A journey through the 4 phases of treatment in rehabs
What can you expect to happen during your stay in rehabs? We have compiled a guide of the four phases of treatment that you can expect at rehabs, in just six minutes reading time. The best rehabs will include the following 4 phases of treatment that you will go through while in rehab and include:
• PHASE 1
Assessment, detoxification and stabilization phase
• PHASE 2
Addiction treatment phase
• PHASE 3
Psychological treatment phase
• PHASE 4
Consolidation, relapse prevention and re- entry phase
James is a 34-year-old male who lives in Cape Town. He has been married for four years and has one son. He tends to work hard and party just as hard. His wife, Lisa is concerned that he is drinking too much alcohol on weekends and his cocaine use is becoming out control. She researched a number of rehabs in Cape Town and then discussed these rehabs with James. She arranged for James to come and meet our team and to be shown our rehab facility.
James had the following questions:
• ‘How long does one need to stay in rehabs?’
• ‘Is the detox process the same in all rehabs?’
• ‘What will the treatment entail in rehabs?’
• ‘What happens after I complete the treatment?’
You may have similar questions regarding what actually happens in rehabs. Rehabs usually provide the following four phases of treatment:
PHASE 1 – ASSESSMENT, DETOX AND STABILISATION PHASE IN REHABS
You will undergo a comprehensive assessment during your admission to rehabs that will include:
1. Physical assessment by a Doctor
2. Nursing assessment by our qualified nursing staff
3. Psychological assessment (And psychiatric assessment if needed) by one of our clinical psychologists
These assessments are necessary to help determine what detoxification you will need. It also helps to identify what treatment goals you can set with your counsellor. Our Doctor will prescribe the necessary medication to help alleviate the withdrawals that you may experience.
Our nursing staff will administer the medication and take care of your physical needs, so as to ensure that you are comfortable during the detox phase in rehabs. The duration of the detox phase depends on the substance that you have been using and the level of dependency. Most rehabs subscribe to best practice advisories regarding detox. Please click on the link below to find out more information about:
During phase 1 of treatment in rehabs, you will also receive a comprehensive orientation to the facility. You will meet your counsellor who will discuss the norms and guidelines of your treatment process with you. Your counsellor will work with you in a non-judgmental way and our staff will always treat you with respect and preserve your dignity.
Your counsellors at rehabs will develop 3 to 5 treatment goals with you and together you will decide who would be important to include in your treatment. Most rehabs require that significant family members or friends are included in the treatment process.
James spent four days in detox during which time the medical and nursing staff took care of him. He met with his counsellor and together they decided that his wife needed to be included in his treatment process. He identified that the following treatment goals:
1. To understand more about his addiction
2. To work through a traumatic experience in his childhood
3. To improve his communication and relationship with his wife
4. To identify healthy coping strategies in order to remain abstinent and to sustain his recovery
PHASE 2 – ADDICTION PHASE IN REHABS
This phase is of the upmost importance in all rehabs and cannot be rushed, overlooked or minimized.
James thought that he started drinking and using drugs recreationally and that he started using more to cope with his work stress. He didn’t think that his ‘problem’ was that bad and thought that his wife was over exaggerating. His wife realized that he was in denial and therefore started to research more about rehabs and the treatment that was offered.
Step 1 in the addiction phase is about helping you understand more about denial and how it works. You may have thoughts about why you started using drugs and or alcohol and why perhaps the ‘problem’ got worse. It is normal to question whether or not you in fact have a ‘problem’.
Your counsellor will explore this ambivalence with you. Your counsellor will also help you to explore your denial about the severity of the problem so that you can better understand your addiction and how your denial allows you to continue using.
Below you will find a table that will help you to determine the severity of your addiction. Simply answer yes or no for each of the criteria. If you have more than 2 ‘yes’ responses then it is likely that you have a substance use disorder that requires treatment at rehabs. The criteria illustrated below is accepted and used by most mental health professionals and rehabs.
(Adapted from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition)
Step 2 in the addiction phase will help you to identify your loss of control. This essentially means that you cannot control your drinking or using. I.e.: Once you start drinking or using, you can’t stop. Rehabs often refer to the concept of loss of control as ‘powerlessness’
Linked to this is step 3 of the addiction phase. Your counsellor will help you to recognize the full extent of the damages that has been caused to you and to those closest to you as a direct result of your addiction. This can be quite challenging, as it is not easy to admit how your addiction has affected you and others. We will help you to identify the physical, emotional, financial, and social effects of your addiction.
James and his completed the DSM 5 criteria for substance use disorders. He recognized that he had 5 out of the 11 symptoms and was initially surprised to learn that he has a moderate substance use disorder.
James completed some therapeutic worksheets that helped him to identify how he used to justify his addiction. Together with the help and guidance from his counsellor, he began to understand his denial. He participated in daily group counselling sessions during which he shared some of the examples of events that took place in his addiction. This helped him to identify the damages that were caused in his active addiction. James and his wife had a weekly session where she was encouraged to share about her experience of his. This was important for their relationship so that healing could begin.
PHASE 3 – PSYCHOLOGICAL PHASE IN REHABS
Rehabs will not only focus on the addiction treatment but also focus on psychological issues. You may have some past trauma, or other psychological issues that you believe may have caused your addiction or made it worse. In addition, there may be other self- esteem, family and relationship issues, employment and financial problems and social or living conditions that contribute to the maintenance of your addiction. All of these issues need to be identified with the help of your counsellor and rehabs. You will work through some of these issues during the individual counselling sessions.
Your counsellor will help you to process some of the trauma in a nurturing, caring and safe space. This is important work to do as people at times relapse due to the uncomfortable emotions they experience related to some of these issues. Most certainly you will start to realize that in some instances, these issues didn’t cause your addiction, but in active addiction, you were unable to confront and deal with these issues. Perhaps, even at times, your addiction made things worse.
As James continued with the individual work with his counsellor and during group counselling sessions, he started to identify that there were other issues that he had never dealt with. These included being bullied as a child, feeling that he could never live up to his father’s expectations, and that he is always trying to prove to his employer and colleagues that he is competent at what he does. His counsellor helped him to start the process of working through some of these psychological issues.
PHASE 4 – CONSOLIDATION, RELAPSE PREVENTION AND RE-ENTRY PHASE IN REHABS
The focus in rehabs is not only to detox the client, provide addiction treatment and work through psychological issues. Rehabs have an additional role to help the client to:
• Identify all triggers and high risk situations that could lead to relapse
• Learn healthy coping skills
• Compile a thorough relapse prevention plan
• Re- integrate in their family, home, work and society
James identified a number of triggers and high- risk factors that included:
• Work stress
• Friends that he used to drink and use drugs with
• His dealer
• Difficult relationship with his father
Together with his counsellor, they developed a relapse prevention plan that included some helpful strategies to deal with high- risk situations, uncomfortable emotions, interpersonal relationship challenges and follow up support.
James realized that he still has a long way to go and was glad to hear that he could attend an aftercare group at Rustenburg Addiction Care once a week. His counsellor also agreed to see him once a week to help with the adjustment and re- integration phase after he completed his treatment.
Most rehabs will encourage clients to participate in support groups during and after the completion of their inpatient treatment. You will be encouraged to attend a few 12- step fellowship meetings during your inpatient treatment. These meetings consist of people with addiction who realized that they needed the support of others who understand what they are going through. It is a non- judgmental and supportive environment where others will share their experience, strength and hope with you.
Please click on the link below to find out more about the 12- step fellowship:
‘This has been the most remarkable four weeks of my life! I never thought that my problems were that bad and never in my wildest dreams did I ever imagine that I would end up in a rehab. I am so grateful that I came to Rustenburg Addiction Care. It has been a life changing experience. I faced my demons and have come to realize that my happiness does lie in a bottle or in using drugs. I am so grateful that my wife looked at a number of rehabs but chose Rustenburg Addiction Care. Thank you for giving me my life back!’
When you replace the ‘I’ with ‘we’, even ‘illness’ becomes ‘wellness’