Many people find a stint in a detox facility to be a blessing. After having gone through the required detox period, a man or woman feels better. He’s acclimated to the routine at the facility, and spent quality time with the staff and other fellow patients. He has had an opportunity to watch others come in and go through detox, just as he did a few days ago. As the customer nears the end of his month in rehab, however, anxiety begins to rear its ugly head.
Just prior to discharge the nervousness becomes even more severe. Some of this anxiety is, of course, normal apprehension that precedes any life transition. But what he really fears is life outside the facility. He’s learned, during his visit, how to manage life inside the strange world of drug & alcohol rehab. But the rules there are very different than in normal life.
The sense of safety inside the treatment facility is called ‘the bubble.’ It is a sense of being inside the thin protective wall of the rehab. The basic premise of these facilities is flawed: dip into rehab/recovery and emerge with a coating of sobriety. This protection is short-lived.
Sometimes, if connections have been formed with veteran rehab clients, news comes back from the outside world. Typically (95% of the time) that report goes something like this:
I was back in daily life and I thought everything would be better. But instead, all my problems have gotten worse. Well, except the physical symptoms; they’re better. But my wife is angry with me. It’s like once she saw I was sober, she really let me have it. Also, my coworkers are now chilly toward me.
As this information wends its way through the clientele, fear spreads. This revelation inevitably comes after the client has already coughed up intimate details of his addict-times to staff and peers. This can be a problem, since the general staff of most rehab facilities are people whose credentials frequently consist of being a “sober person.”
These “techs,” are sometimes frenemies, and they can wield significant power. Especially once 5 p.m., rolls around. The senior faculty and professional staff have gone home. In the evening, petty envies, rickety commitments to sobriety, and financial opportunism can arise. An anxious customer looks at the calendar to count the remaining days in his stay. If he has a week or less to go, he usually clams up.
At discharge, relationships with peers and staff end. One’s counselor, exercise trainer, and even the kitchen chef are left behind with the sound of the graduation gong. Clients are acutely aware they no longer have their support group to lean on, and their prehab vexations return as soon as they walk out the door. Who wouldn’t be nervous?
We know that the brain remains impaired for months after stopping drugs and alcohol. Yet after a mere 28 days, people are thrown back into their old lives with scant improvement in the necessary skills to stay on the path. You can see why the success rate of these programs drags along in the low single digits. It’s a bit of dark humor in the rehab industry: keep coming back.
A 2006 Cochrane review of treatment efficacy concluded AA does not demonstrate efficacy. Nearly all treatment programs in the US are based on Alcoholics Anonymous. The coping skills imparted are somewhat useful while inside the treatment program. The problems in the outside world remain as complex as ever. More, the drugs & alcohol which were reliable tools for managing life’s unpleasantness have been been removed. A new set of strategies for coping with anxious feelings is critical to not just maintaining abstinence, but to being satisfied with life.
The bubble is also at the root of recommendations by rehabs for their soon-to-be-graduating clients to stay even longer. The implication is simple: if you don’t want the discomfort of going home, hide out here.
There is also the tempting invitation, if you can afford it, to return to rehab whenever you find life on the outside is too grueling. This is rehab in 2018. Clients muster out feeling overwhelmed, having achieved success only within the borders of the facility. Stories of relapse inevitably trickle back to the current crop, making them feel even less confident about their chances of staying sober on the outside.
The way to confront the bubble phenomenon is to avoid allowing one to form. If we help people build and maintain healthy habits in the real world, they will grow stronger. Subsequent choices become clearer and less painful. Every discipline practiced affects every other discipline. The better you get at handling reality without running away to drugs and alcohol, the easier daily life becomes.
No one should miss out on the satisfaction and personal growth that comes from doing the right thing, even when doing so is difficult. The trick is to build a strong and flexible support network of people that you can – and do – rely upon. Show up, tell the truth, ask for help, and help others. If you are honest about it, admitting that drugs and alcohol don’t work, it’s easier to say goodbye. In the end, every sober person must make this choice daily. You can’t make a real-world decision inside of the bubble.
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