How to stay sober from drugs and alcohol after leaving rehab
At first, being in rehab can be a stressful experience. You are torn between your compulsion to keep using drugs or alcohol and your desire to feel normal again. You are tired of feeling sick all the time, but you still feel like you could just go out and get high or drunk just one more time.
After a few days, you get used to the routine. Your entire day is planned around activities that promote a sober recovery. You become hopeful about your future and you start to believe in the recovery process.
Yet, what happens when it is time to leave rehab? Some rehab programs last only a month. Others can last for anywhere from three to six months. Either way, at some point it will be time for you to graduate from the program and return to the real world.
Rehab provides freedom from the usual stress of everyday life. You are spared the painful dynamic of a dysfunctional family. There are no drug dealers or bars in rehab.
In rehab, they talk about living a life of sobriety and avoiding triggers, but you do not have to face those triggers during your stay. Getting clean and sober in rehab is not easy, but the challenge of returning to regular life outside of rehab is a whole new challenge.
Living with sobriety in the real world.
Fortunately, most rehab programs understand that the need for support does not disappear when you walk out the door. They often provide ongoing aftercare meetings and therapy. If your program provides these resources, you can take advantage of them to make for a smoother transition when returning home after rehab.
Some rehab programs recommend sober living after rehab. In a sober living home, you will be in a living environment with other recovering addicts and alcoholics. There are strict rules and guidelines in most sober homes.
You will be monitored for drug or alcohol use. And, you will be expected to attend recovery meetings on a regular basis.
While sober living homes are not for everyone, and not all of them are positive environments, if you are able to find a good sober home, it may be a better transition from rehab rather than going straight to living at home again. It depends partly on your home situation.
Do you live at home alone? Or, do you have a supportive family waiting for you? On the other hand, is your family a major trigger for you to go back to using drugs or alcohol? Is your home located in an area where there are drug dealers or other dangerous triggers you might see when you come and go from home?
The decision to enter a sober living home is personal and depends on a person’s individual situation. In some cases, going home to a supportive family is the best option.
Is outpatient rehab a good idea?
Some rehab programs involve a step down approach, where you move from one program to another with gradual integration back into society and everyday life. You may start in residential rehab and then go to a partial hospitalization program, or PHP.
A PHP is a program where you spend much of your day at the rehab facility, doing many of the same activities you were doing in residential rehab, such as group meetings and therapy. The difference is that you go home at the end of the day.
After completing PHP, you may then be transferred to an intensive outpatient program, or IOP. IOP is very similar to PHP, but the difference is that you only go for a few hours daily and only several days per week.
The next step may be a less intensive outpatient program, known as OP. During the series of step down programs, the rehab facility may recommend that you live in a sober living home. As noted earlier, this will depend on your home living arrangement and individual situation.
Should I continue seeing a doctor after leaving rehab?
Rehab programs differ greatly in their dedication to medication-assisted treatment of substance use disorders. Some rehabs do not offer any form of medical treatment for addiction, while others provide a full array of options to their patients.
If you were started on a long-term medical plan while in rehab, you should definitely make arrangements to continue that plan after leaving rehab. For example, if you were given Suboxone (sublingual buprenorphine/naloxone) for opioid addiction, it is critically important to continue treatment after you leave.
Some short-term detox programs use Subutex (buprenorphine) for a fast detox off of opioids such as heroin or fentanyl. You are given a specific dosage on your first day, and a decreasing dosage each day. After a week or two, they have you stop the Subutex and declare you to be opioid free.
Unfortunately, fast detoxing with Subutex or Suboxone can be a recipe for disaster. In the past two decades of providing these medications to treat opioid use disorder, we have learned that the best way to get lasting, long-term success is to prescribe Suboxone for at least one year.
A fast buprenorphine detox may work in the short term, but over time, intense opioid cravings can occur, leading to a high risk for relapse. Fortunately, more rehab programs are coming on board, realizing that they must coordinate for long-term Suboxone treatment.
Some rehab programs provide an outpatient Suboxone clinic for patients to continue treatment after they have graduated from rehab. Others will arrange for clients to see an outside doctor after discharge.
If your rehab has started you on medication, but not arranged for your ongoing medical care, it is important for you to find a doctor who can continue prescribing Suboxone and arrange for psychotherapy. There are several excellent online tools to help you to locate Suboxone doctors in your area.
With Suboxone therapy, getting clean without rehab is a possibility. All that it takes is making an appointment with a Suboxone doctor in order to start medication-assisted therapy (MAT).
Should I get a Vivitrol shot before leaving rehab?
Vivitrol is a special injection that is given in the muscle, providing a full month of medical treatment with the addiction medication, naltrexone. Naltrexone is FDA approved to treat both opioid addiction and alcohol addiction. There has been some evidence that it can help with other addictions, such as cocaine and methamphetamine addiction, and even binge eating.
While not all rehabs offer Vivitrol, it is available in many programs. Some rehabs may strongly recommend it to qualifying patients, or they may simply have it available to those patients who ask for it.
If you do agree to the Vivitrol injection, keep in mind that it is recommended, for best results, to take it for at least several months. Ideally, you should plan on six months to a year of treatment, and possibly longer.
One problem that can come up is that Vivitrol is very expensive and sometimes hard to get approved by health insurance. There have been cases where patients were given their first shot in rehab and then had trouble getting their follow up injections in subsequent months.
If you or a loved one is in this situation, of course it would be ideal to fight for your right to get the Vivitrol shot continued. The Affordable Care Act of 2008 included the Parity Act which promises that addiction treatment and mental health treatment will be as accessible as any other form of medical care.
The Parity Act should guarantee that your insurance company will cover your ongoing Vivitrol therapy. Unfortunately, health insurance companies are well aware that this law is not often enforced, so they have no fear of ignoring it.
An alternative to Vivitrol, if you cannot get access to it after rehab, is the naltrexone tablet. Any doctor can prescribe naltrexone daily oral tablets. While the Vivitrol shot may be better than the tablet form for opioid addiction, the tablet still works and is better than stopping medical therapy too soon.
Are nutritional supplements important after leaving rehab?
I once interviewed the founder of a nutritional supplement company on my podcast. Their supplements were uniquely designed to help people overcoming substance abuse.
When quitting drugs, you may experience difficulties in mental functioning that can take a long time to recover from. In some cases, chemical imbalances in the brain can even lead to relapse.
Ideally, if your diet includes the precursors to important neurotransmitters, which are usually special amino acids, and also important cofactors, such as calcium and magnesium, your brain will be able to recover more quickly. A healthy, well-rounded diet and additional supplementation can make a huge difference in recovering mentally from the effects of long-term active addiction.
Unfortunately, many rehabs have no interest in providing healthy nutrition to their clients. They often provide high-carbohydrate snacks and meals without a great deal of thought regarding nutrition.
The podcast guest from the recovery supplement company told me that it was unbelievable how much difficulty they had in promoting their supplement products to rehabs. At many programs, there was a complete lack of interest.
When you do leave rehab, you have the ability to take control of your own nutritional health. Eating the right foods is essential. A diet consisting of fruits and vegetables and lean proteins, such as grilled fish or chicken, is good. Also, you should take a multivitamin.
You may also be interested in brain function support supplements. L-tyrosine is an example of a supplement that acts as a precursor to several important neurotransmitters. Your brain is always producing more of these important chemicals and it requires the building blocks to be able to make enough for healthy brain functioning.
Should I exercise after I graduate from rehab?
Of course, exercise is a healthy way to keep your weight under control and to keep your heart healthy. A moderately paced daily walk for 30-60 minutes is adequate for most people.
Additionally, exercise is good for your mental and emotional health. A nice early morning or evening stroll is a good way to clear your mind and enjoy a beautiful sunrise or sunset.
If you also choose to go to the gym and engage in weight training, please be careful. Injuries from lifting weights can be disappointing, and may even lead some people to a relapse. Gym workouts should involve an experienced and professional trainer.
How do I find a good therapist when I leave rehab?
Rehab programs include therapy, and often continue to offer therapy after you leave the program, but in some cases, you may want to, or need to find a new therapist. An excellent place to start is to ask your doctor if they can recommend a good therapist.
While therapists are a personal and individual choice, you should keep some important points in mind. If you are on medication, such as Suboxone, make sure that you do not get started with a therapist who is against medication-assisted treatment of addiction.
Having your therapist try to talk you out of taking your prescribed medication can lead to disaster. While it seems obvious that a licensed therapist would not contradict medical therapy prescribed by another healthcare practitioner, this is not always the case.
In fact, some patients have had their primary care doctor tell them to quit Suboxone prescribed by another doctor. Before trying to intervene in someone’s medical care, therapists and other healthcare professionals should contact the prescribing doctor to voice their concerns. Giving a patient conflicting views of effective medical treatment for addiction can be confusing for the patient who is looking for clear answers from the medical community.
Many of us who go into healthcare bring along our own beliefs and prejudices, but our commitment must be to providing evidence-based treatment in line with community standards. We are expected to understand standard treatments for medical conditions and why they have come to be accepted as a standard.
Otherwise, you may also want to consider the credentials of your therapist. Are they a licensed psychologist or addiction counselor? How many years have they been practicing? Do they have a doctorate degree in psychology?
How do I stay happy after I leave rehab?
Were you happy during your stay in rehab? For some people, rehab is a miserable experience of being in the midst of drug withdrawal and experiencing regret for the events leading up to a rehab admission.
For others, it can be an uplifting experience of embarking on a new spiritual way of living with hope for the future. If rehab provides one thing well, it is a sense of hope that getting more involved in recovery and working the 12 steps will provide a spiritual awakening, leading to a new and better way of life.
Regardless of your experience in rehab, leaving the facility prevents new challenges in learning how to be happy and find fulfillment in life. The people who were hopeful about the promise of the 12-steps may settle into the daily routine at home, their pink cloud dissolving away to reveal the cold gray reality of the daily grind of life.
Quitting drugs often leads to a condition known as anhedonia. This means a lack of the ability to feel pleasure. It is the result of detoxing drugs out of your system and your brain’s long, uphill road to recovering normal functioning. Brain health supplementation, as mentioned earlier, may help with this brain recovery process.
Still, there are rewarding activities in life that provide a sense of fulfillment that goes beyond simple pleasures. True happiness is better associated with this spiritual sense of fulfillment than with the pursuit of short term pleasure-seeking. Even in a state of anhedonia as your brain recovers, you will be able to experience happiness as the result of engaging in more spiritual activities.
Finding happiness through spirituality.
Service to others is one way to experience a sense of lasting happiness. Knowing that you have done something to make someone else’s life a little better is a great way to feel better about yourself and about life in general.
Some examples of service include signing up for a service position in a local 12-step group, such as setting up chairs, or being a greeter. Or, you could volunteer at a local soup kitchen or hospital. If you have the resources, you might want to get involved with a charity, providing financial support as well as volunteer services to the same institution.
Gratitude is another way to feel a sense of calm satisfaction with life, even when you are still dealing with the anxiety of early recovery. 12-step sponsors often ask their sponsees to keep a daily gratitude list, writing down all of the things they are grateful for in their lives.
Mindfulness and meditation are also helpful. Do not let the idea of meditation scare you. Anyone can meditate. You do not have to follow any specific rules or techniques. You can simply focus on one thing, such as a sound or the feeling of your breath at the end of your nose.
Mindfulness simply means being aware of the present moment and what is happening around you. Rather than rehashing the same old memories and thoughts in your head, stop, look, and listen. Focus on being where you are at the present moment.
Happiness is not spending money, buying stuff, eating fancy food, riding on roller coasters, or showing off how good you are at something to other people. These things can be fun in moderation, but can also become unhealthy in excess.
Do not feel down because you are not going out to party on the weekend nights with your old friends. Just because you are not doing as well as you would like financially or in your career, there is no reason to obsess over it. Give yourself time and enjoy the simple pleasures of being alive.
There is no rush to get back to the life you left behind when you started using drugs. In fact, that is not necessarily the life you should be getting back to. Now is the time to rethink who you are and what you want out of life.
There is a whole new world available to you when you stop using drugs and alcohol. You have the opportunity to start over again and live a life beyond what you ever dreamed possible. To learn more about how you can enjoy your recovery, I recommend that you listen to the best addiction recovery podcast, The Rehab Podcast on The Mental Health News Radio Network.