovery. In our own pocket, we can access information about alcohol and the way it affects us, tools to deal with cravings, and community support. (In fact, the Reframe app offers all of these!) These strategies can act as supplements or even alternatives to traditional rehab.
Rehabilitation facilities can serve as a pivotal chapter in the story of overcoming addiction. Here's how rehab programs aim to address the insidious addiction trap:
Today, there are more options than ever when it comes to rehab facilities, and it’s important to understand the differences between them.
Some people might need to go through a detoxification process before moving on to treatment that addresses the emotional and cognitive aspects of addiction. This is especially true for anyone who has developed alcohol dependence as quitting abruptly can be medically dangerous.
Detox centers provide a safe environment to rid the body of addictive substances under medical supervision, clearing the way for further treatment. Usually, this means staying in a hospital-like setting with regular visits with doctors and daily activities to get started on other aspects of the recovery process.
Inpatient rehab involves staying at a residential treatment center, typically for 30-90 days. It's intensive and immersive, with medical and psychological care around the clock.
A stay at an inpatient facility is a full-package deal, kind of like an out-of-town work conference trip. No matter where the facility is physically located, patients usually stay on the grounds at all times as they undergo treatment that addresses the physical, mental, and emotional aspects of their recovery.
Sitting somewhere between inpatient and outpatient, PHPs are for those who are looking for structured support but don’t need 24/7 monitoring.
PHPs are a bit like a rigorous day job. Participants arrive in the morning and spend several hours a day at the treatment center for therapy, medical care, skill-building, and meals, then go home in the evenings.
If inpatient rehab is an out-of-town conference, outpatient is more like a half-day company training. These programs are less disruptive to everyday life for those with fewer care needs and allow participants to work around jobs and family schedules. Outpatient rehab often serves as a step-down after a participant has “graduated” from inpatient treatment.
Participants live at home and continue with their daily lives but visit a treatment center for regular therapy and support sessions on an ongoing (though usually not daily) basis.
After an intensive rehab program, some people choose to live in sober- living homes — also known as halfway houses — to ease back into daily life in a supportive, substance-free environment.
Living in a sober house is like having training wheels on our bike as we learn to ride again — the motions participants go through on a daily basis might look the same as regular home life, but there’s an extra layer of support as they rebuild healthy routines.
Alternative or holistic programs might incorporate nontraditional treatment methods while focusing on treating the whole person, not just the addiction. The downside? They may not be covered by medical insurance, and some might not use science-backed approaches.
A holistic or alternative setting might be similar to a regular inpatient residential program but may have a more unique atmosphere and offer activities such as meditation, yoga, or acupuncture. (That said, the science-backed benefits of mindfulness-based activities are clear at this point, so it’s not uncommon to find them in traditional settings as well.)
Rehabs — just like the people they’re meant to help — come in many varieties and are not the same. It’s no wonder they yield different results! Some folks emerge feeling renewed, while others find themselves back where they started. It's not for lack of trying, though. It’s important to set ourselves up for success when it comes to recovery, so picking an option that’s likely to have us packing our bags to go home before we’re ready can sabotage our efforts.
Here's a look at why rehab might not stick for everyone:
In spite of this, some might find that rehab is simply not the best solution for them — and that’s okay, too. There are other ways to address substance misuse (and alcohol misuse in particular). Although it can feel disheartening, don’t despair — it might just be a matter of creating a different roadmap to recovery. As we mentioned earlier, personalization is key when it comes to creating a plan that works, and chances are there are important pieces that need to be put into place. Let’s figure out what they are!
Here's what you can do if you find yourself at this crossroads, whether you’ve tried rehab and it hasn’t worked or you’re weighing it against other options:
There’s another song that comes to mind when thinking about the journey of recovery — “Amazing” by Aerosmith. As the lyrics go, “Life’s a journey, not a destination — and I just can’t tell just what tomorrow brings.”
Recovery is, indeed, a journey, not a destination, and rehab is only one potential part of it. It might take several attempts to find what works for you. Remember, finding that rehab hasn't worked as hoped isn't the end — it’s a chapter in the long story of recovery. With the right adjustments, support, and mindset, you can continue to write a story of success. Keep believing in yourself and keep moving forward!
1. What exactly is addiction?
Addiction is a complex condition characterized by compulsive substance use or behaviors despite harmful consequences. It involves changes in the brain's reward and motivation systems.
2. How does rehab help with addiction recovery?
Rehab helps by interrupting the cycle of addiction, providing medical and psychological support, educating individuals about addiction, teaching new skills, offering peer support, and preparing a long-term relapse prevention plan.
3. How do different types of rehab address addiction?
There are several types of rehab, including inpatient, outpatient, and holistic approaches, each offering various therapies, support levels, and strategies tailored to individual needs and lifestyle.
4. Why do some people not succeed in rehab?
Success in rehab varies due to factors like the lack of personalized treatment, untreated co-occurring disorders, insufficient support networks, stigma, the perception of relapse as failure, and inadequate aftercare planning.
5. Can rehab be customized to individual needs?
Yes, effective rehab should be tailored to an individual's specific needs, preferences, and circumstances, including the type of addiction, personal history, co-occurring disorders, and lifestyle.
6. What should I do if rehab doesn't work for me?
Reflect on the experience, seek feedback, consider additional or alternative treatments, strengthen your support network, and develop a robust aftercare plan. Remember, relapse isn't failure; rather, it’s an opportunity to adjust your approach.
7. Is it normal to go to rehab more than once?
Yes, recovery is often a journey with setbacks and learning experiences. Going to rehab more than once can be a part of the process for many as they refine their strategies and understanding of their own needs and challenges.
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