Inpatient Treatment // Monetized Recovery
Understanding the complexities of the rehabilitation industry.
In a society plagued with addictions, be it to drugs, alcohol, sex, sugar, gambling or other behaviors, the industry of rehabilitation is open for business and booming. This is telling of the world we live in—millions of adult people wind up living in such a sick and disparaging manner that they need a total course-correction, complete reconsolidation of fundamental thoughtforms, emotional networks and belief structures related to themselves, others and humanity.
Culture and familial dynamics shape us drastically from a young age, leaving sharp imprints that are often useless or even detrimental. For example, my own upbringing largely normalized the heavy usage of alcohol as a social lubricant, teaching me that weekends were generally meant to be spent in booze-fueled debauchery with like-minded acquaintances. Within a healthy community, this is not the case. I operated under that destructive guise for years, believing it to be the only way and never really asking myself why—until it was too late.
Psychological and behavioral conditioning affect every living soul. There is no feasible escape from the chaotic rat-race of modern life, at least not without first playing within it and “beating” its complex suppression. Children are subjugated by multiple layers of dysfunction, typically starting within the family system and moving outwards into public schooling, social media, communal fabric and further. Unsurprisingly, many people live in mental and physical malfunction, firmly stuck inside an overtly complicated framework, rendered helpless and clueless until spiritual or stochastic fate intervenes.
The microcosm of inpatient treatment, whether for mental health, addictions or both, is a looming shadow that represents the legacy impact of unhealed ancestral and collective trauma. It is a safety net for those fortunate enough to become ensnared—many are not and live out entire lives compressed and throttled by societal mishandling. Everyone in the world, along their initial developmental trajectory, is sick to some degree. This paints a spectrum. Some get by blending in with social norms and trends, effectively disguising the festering disorder living inside their minds and bodies. In this way, those more gravely affected are lucky—such lowly placement on the scale of sickliness entitles them to higher probabilistic outcomes for genuine help and eventual betterment. Many remain in denial, perpetually, having lived so long in a low- to medium-grade psychic malady that it has become standardized, their existence wholly permeated by a slightly-off essence.
In all transparency, my interpretation of treatment-culture stems primarily from an isolated 7-week stay at a highly-rated facility on Vancouver Island, along with interspersed visits to centers in Calgary and extensive discussion with an old sponsor, a man embedded in all aspects of recovery. My stay was bittersweet in many ways and I regularly contemplated the duality of such a facility—the inevitable battle of opposing forces, altruism and capitalistic gain. Most who worked there were certainly well-meaning; however, always lurking was the insidious, intrinsic motivator of cashflow, sometimes rearing itself as blatantly obvious and other times manifesting as a nearly imperceivable hum.
During this novel adventure, my most significant gripe was towards a component termed “extended-care,” something that adeptly exemplifies the corrupt underbelly of rehab. Originally, potential patients are sold on a standard x-week allocation in extensive therapeutic programming; however, once arrived, a secondary, additional program is quickly revealed and marketed, vehemently so in some cases. For select clients, suddenly, the expected length of institutionalization doubles. Although I cannot affirmatively claim this to be true, incessant rumor held that counsellors are incentivized to motivate commitments to this prolonged form of treatment. In my own experience, this was done forcefully in an arguably unethical fashion. Keep in mind that rehab inpatients are incredibly vulnerable and borderline lacking agency all together, sometimes backed by desperate and wealthy families or companies who would sign off on anything should it mean the output of a healthy, revitalized individual.
I agree, to an extent, with involuntary placement of powerless addicts in the rehabilitation stream—as long as the choice remains to exit as free, autonomous persons, at any time should they choose, enticing late-stage chronic substance abusers into transformative programs is morally sound. However, there is a not-so subtle line that is clearly crossed in the aforementioned case of extended-care procurement. Firstly, this extra treatment package is ground into you as a possibility from day one in the primary, already-paid-for, program. Hustling wounded people into their secondary-stage recovery plan, well before the majority of their initial treatment has unfolded, screams to me as a selfish presumption of plutocratic beneficiaries. No two recovery paths are identical and this form of entrapment assumes that each patient will, in fact, require a protracted stay. In reality, rehabilitation is non-linear. Not all members of a treatment facility are at similar points in their journey, thus necessitating a diversified, individual-focused practice and approach.
Secondly, inexplicit monetized impetus, once uncovered, damages the restorative cord that ideally connects patient and caregiver. For a person in power, especially in a healthcare-type role, the primary driving metric should be a desire to improve the lives of those they care for. When this is unmasked to be illusory, motives become questionable, actionable care is sidelined and feelings are hurt, reducing morale to a quiet whisper. My own experience corroborates this notion. I tried best I could to perform the divine act of surrender during my time spent in treatment; regardless, I always needed to maintain some semblance of an active role in my own recovery—something I urge all newly-clean addicts to do.1
Immediately upon learning of it, I knew in my heart and gut, viscerally, that the extended program was not for me.2 Given the beguiling properties of my newly-found environment, I acted strategically and boldly to prevent this placement from happening. It was rapidly evident that my assigned, core therapist was determined to circumvent my wishes and persuade me into accepting this fate. Matters went as far as being taken to a remote, camera-free location, in the pouring rain, with not only my counsellor but his boss and a peer, who had already been confirmed as extended-care clientele. There I was subjected to a good-cop, bad-cop routine, passive-aggressively insulted and demoralized, leveling my already exhausted psyche to a state of emotional breakdown.3
Ultimately, I was successful in evading the extended-care program and six months later, I am satisfied with this decision. Some of my peers who did go would often refer to it as “expensive free-time,” illustrating its superfluous, extraneous foundation, relative to the main program. There is a fine distinction between genuine care and financial overreach. I was haggled mercilessly for a good portion of my stay and to be frank, this undue pressure was injurious, detracting greatly from why I was there in the first place.
There is certainly such thing as too much in regards to inpatient placement. These structures act as safe-havens for those who reside in them—bubbles of naivety shielding patients from the real complications awaiting them upon exiting. I observed multiple people leave extended-care entirely ill-equipped, quickly getting overwhelmed by personal matters long shoved out of their perception and unfortunately relapsing.4
A healthy, prosperous recovery is sustained through interaction with actual recovery communities. Although exposure to normal, outer-world meetings was possible for inpatients, even multiple times throughout their stay, clients are, in general, housed inside an idealized, simplified model of recovery. The superposition of real-life difficulties, post-treatment, can prove challenging. There must be a “sweet-spot” of temporal optimization—an integrally designated duration of stay as a function of individualized uniqueness.
To be clear, I am not denying the undoubtable positive attributes of in-house rehabilitation. Personally speaking, it served well as a secure container in which I could explore foundational pieces of my recovery that I could not establish prior, despite trying—most notably, the completion of a thorough and fearless moral inventory, shared with an actual chaplain. Furthermore, the experience was painful enough that I vowed never to repeat it—in the tumultuous end-days of active addiction, I was waging war with the dangerous ailment of benzodiazepine withdrawal, consciously trying to wean my way off them completely before reaching the pearly gates of treatment. I failed in that effort and thus had to undergo a comparatively brisk cessation period whilst simultaneously working through intensified inner-work.5 This was untimely and cast a miserable shade on an already difficult procedure; however, I had no other option. I tried my best to garner as much advantage as possible from the allotted programming while managing an anxiety-riddled psychosomatic condition. Treatment provided a safe, medically supervised space to suffer through this detox phase, hopefully for the final time in my life.
The most magnificent benefit gleamed from the laborious process of inpatient treatment, however, is the wonderful community and authentic friendships made. It is a unique trip, where deep-seated vulnerabilities and emotional wounds are opened and co-carried by surrounding peers, all on their own journeys. Completing it with another human being creates a strong bond. A large percentage of time is spent interacting with each other—socialization is strongly encouraged if not coerced. The majority of my closest friends in the present are people I went through treatment with, people I truly value and wish the best for.
The commonality of hitting bottom, demanding an entire psychic and situational overhaul, creates a strong cohesive pull between once strangers. Navigating the hierarchal complexities of treatment creates a unified front, a team rooting for one another’s victory. After treatment, the facility itself is a beacon of protection—patients become alumni and are allowed back to visit anytime. Social gatherings are held regularly to celebrate sustained clean-time, a wonderful harmony of informational interchange between seasoned veterans and current inpatient novices.
In summary, the kingdom of inpatient treatment is richly complex and brimming with moving pieces, depicting a useful saving-ground for those who can fund it yet somewhat tainted by overarching themes of greed. The programming itself is comprehensive yet rudimentary, at least when coming from a history of attempted recovery implementations. Healing is largely facilitated by group-therapy—as patients connect and build trust, they become willing to share intimate pieces of their past that otherwise keep them sickly. Unshakable attachments are initiated as addicts work in coherence with one another—a drastic shift from the isolating nature of addiction.
Like any monetized industry designed to serve struggling people, the rehab business shows ample room for compassionate, intelligent and informed growth. Based on my limited exposure, some straightforward guidelines which any treatment center would do well to adopt, in regards to optimizing experiential fulfillment, are as follows:
Full transparency: informing patients, both current and prospective, of exactly what they are getting into, what they will be sacrificing while remaining in the facility, and what they have to gain; being tricked may help to get people inside but breeds a nasty sense of resentment and psychic freeze.
Addicts healing addicts: non-addicts cannot deeply comprehend addiction, at least not to the level needed to offer transcendental advice to late-stage sufferers; thus, successful, compassionate treatment centers are run largely by recovering addicts who have left their disease in remission.
Foster equality, safety and autonomy: an environment in which the patient feels less-than or insignificant is not one that promotes flourishing or realistic recovery; in order to achieve initial entrenchment of sobriety, clients must be contained in a system of steady-state safety and security and should be offered the opportunity for a positive, affirmative say in their recovery plan.
Prioritize patient-therapist trust: the bond between an inpatient client and their core counsellor is one of the most important facets in a successful and extrapolatable recovery; therapists ought to act with utmost care and thoughtfulness in regards to this relationship—once its broken, its gone and therapeutic efficacy plummets.
Abolish incentivization: for places of healing, existing within the realm of capitalism is bad enough, yet inevitable; however, to motivate employed therapists to deceive and persuade vulnerable patients, in order to score a bonus or rise in prestige, is despicable and carries with it the potential to harm already hurting persons—thus, it should be outlawed lest karmic repercussions wreak havoc on the economic bottom line.
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Having an active role in one’s recovery is critical for anyone; however, the extent of this may be lesser for those with little or no prior experience. Personally, I had reached treatment after years of undulating recovery activities and exposure to 12-step fellowships, yet still I was often treated the same as those brand new.
I am not saying that this extended program is not suitable for anyone. For me, it was not a good fit and I did not appreciate it being shoved down my throat while I was trying to optimize my experience in a treatment setting. To have the first-line plan of treatment placed upon you is one thing; once that foothold is established, the addict should have some level of input into what the subsequent steps are.
There is, of course, a great deal more context involved in this story, and I can honestly say that the word “complexities” used to describe the inner workings of treatment facilities is an understatement. Some stuff that I witnessed is outside the scope of this essay.
This is not meant to be a generalization and is based purely on a few observable cases of people that I knew. The treatment center I attended touted that success rates were higher for those who attended extended-care; however, that is a tough metric to properly measure and is somewhat loaded coming from a massive money-making entity.
Along with the benzodiazepine detox, I also tapered my way off of caffeine while in treatment, and left totally free from both, remaining that way still to this day. Although I am grateful to have done so, it was extremely difficult to manage these terrible anxiety-inducing states of body and mind while completing a rigorous recovery program.