The Stages of Drug Rehab You Should Expect Before Beginning
Drug abuse and addiction treatment is highly variable. The National Institute on Drug Abuse (NIDA) reports that there are more than 14,500 drug rehab facilities operating in the United States. Drug rehab should be individual and cater to each person specifically as addiction is a complex disease.
Typically, there are four main stages of drug rehab:
- Treatment initiation and achieving abstinence: the start of a treatment program, often including physical stabilization methods like detox
- Early abstinence and acute treatment: learning coping skills for managing cravings, often through therapeutic methods
- Maintaining abstinence: relapse prevention and life skills trainings, working toward overall life improvement
- Advanced recovery: often includes transitional services, aftercare, and recovery support programs for sustaining abstinence and minimizing relapse
These stages of drug rehab can be provided through both outpatient and inpatient treatment programs by both public and private providers.
Before entering into a drug rehab program, it can be helpful to know what to expect and what the rules are going to be. Each program can vary, so contact the facility directly to get answers on what you should know prior to admission.
Initiation of treatment is when a person first seeks help for drug abuse or addiction.
Addiction is a common disease. The National Survey on Drug Use and Health (NSDUH) estimates that in 2016, around 1 out of every 13 adults in the United States needed treatment for substance abuse.
Treatment initiation can come in the form of a referral from a mental health or medical provider, an intervention and request to seek help from loved ones, personal desire to find services, or legal or criminal encounters. Regardless of the reason to seek drug rehab, NIDA publishes that treatment can be beneficial even if it is court-ordered, mandated, or the result of legal pressures.
As the first stage of drug rehab, you can expect detailed assessments that will ask about medical and mental health history, substance use, and family history of drug use and addiction. Expansive questions about lifestyle and personal information can help treatment providers to develop a complete treatment plan that is specific to your needs and circumstances.
Treatment initiation is also the first stage in establishing abstinence. This will include helping you to become physically stable, often through detox.
Detox and Physical Stabilization
One of the earliest stages of drug rehab commonly involves physical stabilization, which is commonly accomplished through a detox program. Detox can help your brain reset after being impacted by chronic drug use.
Mind-altering drugs of abuse interfere with the normal way the brain sends and receives its chemical messengers. Regular and repeated drug abuse over time actually changes the wiring and chemical makeup of your brain. When you then stop taking the drugs, you can experience intense drug cravings and withdrawal symptoms that can make you feel physically ill and emotionally unstable. This can make it difficult to stop taking drugs without medical intervention.
In the case of alcohol and certain drugs, such as benzodiazepines or opioids, withdrawal be especially significant. It can even possibly be life-threatening if use is stopped suddenly, or cold turkey.
Drugs are often tapered down slowly during detox to ensure that they wean safely out of the brain. Medications are often helpful during medical detox to manage drug cravings and withdrawal symptoms.
When you have been using drugs for a long time, struggle with mental health concerns, or abuse drugs through injection, medical detox is the first necessary stage of drug rehab. Detox can be performed through an outpatient or inpatient program based on the level of drug dependence. Ultimately, medical detox helps to ready you for the comprehensive treatment program to follow.
During early abstinence and the beginning stages of drug rehab, a person is often not entirely ready to accept that abstinence is the only way or even completely necessary. Even when treatment initiation is voluntary, right after entering rehab, the brain is still rigid and not completely ready for change. It is during this early stage of drug rehab that the Substance Abuse and Mental Health Services Administration (SAMHSA) publishes that immediate concerns, such as managing cravings and minimizing relapse, are most important.
Group therapies can help individuals become motivated in treatment and find the desire to persevere into recovery. Acute treatment programs are often inpatient programs where you will stay on site in a highly structured environment for a length of time while you work on learning how to work within a group and remain abstinent.
Other models of drug rehab include intensive outpatient programs (IOPs), partial hospitalization programs (PHPs), and traditional outpatient programs. IOPs typically involve highly structured programming a few days per week for several hours at a time, while PHPs are often more days a week for longer periods of time.
General outpatient programs allow individuals to schedule treatments around family, school, and work obligations. They are best suited for individuals with a strong support system who struggle with milder drug dependence and addiction.
The third stage of drug rehab is often the most significant. It deals with learning how to make positive lifestyle changes to support abstinence, minimizing relapse, and sustaining recovery. During this part of drug rehab, individual counseling and behavioral therapies are especially beneficial.
You will work through personal concerns and make changes to negative ways of thinking. You will learn tools for coping with stress and managing triggers as they come up, and how your thoughts impact your actions and behaviors. Positive changes to thinking patterns help to improve self-esteem and self-reliance. They can therefore make a difference in dealing with stress and difficult situations that are bound to occur in life.
The root cause for drug abuse is looked at in detail during this stage of drug rehab. Behavioral therapies, such as CBT (cognitive behavioral therapy), can teach problem-solving and important life skills for overall enhanced quality of life. The American Psychological Association (APA) publishes that CBT is an evidence-based treatment protocol that is effective in managing drug addiction. CBT and therapeutic techniques are especially beneficial during this middle stage of drug rehab.
Transitional, Aftercare Support, and Advanced Recovery
During the fourth stage of drug rehab — advanced recovery — you will learn how to integrate back into everyday life. At this point, abstinence has been established and maintained for a period of time. You will focus more on your long-term goals for recovery and life. Healthy lifestyle choices are established, and habits have some time form.
Support groups and 12-step programs can be helpful. The Journal of Addictive Disorders states that those who participate in programs like Alcoholics Anonymous (AA) — a 12-step peer recovery support program — are doubly likely to remain abstinent long term.
Peer support can provide mentorship and ongoing encouragement from others who truly understand and relate. Support group attendance is often established during drug rehab and carried on into ongoing recovery.
Transitional programs, such as sober living environments, can provide a segue between inpatient drug rehab programs and a full return to daily life. These communities have specific rules and requirements of admission, such as living by the house rules and remaining drug-free. They can offer a transitional period of time to ensure that positive habits and lifestyle choices are firmly established prior to returning home.
Aftercare and alumni programs also help to provide ongoing and lasting support to sustain recovery.
What to Know Before Admission
It is important to understand that the stages of rehab may not look exactly the same for everyone. Addiction is a highly personal disease.
Treatment should be fluid, and you may move between levels of care as it progresses. This may mean that you will go between stages, but it is not an indicator of failure. It merely that your needs may be changing as time goes on.
Relapse rates are high for addiction, as high as 40 to 60 percent, and relapse can indicate that treatment needs may change. You may need to switch from an outpatient program to an inpatient one, for example. Be open to changing as needed.
Treatment programs should be at least 90 days in duration, NIDA reports, regardless of the type of drug rehab program you are looking at. The longer period of time spent in treatment, the more established your healthy habits, coping techniques, and relapse prevention tools will be.
Other things to understand before entering a drug rehab program is that there will be rules you will need to follow. These rules will differ from center to center and program to program, but some general rehab rules and expectations may look like this:
- No drugs or alcohol of any kind are to be brought in or used. Medications will be dispensed by staff. Random drug tests are commonly performed to check for compliance.
- Visitors are typically allowed during specific days and times.
- Personal items are searched on the way in and may be limited to specific items. Check with the program directly for a list of accepted and restricted items. Programs will also provide you with a detailed packing list.
- Schedules are highly structured, and you are expected to make all appointments and meetings on time. Inpatient programs will have set sleeping, eating, and waking times as well as built-in free time.
- Typically, there are no personal electronics allowed, such as smartphones or laptops, except potentially during specific supervised times. This is to ensure that you are focused on recovery.
- Music and television may be monitored and restricted to common areas to limit potential triggers.
Prior to admission into a drug rehab program, you will set up a payment agreement and determine insurance payment information (if applicable). You will also receive detailed instructions on what to expect and what is expected of you specifically.
Drug rehab will differ for each person, and specialized care is essential for a sustained recovery. Treatment professionals can walk you through the admission process and design a detailed program that is optimally suited for you.
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Key Substance Use and Mental Health Indicators in the United States: Results from the National Survey on Drug Use and Health. (September 2017). Substance Abuse and Mental Health Services Administration.
Is Legally Mandated Treatment Effective? (April 2014). National Institute on Drug Abuse.
5 Stages of Treatment. (2015). Substance Abuse and Mental Health Services Administration.
What Is Cognitive Behavioral Therapy? (2019). American Psychological Association.
Alcoholic Anonymous Effectiveness: Faith Meets Science. (September 2009). Journal of Addictive Disorders.
How Effective Is Drug Addiction Treatment? (January 2018). National Institute on Drug Abuse.
How Long Does Drug Addiction Treatment Usually Last? (January 2018). National Institute on Drug Abuse.