What Are Aftercare Programs All About?

When you discharge from rehab you should be working an aftercare program if you plan on really getting serious about recovery. 

Transcript

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It's time again for Doc Jacques, your addiction lifeguard podcast. I am Dr. Jacques DeBruyckert, a psychologist, licensed professional counselor, and addiction specialist. If you are suffering from addiction, misery, trauma, whatever it is, I'm here to help. If you're in search of help to try to get your life back together, join me here at Doc Jacques, your addiction lifeguard, the addiction recovery podcast. I wanted to be real clear about what this podcast is intended for. It is intended for entertainment and informational purposes, but not considered help. If you actually need real help and you're in need of help, please seek that out. If you're in dire need of help, you can go to your nearest emergency room or you can I was talking to one of my colleagues yesterday about a problem. that many people have when they start tackling their own addiction. And that problem is expectations. The expectations of how long does this take? And how does this work? The question of how long does it take really depends on a lot of different things. Drug of choice, your history, your usage history, your family, your level of trauma. That kind of thing. But the one question that really kind of gets... We were talking about anyway, that gets asked a lot is... How does this work? And the magic pill of either getting on Suboxone or Rathadone as a replacement drug if you're an opiate drug user. And the other one is about rehab and the purpose of it. Well, we know the purpose is to put a barrier between you and your drug of choice and for you to have enough time to start to kind of orient yourself to the fact that perhaps you do have actually a problem that's pretty severe. And that's pretty self-evident in the experience of rehab. And it doesn't matter if you're, you know, a super wealthy person who's powerful and capable of saying whatever you want to say and making people do what you want, or if you're just a really, you know, a homeless person on the street and you just, you're struggling just to survive. It doesn't really matter what the situation. Going to rehab is about getting a little bit clearer thinking, changing the brain neuropathology or the neuropathway activity and finding ways to kind of intervene in that addict brain, kind of getting it to settle down just a little bit so that you can at least seem like a somewhat reasonable, rational person. And that's the purpose of that. And so when you get out, you're not really anything other than that. You're not cured. Things haven't really changed. perhaps just the way you're looking at addiction has changed a bit. And that's about it. So the real purpose in rehab is to set you up for what happens when you get out of rehab because that's where it really happens. And I think I may have said this in other podcasts, but if I have, forgive me, but the real purpose of rehab is to set you up to get to the point where you can actually start working on your sobriety. We've got a lot of sayings in recovery, and one of them is anybody can be sober in rehab. and that's true except if you're sneaking things in and then of course you can't it's really hard to uh to be sober if you're using and that happens and people get kicked out of out of uh rehabs for that kind of thing but the the the bigger problem is when you get out of rehab that's where the work begins and so When you are sitting there in rehab and you're wondering what in the world is going on and you're seven days a week, 24 hours a day, 168 hours a week, you're sitting there day after day, hour after hour, minute after minute, trying to just, and you're looking at other people that probably are a big hot mess and you're thinking you're not, and maybe you're somewhere in the middle of the hot mess versus I'm mildly engaging in a problem here. Whatever you are, it doesn't really matter. But that's kind of what goes on. So when you get out, we have this thing that we put together called aftercare. And if you're going to a rehab, and I don't really know that it makes any difference where you are in the world, but when you go to rehab, you really need to have a very, very strong aftercare program because that's where recovery actually starts to happen. When you get out of rehab, And so like when people come in to see me, I start the recovery anniversary celebration clock the day they get out of rehab. I don't count rehab. And the reason I don't do that is that it gives people a false sense of understanding that they think they are further along in their recovery than they actually are. So I do it for, if you want to call it manipulation, perhaps. But psychologically, I think it helps you understand that when you're starting a race, that you have to take things seriously in that race. Otherwise, you're not going to win, right? And the whole point of racing is to see if you can win. So if you're just practicing, And you're doing, or like if it was car racing, you do time trials to figure out who's going to start where in the positioning. And that's kind of what rehab is for me. I think of it in those terms. It's the place where you're starting to practice and understand what you need to do. Because you did not go into rehab understanding that this is the beginning of your recovery. You probably went in there fighting the whole way and being full of resentment about the fact that you were going. So I do not count rehab as day one. The minute you walk into detox for five or seven days first and then you go to rehab, I don't count detox as day one. I count the day you discharged from rehab as day one. So day one, if you're really wanting to know how long have you been clean or sober, as many, many people do. For me, I like to instill the idea that day one starts when you hit the ground where you can actually use. And that's really where the difference is because just like the saying, anybody can be sober in rehab that I said earlier, because you can't get anything. And so really the fight and the struggle to get into sobriety happens when you can get a drug of choice and the temptation is there. And then when real life is happening, the struggle, the real struggle, it's happening. And so you get into situations where you get emotionally upset or you get re-traumatized or you have to be around the people that are triggering you into these ideas of feeling bad. And so day one for me starts then. All right. So aftercare is the process of starting to work that process. And if you don't have an aftercare program, you don't have a strong aftercare program, when you're discharging from a treatment center, do yourself a favor and and get with a professional immediately upon discharge, a counselor or therapist, psychologist, psychiatrist, somebody who specializes in addiction and say, I need aftercare. They didn't give me an aftercare program when I discharged. You know what? I hate to say it, but I've run into this more than a few times. Treatment centers that don't really have an effective aftercare program. I had one client that discharged and he actually didn't have any aftercare Actually, it was more than one. It was from the same treatment center that's now shut down. It went out of business. But it was a pretty regular occurrence for people to leave. And I would call them because these people were my clients. I'd call them and I'd say, what's the aftercare paperwork? Can you send that to me? And they didn't have any. And I was like, well, what's the aftercare plan? And they said, well, we wanted to leave it up to the client. I was like, wow, you can't leave this up to your clients. They don't do it. Thankfully, that place is no longer in business. But that's just one example. I've had many. Or sometimes it's a very weak aftercare program. They don't do an effective job of helping you identify a good therapist, for example. And I can't necessarily fault these programs because if you go to treatment in Utah and you live in, I don't know, Chicago, how many therapists does somebody in Utah in a treatment center know in Chicago? And so they're kind of handicapped in that way. But we do have resources for that such as the listings on psychology today as an example it's probably the most well-known and most robust form of directories for therapists all across the country in the United States in other countries I don't know and I wish that I did because I'd like to be able to speak to that for you in South Africa and Germany and England and in Ireland and in Italy the various places where I have listeners but But please, do yourself a favor and make sure that you have a therapist. That's one. Two, you've got to make sure if you're taking psychiatric medication, if you're taking antidepressants or anti-anxiety medications or anti-seizure medications to help with depression or anxiety, because that's the preferred, sleep medications, whatever you left that treatment center with, and I can promise you most treatment centers are going to leave, you're going to leave with a number of prescription medications. You need to find a psychiatrist. And I'm going to emphasize this. A psychiatrist, not a family practice physician or a gynecologist or a general practitioner. They should not be dispensing prescriptions to you, providing you with prescriptions for psychiatric medications when you have been a mental health patient. I'm going to say that again, a mental health patient. When you go to residential treatment, you have a mental health condition according to the AMA and according to the standards of the DSM, the Diagnostic Statistical Manual that we use for diagnosis. It is a mental health condition. When you go to the emergency room, that person's a generalist, and they're going to do what they can, but they're going to refer you to a specialist. And I don't know why, but doctors, for some reason, have convinced themselves that they are the specialist in psychiatric medications when they're not, if they're a general practice physician. There are some that are very good at it, I'm sure. I don't want to disparage my colleagues, but they really have no business doing it, especially when it comes to addiction, because you are a mental health patient. So get a psychiatrist immediately, because you know what? In this country, we've got a shortage of those, and it's difficult to get in, so you might end up spending... Six weeks waiting to get in, and hopefully you've got medications to cover you during that time. If you wait until you're out of your medication, it's too late. Now you're going to wait weeks on top of that, and now you're going to get all dysregulated, and you're probably going to relapse. So you've got to get a psychiatrist. You also need to check in. If you have a doctor, just a family practice, general practitioner, you need to make an appointment and see them and tell them what you've been through. That you went to rehab, you got out, I'm on these psych meds and I just wanted to let you know, but I want you to do it. I'm just here for a checkup and let them give you a once over and see how you're doing because your physical health is tied into your mental health. And so if you're doing that and you have the ability to do that, please do that too. But don't skip the psychiatrist and don't let your family practice, general practitioner, doctor, write prescriptions for meds for psych meds. So a counselor, psychiatrist, a general practitioner, doctor, and then you need to, on top of that, you need to start to engage in the recovery community. I cannot emphasize enough that you let You left an environment where you were in a safe, secure group environment. You had a community around you, whether it's a 100-bed facility or an 8-bed facility for residential treatment. It doesn't matter. That was like your family, right? Those are your peers. Those are your colleagues. Those are your friends. And when you left treatment, you lost that. You need to replace it with those same types of people that are your equals, your peers. They get it. You need to be in that community. And so you've got to get into the community. I know a lot of people have issues with going to AA because the God talk. I get it. Okay, but there are other versions of recovery. There's smart recovery. If you don't like the God talk, do smart recovery. If you don't like the God talk and you live in a smaller area, an AA or NA, it's the only thing available to you and you are just a devout atheist or agnostic, go and don't listen to the God talk, okay? Because that's not what you're there for anyway, are you? You're there for community, for the fellowship, for the camaraderie of being with your equals, your people, the people that get it. So you got to get into the recovery community. And if you don't do that, you're probably not going to do well. You really don't. Because who's addiction's best friend? Isolation. And so that's a Doc Jacques-ism. Isolation is addiction's best friend. And that is where the voice in your head starts getting louder and louder. And the next thing you know, the old ways, the old drugs of joy start creeping in. If you're in a community and you say, the voice in my head is talking to me about using, every single person there is going to get it. Because they have been in or are in the same place. And there's strength in numbers, right? So... Circling the wagons. And if you will not get into the recovery community, I seriously question whether you're actually either committed to your recovery or you're going to be successful at your recovery. Because statistically, the odds are against you to begin with in a huge way. This is some serious stuff. You can't pretend like it's not. So get into the community and engage in the community. There's a thing that... description I have of people that go to meetings and they just kind of sit in the back and they don't they don't engage they don't talk and I refer to it as they're living on relapse row and they're just sitting there they're backbenchers they're waiting for the meeting to be over so they can walk out and just be done with it and check the box and say they went to the meeting so listen if you've been to rehab and you're getting out you know what it's like to talk in a group so you can't use the excuse to That you're all paralyzed and you don't know how to do it. Because you do. And so there's no reason for you to sit there and say nothing. And give the excuse that you felt uncomfortable. Because you had to speak in front of people. Because you've been doing it for three weeks or four weeks or five weeks or six weeks or whatever. So start speaking. And then with that, you need to find somebody that can help you and mentor you. It's kind of like your recovery guru, if you will. It's a peer, and in the AANA rooms, we call them sponsors. There are other structures that have different terms for them, but it's somebody that meets with you, talks with you, and helps you get through the process. In the AA model of 12-step, that person is going to actually help you work the steps. Um, and so finding that, that person that can mentor you is vital. Um, Russell Brand wrote a book called recovery and he just hammers away at that notion. And he is a guy who I would imagine, uh, has a very difficult time, uh, openly revealing himself to anybody, especially when he was a crazy addict, a very opinionated, very vocal guy, talk, talk, talk very quick on his feet. I imagine it was hard to, um, to one, find somebody that he could talk to, but also to listen. And if you're a person like that, that's a type A personality, or maybe you're the other end of it and you're very shy, you still have to do it, okay? It's a process that works. People who like to be cowboys and independent, riding the range on their own, they don't make it. That's just as simple as that. They just, they don't make it. because they don't have any experience in recovery. They have a lot of experience in usage, so they think that makes them an expert in recovery, and sadly, it actually does not. And so, when you are trying to get help, and you're trying to figure out how to do it, and you're trying to figure out what can I do, what you can do is start to lean on others. Lean. into the community, lean into sobriety. I have talked about this previously, and I am thoroughly convinced of this. If you're not really all in, then you're not serious about recovery. Now, if you're all in and you don't know what you're doing, that's not the same at all. But if you're all in, then you're going to get into recovery. You're going to get there, okay? It may look ugly, and it may not happen right away, but you will get there. If you're not all in, you can go to the meetings. You can work with a sponsor. You can go to the psychiatrist. You can go to your therapist. But you're never going to get there because you're not all in. And this is a very binary thing. It's ones and zeros. You're either a one or a zero. So you're either in recovery or working on it or you're not. There's no gray area in recovery. None. And the people who live in the gray area, they're actually living in the, I'm not going to get into recovery. They just like to look like they're working on it because they have to satisfy the need of somebody that's been yelling at them about it all the time. So you're either all in or you're not. One of the things that can help people understand the incredibly awesome, fear-inducing, earth-shattering powers that addiction has is that movie that Denzel Washington was in called Flight. They showed that movie in rehabs constantly all over the country. Every time I've gone to a rehab and I'll look and I'll see they have DVDs of movies and I'll look and Flight's in there. It's always in there. It is a perfect demonstration of the destructive force of the enemy known as addiction and watching Denzel play the pilot who can't stop using no matter what like he just he's not going to and he goes through all of the all of the demonstrations and machinations of of pretending like he's doing it or trying to show that he's doing it and then it comes down to it and he just can't stop he's got a drink And it's disturbing to watch it. I was disturbed the first time I watched that movie, especially the scene in the hotel room right before he testifies. Oh, it's just, it's so, it's painful to watch. And if you've ever been, uh, uh, you know, you, you have subjected yourself and given into addiction, you know, exactly. You can feel it. It's a visceral feeling when you're watching that movie and you know what that guy's going through because you've done it yourself so many times and it's, it's disturbing. Um, that's the power of the enemy you're up against. And so if you have gone through, uh, uh, residential rehab and you've worked to the point where you feel like you're starting to really get, um, to get what you, what you need out of it. And you don't continue it. Once you, once you discharge, you've just wasted your time and probably a lot of your money. So I think if I look at the statistics of like, uh, let's just take alcohol. The average numbers of residential treatment that an alcoholic has to do is four stays in residential over five years for one year of sobriety. For opiate drugs, it's completion, the average. That's the average. So if you think about it, like the bell curve, like that's the top of the curve. So that's four and five years to get one year of sobriety. For opiate drugs, it's more, it's painfully worse. It's six completions of residential treatment, 30, 60, 90, 120 days, whatever. Six completions before you get clean. And that's a lot of money. That's a lot of time. And I can tell you as a clinician from years of experience with this and facing the enemy and battling the enemy, I can tell you a lot of that is influenced by robust engagement in aftercare or not. Here's the scenario that plays out. So a person goes to residential treatment. Let's say that they stay. The average for my clients that I work with is about 45 days. So they go to residential treatment for 45 days and they're doing residential treatment. They discharge. And then they don't really have a strong aftercare. They're not engaging in a strong aftercare. And so there is going to be, I guarantee it, absolutely a drive towards usage when you discharge. So you're out and maybe you're all full of yourself and you make it 30 days or 60 days or 90 days. So you get to a three-month mark, let's say. And then addiction gets a hold of you. And your frontal cortex is betraying you and it's telling you, no, no, no, go ahead and do this. And if you don't have a community around you because you haven't engaged in your aftercare, you have no one to call for help. No one. And so that's a key part of it. And when you get to the point where you are needing help, that's where it comes from. from you jumping into the recovery community and engaging heavily in your aftercare. Find a professional to help you. If you don't have an aftercare program because you went to a rehab and they didn't allow you to put one together or they didn't help you with it, hey man, that's not your fault. That's okay. But just find a professional. Find somebody like me that knows how to do it and get it done. so that you can stay safe and you can start walking the path of recovery. If you do have an aftercare program, you need to share it with your treating team. The psychiatrist needs one, your counselor needs one, Perhaps your other family medicine doctor would need one too, maybe. But your team, right, your treatment team on discharge, give them a copy of the discharge planning and the aftercare so they can understand what you need to do. It's really, really, really important. I want you to get there, man. I want you to get clean. I want you to get sober. I don't want you to die. It's a failure if you do for everybody who's trying to help you. So join in on that team of recovery and get there. You could do it, man. You could do it. You just have to engage and be fearless. Always fearless in your recovery. Okay, well, listen, before I go, I wanted to take a moment to tell you that if you, seriously, if you are looking for help and you need help, reach out to me. I can help you. You can reach me on my website, through my website. It's wellspringmindbody.com. It doesn't matter where you are in the world, but if you need help, you need coaching, you need something, reach out to me. I want you to really try to get there, and I really want you to be successful. Get your life back. It's worth living. We are in a very difficult time, post-COVID world. has been very challenging. I know that because I just met with about 20 of my colleagues in a meeting, and we all had the same concern. We're seeing the numbers of people seeking help, it's exponentially exploding. And I am seeing a large number of people, larger than usual, year over year, and this year has been particularly bad, with people who have addiction problems. It's nothing to be ashamed of. It's nothing to be embarrassed about. Many people have it, many very prominent people have it many prominent people some of them I have met and you can overcome it so get the help that you need don't let it kill you but get some help and if you're in another country And I know I have listeners in a lot of different countries. If you're in another country, seek out the help you can where you are. Meetings are easy to get to. They're online. You can go to any country that speaks your language and go to an online meeting. It's not as good, not by far, as going in person, but it's better than that. But get the help that you need because we're seeing people die. And especially in the United States, I know the statistics are very high. About 300 people a day are dying from overdoses of fentanyl, and the numbers just keep going up. And it's tragic and horrible. And I'm seeing a number and a number and a number of people doing it. I'm now treating 16 to 17-year-olds, whereas before my average was about 30 years old. And now they're 16 to 17-year-olds. So don't let this be discouraging to you, but just get the help when you need it, okay? So you can reach out to me.

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So I hope you've enjoyed this episode of Doc Shock Your Addiction Lifeguard and you learned something from it. And I hope you come back and listen to some more episodes because I enjoy doing them. I hope hopefully you've learned something. And in the future, we're going to be having some guests coming on from treatment professionals who can talk about their experiences with recovery. So until next time. Go out there and start living a sane, stable, sober life. And if you're not there, get there. Go to a treatment center. Go to a hospital. Seek out some professional help. But please, don't try to save your addiction by ending your life. It's just not worth it. It really is not. There's a better life out there for you somewhere if you just can get there sober and clean. So until next time, this is Doc Jacques, your addiction lifeguard, saying see ya.