Making the choice to get help for substance use disorder (SUD) is a huge step and one that should be applauded and encouraged by family, friends, and treatment providers. But as providers, we also have a responsibility to make sure patients who come to treatment also understand that this is not the end of their journey. In fact, it’s just the beginning.
The truth is, living in recovery takes constant work and the early days can be some of the toughest. While we certainly don’t want to discourage people from getting help, it’s essential that we’re transparent about the process. Failure to adequately prepare patients for life in recovery puts them at risk of a re-occurrence of symptoms so we must make sure they’re equipped for what lies ahead.
Here are five things patients need to know well ahead of discharge.
The transition to real life is challenging.
During treatment, patients live in a very structured environment with nutritious meals prepared for them daily, a healthy sleep routine, exercise, etc. Because they feel so much better, it almost feels like a high in itself—a phenomenon we call the “pink cloud”—which can mean they come out of treatment a bit overconfident. Once they’re thrust out of that bubble and into the realities of life outside the facility, it’s difficult to maintain that sense of control, routine, and structure.
When my time in a treatment facility was over, the first 30 days were extremely tough. The anxiety was overwhelming. I’d just gotten accustomed to the structure of sobriety in treatment and was suddenly forced to navigate it on my own. I had to get somewhere safe, which for me meant turning to a pastor, my therapist, and my sponsor. Patients need to be prepared for the reality-shock of life outside of treatment and have structures in place to help them navigate the uncertainty.
Forgiveness isn’t automatic.
When in active addiction, we often do things that bring tremendous pain—mental, emotional, and sometimes physical—to those we love. The need for a fix drives us to great lengths to fill that need, and everyone else be damned. It takes time to re-earn the trust of those around us, and sometimes we burn bridges we can’t rebuild. Patients must recognize that mistrust may linger, and forgiveness may take time, but by keeping your eye on the prize and making the right choices, you can regain that trust and connection.
Life as you once knew it is over.
It’s hard to believe, but there’s actually some sense of comfort in the chaos of addiction. It’s extremely stressful, but you get used to it, and the idea of starting over with an entirely new life is scary. In treatment, we’re asking patients to change everything, and that often means saying goodbye to old habits and old friends.
Too often, patients leave thinking they can keep the same company and just not use—that they can go to the bar and hang out without drinking, or they can go back to the same toxic romantic relationships out of fear of being alone. But this is a recipe for disaster. “Just don’t use” is a gross oversimplification of life in recovery. Success most often requires a completely new lifestyle and social group.
It can be lonely if you let it.
Because you have to leave those social circles behind, recovery can be a rather isolated, lonely existence if you don’t work at it. We saw this intensify during COVID lockdowns when people who desperately needed their therapy sessions and group meetings more than ever, slid back into addiction, or worse—overdosed or committed suicide.
It’s essential that patients have a community of support to plug into after treatment. As therapists, we must stress the importance of building a support group, attending meetings, and taking part in sober activities in order to stay on the right path. There are lots of sober groups and activities across the country, in every community, and finding like-minded people who are experiencing the same issues is key to success.
It won’t be easy.
People often arrive at our facility falsely believing that the hard part is over, that walking through the door means their life will magically be better from now on. That’s just not realistic—you still have to face life on life’s terms. There will be challenges and loss and all the other obstacles people contend with every day. And sometimes you’ll be forced to deal with problems you created yourself because of your addiction, like health problems, debt, lack of housing and employment and family issues.
That’s why sticking to the aftercare program is so important. Patients must learn new coping skills, how to manage stress and how to re-engage in society without the use of substances. For example, I don’t recommend patients return to work full-time right away—instead they should go back part-time, if possible, until they acclimate to life in recovery and have an established community to support them.
What’s important to remember is that the upsides of recovery by far outweigh the challenges. Living in recovery means having the opportunity to rebuild relationships, to have meaningful connections with your significant other, children and extended family members. It means regaining self-respect, respect from others and being able to hold your head high instead of walking with a cloud of shame and guilt. It means having money in the bank to pay your bills, a place to live and a car to drive. So many people forget what that’s like!
Recovery is a freedom like no other, and the restoration you feel is overwhelming–I’ve even heard clients say they can see colors more vividly. It’s true that the world of addiction is very dark and living in recovery is a world full of light. But it’s not always pink clouds and rainbows. It takes hard work, and we as therapists must be transparent about that, while reminding clients that it’s so unbelievably worth it.
Todd Garlington is lead therapist at Greenhouse Treatment Center, an American Addiction Centers facility.