Addiction-Treatment Model
A Caring Therapeutic Community (Formal or Informal)
I had innumerable fears of rehab. As a typical addict, however, they were all self-centered. It was about what would happen to me, as if I were a car having an engine overhaul. I thought I’d be acted on — diagnosed, de-constructed, reprogrammed, discharged.
I entered rehab convinced it was me against the world because that’s how addicts think. Against the staff for sure, but against the other patients as well. I didn’t care about their problems and wanted nothing to do with them. I assumed they didn’t care about my problems any more than I did about theirs. Yet, I quickly learned I was supposed to bare my deepest inadequacies in front of these random strangers. I found it acutely shocking that rehab involved others at all, to say nothing of how intimately I was supposed to reveal myself to them.
I didn’t understand that the key to treatment is immersion in a therapeutic community. And the key to a therapeutic community is people. Two groups at the hospital were instrumental to my embrace by the community: patients, both my fellow inmates and former ones; and the staff.
Fellow Patients and Alumni: After I got to know my rehab mates, and especially after I heard their First Step Stories, their histories of struggle with alcohol and drugs, I began to see we were all in the same boat. This was largely because even before I could remember their names they went out of their way to help me through the pain and emotional upheaval of detox. When I asked why, their reply was some variation of, “Because when I was detoxing the patients here took care of me and I was so grateful I have to pass it on.”
Lesson one in therapeutic communities.
Fellow and former patients, who I met through the weekly Alumni Association meetings I was required to attend, comprised the bulk of my support group. I could see the miracle of sobriety in the positive changes I saw in them. I could run into my heroin-addict friend who always greeted me not with, “Hello,” but, “I forgive you.” I could talk to a skid-row bum who’d blossomed into a human being once he’d had his alcohol-ectomy. I could see a drunk with such a skewed world-view he was furious that DMV took away his license (after his seventh DUI!), and only several sober months later hear him agree that giving up driving was good for him and DMV should have gotten wise sooner. In turn, they saw my metamorphosis in a way I couldn’t and reminded me how far I’d come.
Like larvae in mid-development, we were enveloped in a cocoon of trust in the hospital. It was so safe that often someone I knew only slightly would ask how I was doing and I felt secure enough to say I sucked and dump a whole load of crazy shit at her feet. And it was OK. People were willing to listen, commiserate, offer support. When you’ve experienced the gift of genuine, generous interest from a relative stranger it makes it easier to do it yourself, so the next time you ask someone you know casually how he’s doing and the tears start to flow, you can listen and be grateful for the opportunity. That’s the essence of a therapeutic community.
Over the months and years, I found the rooms at 12-Step meetings to be like that too. They’re a less-formal therapeutic community, but they’re still an endless source of knowledge, instruction, inspiration, tolerance and support. They’re safe places that encourage honesty where you’re not alone in your struggle. (For more, click on 12-Step Meetings.)
The Staff: It took longer to get past viewing the staff as enemies than it did the patients. For the first week or so I saw them only as despots. They pushed me to do things I didn’t want to (get out of bed), didn’t think I could (walk), or didn’t think I should (attend therapy). I rebelled against them because they were the only ones around to rebel against and it was a whole lot easier to blame them than me.
Eventually, however, my attitude about the staff turned full-circle and they became my most important role models. What altered my outlook was discovering that all but a couple were addicts in recovery themselves. Once I found out they had both personal and professional experience with addiction it was impossible to dismiss what they said. As they related their own experiences, I gradually learned to trust that they knew what they were talking about and pay attention.
Like with the patients, I realized that staff not only cared for me because it was their jobs, they also cared about me because they’d been where I was and genuinely wanted to help.
Beyond, that, the staff were living, breathing proof there was a chance for a fulfilling life after addiction, something I couldn’t conceive when I first met them. Some had been imprisoned or committed to mental institutions. Yet they got sober and now had long-term sobriety, steady jobs they found meaningful, and loving relationships. I couldn’t help but be inspired by them.
The safety and care of the therapeutic community enabled me to open my mind, discard my erroneous preconceptions and learn to model my behavior after those experienced in sobriety. They accepted me despite all my faults. They insisted I was not only redeemable but deserving of it. They were the key ingredient in becoming willing to accept my alcoholism and immerse myself in recovery.
