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Treatment, self-help and other responses to addiction or dependence, changing consumption patterns, detox, residential treatment, self-help programs, pharmacotherapy, talking therapies

Residential treatment

NOTE: Quotes are presented word for word apart from minor editing for readability and clarity. Identifying details have been removed. Square brackets show text that has been added, e.g. ‘I want to maintain [my current level of drug use]’. Ellipses within square brackets […] show where text has been removed, e.g. ‘Counselling was good but […] I would have liked more information about other treatment options’.

Many of the people interviewed for this website talk about changing their patterns of consumption by seeking formal treatment. One of the treatments commonly described is residential or inpatient treatment (often called ‘residential rehabilitation’ or ‘rehab’). Residential treatment facilities vary but usually offer 24-hour a day care, including on-site housing and medical attention. Clients are required to live at the treatment centre for between one month and one year, depending on the length of the program. Residential facilities use different treatment approaches such as 12-step self-help programs, peer support, counselling and skills training. Many use group work as part of a structured program.

In Australia there are different types of residential treatment including long-term residential treatment (three to twelve months), short-term residential treatment (one to three months), therapeutic communities, and supervised short-term housing offering extended care (sometimes called ‘recovery housing’). Longer term residential treatment usually includes medical care, counselling and professional support in an alcohol and other drug-free setting. Short-term residential treatment often involves a medically supervised withdrawal program, initial intensive counselling and preparation for treatment in a community-based setting. Therapeutic communities are long-term treatment programs that use a self-help abstinence-based approach in which both staff and other residents assist with treatment. Short-term or ‘recovery’ housing provides supervised housing where clients are supported to live semi-independently, often following other types of inpatient or residential treatment. Short-term supervised housing can help people make the shift to living outside a residential treatment setting.

Some of our participants underwent longer term residential treatment, while others completed short-term residential treatment, or treatment in a therapeutic community. Several have experiences of more than one type of residential treatment. Due to the high demand for treatment, a few say they had to wait several weeks or even months for an opening in a residential treatment facility. Others say they had to contact more than one facility to secure a place. As Dawn (F, 38, unemployed, alcohol) explains, ‘I had to ring different rehabs and just wait to see where there was a vacancy or opening. So yeah, I waited for say about three months and then I got into this [one]’. Those with experiences of either short-term or longer term residential treatment say it offers a range of benefits such as medical care, counselling and the opportunity to learn life skills and coping strategies. Those who participated in a therapeutic community say its benefits include a ‘caring environment’, supportive staff and the opportunity to make new friends.

Negative experiences are also described, and a number of drawbacks of residential treatment are identified. These include the highly structured nature of some programs, the limitations of 12-step abstinence-based approaches and the rules and regulations of many residential facilities. A few say they found it hard living with people they didn’t get along with. Having little or no contact with loved ones for the duration of their stay is described by some as a big challenge of residential treatment.

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Long-term treatment

Some of our participants say longer term residential treatment offers a number of benefits including medical care, life skills training, counselling and support. The features of residential treatment they see as helpful include having a wide range of recreational activities, alternative health treatments and caring staff. The opportunity to ‘get in touch with feelings’ and process emotional issues is also mentioned as a benefit. The daily routine of residential treatment appeals to some, while others find it too structured.

Ethan (M, 39, works in hospitality, ice) says that undertaking residential treatment helped him to become aware of his feelings. (Played by an actor)

I remember discovering [at rehab] that I had anxiety […Like] the feeling that I had which I thought meant I needed more drugs was actually the feeling of anxiety […] So I was completely out of touch with my body and reality, and yeah, I was very much all in my head.

[…]

Rehab kind of opened me up to […] this idea that I might have sensations in my body and that’s what people refer to as a feeling [… So, I mean] I learnt a lot through rehab.

Dawn (F, 38, unemployed, alcohol) says that residential treatment enabled her to learn coping skills, discuss her problems and acknowledge her feelings.

Part 1

I guess [treatment involves learning] how to deal, not just with your addiction, because a lot of your behaviours, your emotions, go hand-in-hand with your addiction. So I guess it’s also giving you some […] life skills to be able to live your life sober […] and they are giving you strategies on how to cope without craving for whatever drug you have and [to cope with] your emotions.

Part 2

Well they do have a good, say, routine. We do have morning groups where you can voice […] whatever you are having a problem with and there are no repercussions […] That’s a good thing too. I mean, if someone was really bothering me, I guess I would tell them off, where[as] you can’t do that here. You just have to, as they say, sit with your feelings. That’s a very big saying: to sit with what you’re uncomfortable with. And yeah, that’s a big one for me.

Dylan (M, 27, unemployed, cannabis) attended a residential treatment facility for Aboriginal people and says that, amongst other things, he enjoyed learning about Aboriginal culture.

It was a good rehab […] It was all male, all boys there in the rehab. You know, we had our gym there, we had our wood shed and we had our own rooms. We’d do all our programs through the week. [When] weekends come [it was…] our time, you know. We’d sleep in, do whatever we want […] I really enjoyed it. I got a bit upset when I was leaving. I got really close to a couple of workers. They were really good old workers, good blokes. I learnt a lot [from] them. Yeah, it was a good recovery.

Like I said, I done a lot of woodwork up there. I’ve done woodwork that I’ve never done in my life and the artwork I’ve done is just amazing. I didn’t think I’d have it in me but I do. Been trying to pass it on to my little fella because he wants to learn Aboriginal culture at the moment so […] what I’ve learnt in my four months, I want to teach my little son […] It was a good experience, rehab, because we [did lots of cultural activities].

Some people describe negative or mixed experiences of longer term residential treatment and comment on the limitations of some programs. These include their structured nature, the use of 12-step abstinence-based approaches and the rules and regulations that some programs apply. A few say they found it hard to stick to the rules and decided to leave before the end of their treatment program. Others missed having regular contact with their loved ones during their stay. While talking to others about their experiences was a benefit for some, others found this confronting, especially in a group setting.

Eva (F, 20, works in the entertainment industry, ice) left residential treatment before the six-month program ended because she found it like ‘boot camp’ with too many rules. (Note: strong language)

Part 1

I’ve only been to one rehab so I can’t really generalise and say, ‘Every rehab is the same’. But the one I went to, they had some ridiculous rules. And it wasn’t rehab, it was like a boot camp almost. You had to get up and clean and […] if you talked to boys too much, they’d put you on like a boy ban, and shit like that […] We couldn’t say certain words. We couldn’t listen to certain radio stations. Like things like that […] Everyone’s recovery is different, you know. But they didn’t really seem to notice that so I left and I walked out.

Part 2

The rules, the 12 steps [were not my thing]. Like, I can understand some of them. But I guess things like, ‘Find your higher power’, it’s just a bit old-school for me. It’s, like, beyond its time, you know. Like, I can see how it works with older generations though, definitely. But I think they need to make it, like, more appealing for young people.

Dawn (F, 38, unemployed, alcohol) finds it hard to open up to others in her residential treatment program. She also says it would be helpful if the program addressed mental health issues such as anxiety.

Part 1

There’s so many people here and you really have to be open […] I mean, no one’s going to force you to tell your whole life story but it does help. And […] if you are not totally open, then […] you’re not rehabilitating so I’m really struggling. I’ve always been a very private person and […] I avoid crowds. I mean that’s what’s happened in the past as well when anxiety and depression has hit really hard. I’ve had days where I’ve stayed in my house for a good three days because I didn’t want to leave.

Part 2

I think, yeah, there should be more awareness of mental health, especially of anxiety. I mean, they do talk about it and they touch on things. I mean, we do […] things about trauma. But because it’s a rehab, it’s really about addictions and your behaviour […] For someone like myself where anxiety really does […] affect a person, more [focus on] mental health […] in rehab […] would help.

Ben (M, 29, works in hospitality, alcohol) describes a negative experience of group therapy in residential treatment in which he felt ‘push[ed] to the point of breaking’.

[My] worst experience was probably rehab last year. They were just too full on, trying to push us to the point of breaking. And yeah, lots of people left because of it. They made us hate the place and I think that just deterred everyone […] from that feeling of wanting the sobriety. They wanted to go back out there and use. And I know lots of them have, because I’ve kept in contact with a couple of them. So yeah, that was a bad experience […] We are in there to recover, not to get angry and want to use. We want to be fixed, miraculously fixed, but I know that that’s not the way it happens. But they’d just push us too hard, especially in a big group of trying to open up in front of everyone and then just pushing and pushing. And even when you’ve given everything that you can, like there was no stopping. I don’t know, I just felt like there was nothing else that I could give.

Short-term treatment

Those with experiences of short-term residential treatment say these programs have a number of benefits that are similar to longer term programs, such as medical care, counselling, support and accommodation in an alcohol and drug-free setting. Features described as most helpful include caring staff, and complementary therapies such as yoga and meditation. Some say short-term residential treatment offers a valuable chance to gain knowledge and insight into their patterns of consumption.

Despite his reservations about taking part in residential treatment, Dean (M, 32, works in hospitality, ice) had positive experiences at the different facilities he attended. (Played by an actor)

[My advice to people starting treatment is that] you’ve got to do it for the right reasons. You’ve got to do it because you want to. Don’t do it for anybody else. It’s a long process. It’s not just as simple as [making a] phone call [and saying], ‘Hey I want some help, I want to get into [rehab]’. It’s not that easy. It’s quite a long, drawn out process. It’s not what you think it’s going to be. I was expecting it to be on a farm. I even went out, and bought flannelette shirts and Ugg boots [laughs]. I was expecting, you know, not so much padded walls, but to be under constant supervision and to be constantly watched, and [to be saying] ‘yes sir, yes sir’. It wasn’t anything like that. It was people who wanted to help, who were there because they cared and nothing more […] Every time I’ve been into treatment, it has been a very positive experience.

Drawing on a recent experience of short-term residential treatment, Emma (F, 42, works in retail, alcohol) describes what makes a good residential treatment facility.

The facilitators were just incredibly awesome and they were really, like, wanting to learn with us. So it was more of an open forum and it was a really nice environment. You know, it was like a really safe place [with] couches and free food […] And it was holistic, too. They had yoga and meditation, and a nutritionist. I mean, she was just awesome. She was a recovering alcoholic and really, really open about it. They all were, actually. All the facilitators were very open about their own personal journeys. And I think that really made us all feel comfortable rather than feeling like there’s a professor up there who’s studied this for 50 years but never had a drink in his life, you know? So it was just amazing. The course was fantastic and then [afterwards…] I stayed sober for three months and that was the longest I’d been sober in my whole adult life.

Some describe negative experiences and identify a number of drawbacks of short-term residential treatment. These include the structured nature of some programs, strict staff, regular drug testing and having to take part in confronting group therapy sessions.

Grace (F, 58, works in manufacturing, heroin) questions the need for the strict, highly structured program and daily drug testing in place at some residential treatment facilities. (Played by an actor)

I just don’t have much faith in […] these rehab joints […] Only because of my brief experience at one […] Yeah, I guess it’s because of that […] You had to pee in a jar every day, and you had to be there by a certain time, you know [It was] really pathetic, just the way you were treated. I suppose they’ve got to have some sort of schedule or something. I don’t know. I just didn’t like it. [Especially the staff…] if they go into that sort of work or whatever, you think they’d have a little bit more [compassion] and not be so mean.

Therapeutic communities

A few of our participants have experiences of therapeutic communities. Here treatment involves self-help and mutual support to promote change. Those who had undertaken treatment in a therapeutic community say its benefits include a ‘loving and caring environment’, supportive staff, having the opportunity to make new friends and being able to draw on the support of other residents.

Tiffany (F, 33, works in hospitality, ice) says the therapeutic community she’s part of is a ‘caring environment’ where she feels supported. (Played by an actor)

This is, like, the most loving and caring environment where […] we support each other […I mean] it’s amazing [what] the therapeutic community is like. At first, I was like, ‘Oh my God, this is a cult’ but then […] I found a sense of belonging […and] you know, a new whole set of friends.

Melanie (F, 26, primary carer for her children, ice) says she values the opportunity to learn from others with similar experiences. (Played by an actor)

I think it’s pretty good here, like, I enjoy it. Like, we go to a meeting pretty much every day. Like, we have like relapse prevention […] which is […] how to avoid having a relapse and stuff like that […] It’s good to be able to talk about stuff that you wouldn’t normally talk […] about without getting shunned for it […]

So, yeah, you know, we have good days and we have bad days, but mostly good […I mean] a good day is where, like, everyone gets along and everyone’s open, and let’s you know how they’re feeling, and you can seek support [from] them if you’re having a bad time […] It’s good to be able to relate to other people’s stories when you thought that you were the only one that was going through it.

While most are generally positive about their experiences, some also identify a number of limitations of therapeutic communities. For example, Melanie (F, 26, primary carer for her children, ice) expresses a need for professional counselling because as she explains, ‘A lot of us do come in here with a lot of trauma […] and because we are [a therapeutic community…] we don’t really know how to deal with that sort of thing so that’s why nobody speaks about it’. At the therapeutic community he attended, Nick (M, 50, not working due to illness, heroin) says he didn’t like the ‘strict regime’ and found it ‘a bit […] jailish’.

According to Tiffany (F, 33, works in hospitality, ice), a challenge of therapeutic communities is getting on with different people. She also says that some of the rules don’t apply to everyday life. (Played by an actor)

The challenging part is, like [tolerating] other personalities in here, and, like, watching what you say, you know [And…] like, if you’re struggling yourself, how can you support [others?]

Especially with me being a senior [in the community] I really have to keep it together [And I also have] extra responsibilities, like time management and things like that.

[…]

And it’s also really strict, like, a lot of rules [….I mean, there’s] no eating in the lounge. It’s like, I’m not going to apply that in my life: no eating in the lounge, you know […] I used to go, ‘How does that apply in your recovery?’ […] It’s just funny.

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