Relapse Prevention after Rehab:  Two Key Reflections for Young Adults and Their Families

Young adults considering 28 day rehab programs have a lot on their plate to consider, as do parents, supporting family members and friends. In addition to the emotional heartache, the financial expense, disruption to work-life and family dynamics, there is the looming question about relapse after returning home. Particularly common for young adults is a relapse within weeks, days, and sadly, even within 24 hours of returning home.  When this happens it makes families wonder if the whole effort was a complete waste of resources.

The following are two simple reflections for parents, supporters as well as the young adult considering treatment and long term recovery – reflections best considered before even entering a rehab center. In some cases these could make all the difference in the long term sobriety and recovery success for a young adult after completing a 28 day inpatient rehab program.

1) Consider a long term or permanent relocation  The social sciences inform us that human experience is deeply influenced by environmental cues and triggers. This is exponentially true for individuals trying to recover from addiction, because of biological, psychological and other stressors that exist in the context of transitioning home. Coming home should be a transition from a level of high support to a level of medium support, as it can be like a step off a 20 foot embankment onto hard ground below. Nevertheless, many patients come home with an entirely inadequate relapse prevention plan and virtually no real-time practice under pressure. Think of it this way – a day at inpatient rehab might contain between one and five internal cues or triggers to use a substance of choice with virtually no access to the substance of choice. By sharp contrast, once home, a typical day might contain between one hundred and three hundred cues and triggers to use substances, and twenty viable opportunities to access one’s substance of choice. Leaving rehab and coming home should be “engineered for success”, but often it is just the opposite – familiar faces who use, familiar sights, sounds and smells, familiar routines, familiar feelings – they all return – because they have been rehearsed for years. They come back quick and hard and can often unravel the best 28 day program within a few short days or even hours.

Critics argue that the solution is not geographical. While geographical moves don’t solve everything they certainly can provide a much needed break from cues and triggers, which buys a person time to adapt. A geographic move also provides the opportunity to restructure relationships, the next relapse prevention item worthy of reflection in this article.

2) Invest heavily in reassessment of all close relationships.   One of the hardest challenges facing any addicted person is the enormous psychological strength necessary to put distance between oneself and those who may have been friends while contributing to the substance use problem. No one likes to let a friend down. Even if the friend is blatantly encouraging substance use it can be incredibly difficult for some people to make that necessary clean break.

The psychological preparation is amplified if the individual has been involved for a long time with other substance users, and even more so if those users are lovers or direct family members. Young adults in particular may have even greater challenges as they might have a need to break off association with five, ten or more people. Generally speaking it is rare for a 28 treatment period to equip someone with the level of desire and commitment necessary for such a transition, not to mention the confidence and skill development necessary to begin replacing unhealthy relationships with healthy ones. This fact underscores the importance of the first point.  If the addicted person is not ready to tackle critical relational changes, it’s okay and normal; but they would do well to also consider if it is best to relocate for whatever time period is necessary to prepare for such changes.

Critics here would ask – “what about a job?”  “What about family support?” “How can a geographical move change internal dynamics?” These are great questions and though not easily answered, answers exist. Detailed discussion of these topics is beyond the scope of this article but families who are planning for a successful rehab effort are advised to look just as closely at transitional living facilities and sober community alternatives – not just the rehab center itself.  In a professionally designed and supervised transitional living environment, individuals can find tremendous therapeutic, employment, and social resources that provide rich opportunities to succeed in long term recovery.

Brian T. Davis, LISW-S, SAP is a substance abuse professional living in Columbus, Ohio and practicing for the past 20 years at Directions Counseling Group. He is the founder and CEO of Directions Counseling Group and New Directions Substance and Behavioral Services.

What to Expect When You Need an Alcohol or Drug Assessment

If you are required by the court or advised by your attorney to get an alcohol or drug assessment it’s normal to experience anxiety.  A lot of questions can start popping up.  Who do I go to? What is this going to cost me? How do I know they will treat me fairly? Are they going to assume I am an alcoholic? Should I downplay anything that might be a red flag…. or just outright lie to them?  What if they send me to one of those treatment places?

All these questions are understandable. And if you aren’t careful an alcohol and or drug assessment can be the beginning of a new set of problems….but there’s no reason to panic. Within an hour you can get educated on the subject, find a couple professional service providers, ask them some good questions, and get on with the process in a way that helps more than hurts.

The purpose of a professional assessment is to determine if a problem exists and if so, how severe it is, and what level of intervention might be needed.  But how do “professionals” determine these things? We will break it down for you here and add a few other details that you might want to know before picking an alcohol or drug evaluation service.

Standard and Non-Standardized Questionnaires – Most evaluators start by getting basic information from you about your alcohol and/or drug use history. These come in many shapes and sizes but they are all essentially asking questions about how you use alcohol or a drug (recently as well as past history) and what effect that has had on you.   These questions simply give the evaluator a starting point to ask you further questions.  Most of these questionnaires are brief and standardized for use by most professional substance abuse clinicians.  There are many different kinds of questionnaires, with slight differences between them.  Most of them have been researched with thousands of participants so that there can be a relatively accurate and reliable outcome. Some professionals will also have you answer questions that are not related to alcohol or drug use. These questions are aimed at finding out if you are dealing with unusual stress, anxiety, depression, a recent break up, and so on.

Personal Interview with the Professional Evaluator – The evaluator reads the answers to your questionnaire before they speak with you. A trained professional will start with a neutral position and avoid drawing conclusions about your substance use based on an initial reading of your answers. Similarly, they won’t make a judgement based on a single incident like a DUI, or a disorderly conduct charge. They will also let you explain any of your written answers in detail since many standard questionnaires do not allow for explanation.  If you get your evaluation from us it is of utmost importance that you have a chance to explain your written answers, how the legal violation or incident occurred, and any other information you feel is important to get an accurate picture of your substance use. Our questionnaire format also provides space for you to explain some answers in written form.

Once your evaluator has reviewed both the incident and your history they will share with you how your alcohol or drug use falls on a spectrum of use.  Your situation may have been a very unusual incident. It may have been for a brief period of time which was related to a major life event that is now past. For others the incident reflects a slow drift into more and more problematic use of a substance.  There are many points along the continuum of alcohol and drug use – from no-concern to severe-concern and the evaluator’s goal is to be as accurate as possible in the conclusion they draw.

Once the evaluator shares their findings with you verbally they will proceed to write a report that summarizes their professional opinion, if they have any recommendations, and what those recommendations are.  The evaluator will present the report to you and should also give you an opportunity to respond to it.  We encourage all of our customers to read their report very carefully to make sure it matches what was discussed in the interview.  There should be no surprises when you present your report to the court and the only way to avoid surprises is to read the report and ask questions if you have them.  If the evaluator did not explain something clearly enough in your report or you believe they incorporated incorrect information you should simply discuss it and see if the evaluator feels that any changes to the report are appropriate. It is possible to disagree with your evaluator but the last thing you want is to be surprised by his or her report.

People always ask us – how long does this take?  This is completely dependent upon the customer service orientation and efficiency of the service you chose. At NDSBS.com we generally provide interviews within 1-4 business days of your assessment purchase. We then provide a finished report within 4-5 days of your interview without any additional fees.  We also offer a variety of rush services with fees that vary according to your timeframe.  Same-day service is often available.

How much should I pay for this?  You have heard the saying, “you get what you pay for”.  This applies to alcohol and drug evaluations as much as it does to any other product or service. Pay little, get little in return.  You can find prices for assessments all over the map; $100 at the local clinic…. $500 at a psychologist’s office, $250 at one online service, $350 at another.  In the end, the cheapest assessment may not really be in your best interest.  The real question is – did you get a fair evaluation, good and timely customer service, a professional report, and ultimately something that is useful to you with regard to your use of alcohol or a drug.

So, how much should you pay? We would encourage you to be skeptical of the low and high-priced assessments. Do your homework to get a sense that you are going to get a good value and practical suggestions if you want them.  In our opinion these things are far more important than saving fifty or a hundred bucks.

Remember, some evaluators actually want to help you  – While there are evaluators with a “one-size-fits-all” approach our philosophy focuses on individuals and recognize that backgrounds, lifestyles, stressors and many other things factor into your use of a substance – whether a one time incident or a patter. We aren’t the only ones with this philosophy, but we do have a company vision. That vision includes helping people find their way through stressful times. We have no interest in putting you into a predetermined category or sending you to our own program.  Our interest is to do our best to get to know you, find out how your use of substances fits into known categories, offer our opinion about how healthy or unhealthy your alcohol or drug use is, and point you toward appropriate resources if they are needed.

So here is a quick summary –  1) Don’t panic; 2) Get educated on the subject; 3) Look for a couple services that provide professional assessments; 4) Ask them a few good questions over the phone; 5) Listen to your gut instinct focusing on quality more than price; 6) Be as truthful as you possibly can with the evaluator about how you drink, smoke or use a drug – don’t evaluate yourself – ask for the evaluators best opinion; 7) Learn from the experience and move forward.