Concerns of Patients During and After Treatment

You abused a substance because it made you feel good and you believed you would never be addicted. You ended up with serious problems. And now it has come to this; you are facing treatment for substance abuse disorder in a rehab centre, but you stress about coping with your feelings during your stay, and in life afterwards. You may even be speculating about breaking your promise and walking out.

Ambivalence, the mental struggle between knowing that you need treatment and the urge to avoid it (or to end it prematurely) can partly shut down your mind and limit your ability to think clearly. It is important to examine your thought processes before making a rash decision based on mixed feelings.

It can be difficult to make the mental shift to sobriety. To start off with; all people, not just addicts, have an ingrained resistance to change. We also want maximum pleasure with minimum effort. It is relatively easy to overcome these common instincts, but they are stronger in addicts and there are other factors that may also influence you.

Most in-house patients worry about what they had left behind and what awaits them when they go back. While some patients take it in their stride, others put on an act and try to appear unaffected, but inside they are in turmoil. Some display their anxiety openly by constantly talking about it, or by keeping to one side and sulking in silence.

What you did during the abuse, affected many people and things. It caused problems with relationships, employment, career, finances, legal issues, and so on. It is natural that thoughts about it will cause anguish when you are sober. These thoughts can flood your mind – They create anxiety, impatience and an urge for you to postpone or exit treatment prematurely so that you can take immediate action to fix those problems.

Detox improves your health and removes the fear of withdrawal. You may then feel confident enough to heal yourself without further treatment and you may rationalise that you are being manipulated or unjustifiably detained. The perceived enforcement of an unnecessary stay can inflate your anguish about unresolved problems that had accumulated during the abuse.

Apart from the urge to fix the immediate problems, just the thought of coping with daily life when you can no longer smother or spice your feelings with intoxication, can seem like an unbearable prospect. You foresee a future filled with both stress and boredom. You may feel trapped in a situation that you can neither tolerate, nor abandon.

Some rehab centres are poorly managed and function in a bureaucratic manner. They have inadequate facilities and the staff are preoccupied with admin work. Patients have too much idle time and little to distract them, so they sit around, bored and drowning in worries, instead of being actively engaged and enabled to deal with their concerns.

Your emotions will still be fragile during the first week or two of recovery. In this vulnerable state you may overreact to thoughts and events because your mind has not yet “settled down”.

So what can you do about these concerns? Do not become overwhelmed. There are solutions. These include choosing an efficient rehab centre, keeping yourself busy, thinking positively, getting problems out of the way, and getting support when you go home.

One general rule to remember is: When a worry invades your mind, ask yourself if it will still matter to you a year or two from now? If the answer is “no”, then throw the worry away.

How to deal with rehab anguish

1. Be rational about relationships

Relationship anguish is a heavy burden, but there is no sense in abandoning treatment in an impatient attempt to go and fix it. Relationships can only be convincingly salvaged when you have proven your commitment by completing the program. By then you will also be better prepared for the task. It’s not a unique problem – Substance abuse therapists work with it all the time.

Discuss pressing feelings of relationship anguish and impatience with your therapist. The therapist can guide you and make practical arrangements to alleviate excessive distress. In extreme cases, mood stabilising medication can be prescribed and administered in a safe and controlled manner as a temporary measure to help you to get over the worst.

Your treatment program should also include therapy for dealing with impaired emotion-management. It is the main cause of addiction and this element of therapy will further assist you as your treatment progresses. Your therapist has to know about your extraordinary initial concerns to refine your individual treatment program.

If possible, the best solution is for intimate partners and children to also receive counselling. This is not punishment, but a way to heal and protect them, as they will be able to gain closure and will be better informed going forward in life. If this is not possible, it does not mean that you should give up.

Even if you have already lost an intimate partner, time has a way of healing wounds. Keep reminding yourself that the sadness will eventually fade and be replaced by the joy of new intimacies – or the revival of old ones – and that you must be equipped to successfully maintain it when it happens. Your therapist can help you to build an even broader contingency survival plan to reach that goal.

You may fear that an existing partner could be silently considering leaving you, or that they may turn to someone else for solace while you are in treatment. This temporary anxiety is triggered by your immediate circumstances and the feeling will pass. Even in the worst scenario, it can be managed in the same way as with an intimate partner you have already lost.

Children are always badly affected. Do not neglect them during or after your recovery. Do your best to arrange for therapy or group-support for them. After recovery, show that you care deeply, but be patient. Allow time for them to adjust to the “new you”. If there is discussion, be honest. Do not reinforce their distrust or confuse them.

Competent therapists can intervene with employers and career associates if required. Unlike the distant past, there is now widespread awareness and tolerance for people who submit to treatment – Today’s politically correct climate has improved this sensitivity in the business environment.

Friends, co-workers and acquaintances will also be aware of the unintended elements of addiction and will be even more forgiving if you sincerely apologise. If they do not want to accept it, then they are probably not worth the bother in the first place and you need not punish yourself about it.

You cannot turn back the clock, but with sobriety comes opportunities to heal damaged relationships or to create new ones. Keep reminding yourself that it will take time and buckle down to the task at hand to prepare yourself properly for dealing with it when the time is ripe.

Coping with relationship anguish:

People have different ways of coping with relationship anguish, but these are good thoughts to keep in mind:

  • Therapists can help you to cope.
  • Relationships can be restored.
  • Restoration requires opportunity.
  • You are creating the opportunity.
  • Therapy is the tool you need.
  • Lost relationships can be replaced.
  • New relationships can be formed.
  • Children can be healed with therapy.
  • Sometimes medication can help you.
  • Most people are tolerant and forgiving.
  • You are not broken, you are just hurting.

2. Avoid career fatalism

Despite social kindness to addicts who change for the better, work security remains at risk. Thoughts about poor future prospects in your current job, or the difficulty of finding a new one, can be distressing. But allowing it to spoil your treatment is like trashing a car’s engine before you reach your destination.

Dismiss gloomy thoughts about how bad returning to your workplace will be, or how impossible it will be to find a new job. Returning to an existing job is never as bad as you expect and finding a new job may take time, but it will happen if you persist.

If you are currently employed, a good option before going for treatment is to ask an addiction therapist to intervene with employers or career associates. Qualified counsellors can negotiate with authority, ruling out the doubt and desperation that weakens the pleas of addicts and their close allies.

Sometimes you can attend job interviews while you are undergoing treatment, but you have to ask the rehabilitation centre about it in advance. You also have to make special arrangements so that interviews do not clash with or cause problems with your treatment schedule.

If you are unemployed when you go home, make the act of finding employment your new full time, eight-hours-a-day job. If you persist with this discipline, you will succeed. Most unemployed people allow laxity and negativity to bog them down. They do not put in enough effort to get a job and they give up too soon. The same applies to self-employed people who have damaged their careers. Just keep going in the same way that you would have if you had a normal job.

Consult career specialists or employment agencies and get advice from them. They know exactly what is going on in the job market and can give you valuable advice and assistance.

If you find yourself in a dire situation, consider aiming for a lower grade of work or less payment. Downscaling is a step back, but it may be easier to get a job. It will help you to survive and you will get your foot in the door – in time you can work your way up. At the very least, you will gain a useful reference for your CV.

Volunteer for work at community and charitable organisations. It may seem silly to work for free, but it opens a lot of doors. It shows prospective employers that you are willing and able to go the extra mile. People involved in the establishment will get to know you and can help you to find other work or to improve your circumstances. At the least, you will gain good references.

Consider starting a temporary (or fulltime) freelance service. When you return home, have business cards and small posters printed. Pin the posters up in public spaces and place some in waiting rooms. Go around to businesses to offer your services and to hand out your business cards.

Enlist somebody to help you by keeping an extra eye open, arranging appointments, going with you to interviews, sharing ideas and keeping you motivated. Most people are helpful by nature, but you have to swallow your pride and ask. You will have a lot to deal with, so this is more important than you think.

Ways to create survival income until you find employment or relaunch your career are numerous. Take a pen and notebook and start making a list of all the possible ways to do it. Ask other people for ideas too. Apart from the practical reasons, the process of compiling and discussing the list will give your feelings an enormous boost while you are in treatment.

Dealing with unemployment

Follow these basic rules:

  • Dismiss negative expectations.
  • Know that perseverance wins.
  • This is just part of the journey.
  • Do not let pride hamper you.
  • Do not delay or procrastinate.
  • Arrange career/work intervention.
  • Enlist somebody to assist you.
  • Spread the word among friends.
  • Make job-seeking your fulltime job.
  • Consider freelance self-employment.
  • Make a list of survival income plans.
  • Pin up notices in public places.
  • Hand out cards with your details.
  • If necessary, aim for a lower post.
  • Volunteer for community work.
  • Do not be discouraged by failure.
  • Be patient, disciplined, keep going.
  • Just do it.

3. Face your finances

During the period of active abuse, personal savings are usually plundered and related financial matters like investments, contracts, credit cards, overdrafts, loans and accounts are usually neglected and ignored. When you turn sober, these monetary neglects will be circling you like mosquitoes.

It is tempting to turn a blind eye to it, but the golden rule is to face it and get your financial matters sorted out. It will not disappear by itself and your survival is inextricably tied to it. It may be an unpleasant task, but by acting you will soften the blow and you will feel good afterwards.

Appoint a legal proxy
Even during treatment you should make arrangements by whatever reasonable means available to avoid legal actions by creditors.

If possible, appoint a trustworthy person and provide them with a signed proclamation to act as your legal proxy for making arrangements with creditors on your behalf. This can deflect severe legal actions in your absence and some financial issues will already be resolved when you go home.

Consolidate the debt
In some countries you can apply for debt consolidation, debt counselling, debt review or debt administration. The processes differ, but basically they all involve appointing a certified administrator who assesses your income and expenses, contacts all your creditors and arranges for repayment of your debt in affordable installments.

A fixed portion of your income is paid to the administrator every month for distribution among your creditors. The system protects you against legal action and prohibits harassment by a creditor. You are not allowed to open any new accounts during the process.

Get a helper
When you go home, there may be a lot of administrative work waiting for you and a lot of people to deal with. Do not allow the nature or volume of the work to discourage you. If the task seems overwhelming, then ask a trustworthy person to help you sort out the paperwork, make plans, arrange appointments and accompany you to negotiations.

Getting someone to help you is more important than you may realise. Not only will a helper cut the workload in half, but the added relief of sharing your mental burden is immeasurable.

Save the cash
If your source of income is compromised, hang on to the cash you have, in case you need it for an emergency. Do not spend large amounts on bulk purchases if you can buy small quantities as needed. Bulk purchases work out cheaper, but goods can not be used to pay for unexpected emergencies.

Sell property that you do not need, or exchange it for something more economical. Cut out expenditure on things you can practically live without. Check bank statements for unnecessary debit orders you authorised when you had a good income and cancel them.

Tiny leaks empty a bucket faster than you think. One small saving may seem unworthy, but when you combine several over a period of time, the total becomes sizable. Savings often hide away out of the normal line of sight or thought. A simple example is leaving a light on when it is no longer needed. Avoid all such habitual wastage and foster awareness of savings on all levels.

4. Face the legal issues

During the time when you were actively abusing an addictive substance, your pre-occupation with it would have kept you from paying much attention to your finances and this may have creditors throwing tantrums now. You may also have been arrested for a legal offense and you may be facing a court appearance.

Depending on where you stay, different judicial rules will apply. In most countries you will be able to have a court case postponed while in rehab (depending on the circumstances of the case). In some cases you can have an attorney act as your legal proxy to represent you in court cases in your absence.

In some cases, for example where you are guilty of driving under the influence of alcohol, a court may consider the fact that you have volunteered for rehab treatment a mitigating factor and may reduce your sentence in recognition of your good intentions to avoid a repetition of such behaviour.

In almost any country creditors can obtain court orders to confiscate your property while you are in rehab. Other issues include threatening visits and communications. It is best to appoint a trusted person to act as a proxy for you while in treatment. It requires you to issue a written proclamation in which you empower the person to negotiate and enter into legal agreements on your behalf. Agreements signed by your proxy will be binding on you. This is somewhat risky, but better than dealing with the alternatives.

During treatment you should also inform your therapist about any pending issues. If therapists are not aware of the circumstances, they may not always understand what is happening or what assistance you need. If the pending issues cause intensive distress, such as keeping you awake at night, tell the therapist about that too. The therapist can then take extra measures to support you. You may also need a certificate from the rehab centre to support court applications for postponement or absenteeism.

Depending on your preferences, you may actually benefit from advice by fellow patients in the centre. Substance abusers frequently have to deal with legal issues and you may get good information from them. At least you can find relieve in sharing your issues with a sympathetic audience.

After treatment, it is important to deal with legal issues as soon as possible to avoid undue anxiety. It is essential that you enlist support, such as a trusted friend, to help you with it. They will not be as emotionally involved as you are and will be in a better condition to help you with decisions. They can also assist in many other valuable ways, like making appointments, escorting you to events, and so on.

Typical legal issues include:
  • Unpaid, overdue debt.
  • Driving under the influence.
  • Fleeing from accident scenes.
  • Possession of illegal substance.
  • Criminal violence/assault.
  • Domestic violence.
  • Divorce, child custody.
  • Disturbance of peace.
  • Theft, robbery, fraud.
  • Resisting arrest.
  • Verbal abuse, slander.
  • Civil claims/lawsuits.
  • Labour law issues.
Ways to deal with legal issues:
  • Apply for postponement of court cases.
  • Appoint an attorney to represent you in court.
  • Appoint a trusted proxy to deal with creditors.
  • If necessary, apply for free legal assistance.
  • If necessary, apply for debt counselling.
  • Tell your therapist about anguish issues.
  • Ask the rehab for a medical/sick certificate.

5. Improve your mood

Settle down
Understand that your emotions will still be fragile during the first two weeks after detox. Give it time to settle down. If you start building a stockpile of anxiety at this point, it will only prolong the time it takes before your emotions settle down and heighten your sense of impatience.

If the anguish is overpowering, you must discuss it with your therapist. It is not a sign of weakness or being silly. It is quite common and therapists deal with it every day of their working lives. They have to know where you hurt most, so they can help you best. It’s what they are there for.

Do something
Do not sulk when there is a break in treatment activity. Idleness and isolation opens the door to distracting thoughts and worries. Disrupt the invasive thoughts by redirecting your attention with other activities. You may not feel like doing this, but just force yourself to do it. The more you do it, the easier it will become.

  • Take part in sport activities.
  • Use gym/exercise facilities.
  • Do handicraft, make things.
  • Play card or board games.
  • Take a walk or go jogging.
  • Take part in conversations.
  • Read books or watch movies.

Do static exercises
Most rehabs will teach you therapies like muscle relaxation techniques and breathing exercise. Do not just wait for the classes. Do it on your own. You can also try other relaxation methods like yoga and other forms of meditation. You can also find dozens of easy, effective exercises like these on the internet. If you can afford it, rent a massage.

Clean up the clutter
We feel better when we are physically neat:

  • Wash your hair daily.
  • Shave every morning.
  • Brush your teeth regularly.
  • Take daily showers/baths.
  • Polish shoes, change socks.
  • Dress with fresh clothes daily.
  • Get all the toiletries you need.
  • Groom your hands, feet, nails.
  • Arrange for a haircut/hairdo.

Focus on the good
We focus more on what we lose than what we gain. Life without intoxication is not as dreary as you expect. You have simply conditioned yourself to think like that. Life really is better without the backlash of addiction. Think about the advantages and activities you will enjoy when you are free of the chains that tied you down. You will be in control and able to shape new satisfactions.

You also no longer have to worry about the many troubles caused by your bad habit. No more anxiety about supplies. No withdrawals and illnesses. No disappointed partners, family and friends. No arguments about things you are guilty of. No worries about problems at work. No destructive waste of money. No lying and false excuses. No shame and guilt feelings. The list goes on.

Let go of vanity
Feeling good about yourself is a positive thing, but vanity is a burden. It causes distress about self-image and the situation you are in. Also, empathy is a foundation of therapy and vanity undermines it, because it isolates you from others. To relieve the anguish it causes, you need to let go of:

  • Over-estimating your importance to others.
  • Always worrying what others think of you.
  • Inflating your importance to impress others.
  • Thinking you are better than other people.
  • Trying to overpower and control others.
  • Undervaluing other peoples’ judgment.
  • Thinking others are less competent.

Eat well and supplement
Whether your meals are provided by the rehab centre or not, ensure that you do not miss meals or skimp on the portions. Some rehab centres provide additional vitamin and mineral supplements. If they do not, then buy your own. Good nutrition makes you feel healthy and feeling healthy makes you a happier person. On the other hand, cut back on things like caffeine and sugar. They stimulate heart rate and can increase your sense of anxiety.

6. Pick a good rehab centre

Most people think all rehab centres and treatment programs are the same, but they actually differ substantially. To ensure that your anguish will be contained, you should learn more about the differences between them before choosing a suitable rehab facility.

Rehabilitation should not be a holiday, nor a punishment or a fruitless waste of time. It requires dedication, effort and meaningful guidance to get your life on track – A rehab centre must provide adequate means to accomplish the transition. Check if a rehab centre meets the recommended criteria before you decide on one.

What a rehab facility should offer:
  • Respond efficiently to enquiries.
  • Give you a sense of trustworthiness.
  • Not focus on “too pushy” sales tactics.
  • Have responsive, helpful office workers.
  • Have a tested and proven success rate.
  • Have a clear reason for their success.
  • Use the latest treatment techniques.
  • Have multi-faceted treatment programs.
  • Properly analyse your personal needs.
  • Design a unique program for your needs.
  • Have full, patient-oriented daily schedules.
  • Provide daily one-on-one therapy sessions.
  • Positively encourage and motivate patients.
  • Honour self-respect, dignity and rights.
  • Not harbour unacceptable social biases.
  • Offer reasonable leisure/exercise facilities.
  • Have bedrooms of an acceptable standard.
  • Have a safe, peaceful environment.

7. Persist with treatment

Good things usually take time to accomplish, so do not expect your mood to change overnight. The bottom line is; despite your current concerns, if you are honest with yourself you will know that, in time, your problems will pass and that a better future awaits you.

To discuss any concerns you may have about dealing with anguish during rehab, call the number at the top of this page.