In-Patient vs. Out-Patient vs. AA
Before I was taken to rehab I was deep in denial about my alcoholism but others weren’t. My former law-school roommate, for example, had prior experience with friends’ addictions and he repeatedly insisted that I needed not only needed treatment, but a 28-day in-patient program to boot. I rejected his advice out of hand. Even if a small part of me might have conceded I had a problem, I thought four weeks would be like extended exile, that it was too long to be away from my life and family.
I was wrong. In-patient was where I needed to be for reasons I couldn’t foresee: safety and community.
My many (many, many) self-detoxes resulted in temporary sobriety, but not safety. Almost as soon as I felt better physically, I had to contend with the insistent notion that now, with new-born fortitude and the recent memory of detox pain, I could limit my drinking in a way I wasn’t able to before, despite all previous evidence to the contrary. Inevitably, I succumbed and learned again that feeling strong didn’t keep me secure for long. The hospital was different. For the first time, the strength sobriety brought didn’t lead inexorably to a mental license to drink again, but to build a defense against that license. Like everything else, this was an immense change for me. I couldn’t have been more resistant when I arrived. Weeks of sobriety, therapy, and inspirational role models later, I never wanted to leave because I felt so safe and the world outside seemed so scary.
The fact that I was in-patient also forced me to participate in rehab’s therapeutic community every moment of every day, which was central to both my acceptance I was an alcoholic and my adoption of the program of recovery.
Many people aren’t as fortunate as I was: they can’t go to in-patient treatment. Many can’t afford it. Many don’t have health insurance. Many need to continue working or face destitution.
For them, out-patient treatment, whether during the day or after-work, is a viable option. The goals and techniques are the same as in-patient but you aren’t sequestered. This may be beneficial, particularly if your family participates and is supportive. I’ve been told by lots of people that out-patient was best for them because they were able to access the love of their families (their children, especially) which was good for their sobriety.
But there are also dangers in going out-patient. There isn’t the 24-hour safety of living in a treatment facility. There are bars and liquor stores seemingly on every corner calling out your name. There are obliging drug dealers. These temptations are hard to resist, which was demonstrated to me when one of my closest rehab buddies switched from in- to out-patient (not his choice, his health insurance company insisted) and immediately relapsed.
Whether in- or out-patient, rehab is only a start. Graduates are urged to promptly immerse themselves in 12-Step programs (Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, Marijuana Anonymous), which is the option alcoholics and addicts who can’t afford in- or out-patient rehab have.
The majority of sober addicts I’ve known have gotten sober solely through these programs. The ones who have stayed sober have devoted themselves wholeheartedly to them: they say the length and quality of their sobriety was directly proportionate to how much energy they put into them. Most went to multiple meetings every day (2, 3, even 4 of them), got sponsors, attended meetings with them, called them every day and worked the 12 Steps with them. They found people with stable sobriety and, in the language of the program, “went where they went, did what they did, and followed their suggestions.” They modelled the behavior of their sponsors and others in the program and learned the tools of sobriety from them.