What is Residential/Inpatient Rehab?
Mental health treatment, including that for addictions, is usually separated into either inpatient or outpatient treatment. When people hear the word “rehab”, inpatient – or residential – treatment is usually what first comes to mind.
Inpatient treatment refers to therapies undertaken while someone overcoming an addiction or mental health problem checks into a residential rehab centre for a set period. The length of time tends to vary depending on the severity of the condition, but most centres run programmes that last between 7 days and 90 days.
During this time, individuals are supported by consultants who monitor their physical and mental health and arrange a number of talking therapies.
Inpatient treatment is an excellent option for anyone who is struggling with addiction and is especially beneficial for those with severe and long-lasting addictions, or who have co-occurring mental health problems. It provides a strict routine and access to round-the-clock support, all while you are in a refreshing new environment, distanced from the stresses of everyday life.
Is Residential/Inpatient Rehab Right for Me?
Whether you opt to be treated as an inpatient or outpatient is a deeply personal decision, and will depend entirely on your individual situation. Your GP will be able to provide advice and their recommendations, and if they do offer to refer you to an NHS-funded inpatient centre then it is seriously worth considering, as these referrals are rare.
Most commonly, inpatient treatment is privately funded, making it seem inaccessible for many. There is a range of funding options available, and it is important to remember that the cost covers not only the treatment but also accommodation and food.
Because recovery can be a long and complicated road, you should aim to get the best start possible. For many people, the additional support that is available as an inpatient makes a huge difference to their recovery journey, especially during the challenging early days of detoxification.
If you have a moderate to severe substance addiction, you will most likely experience some difficult withdrawal symptoms during detox. As an inpatient, these can be mitigated by medicine-assisted therapies and curated nutrition support, including regular, balanced meals and supplements where necessary.
Studies have found that those who undergo addiction treatment as an inpatient are less likely to relapse in both the short- and long-term1, with outpatients being 4 times more likely to relapse before ending their treatment.
Continuing to live at home during treatment is more convenient for many, but is often not recommended for those with severe substance abuse issues. Even with all the right treatment, continuing to live in your usual environment, at risk from your usual triggers, can cause roadblocks.
This is particularly true if you have friends or loved ones with the same addiction, who might tempt you to abandon your treatment, even inadvertently. Spending some time away, in a place that is dedicated to your recovery, will most likely give you the best chance of staying on track.
If you already have a great support network at home, and being uprooted from that – even for just a week – is likely to cause a lot of stress, then inpatient treatment might not be the best option for you. There are fantastic outpatient treatment options out there that are ideal for those who are self-motivated and already well-supported at home.
What Happens in Inpatient Rehab?
The types of therapy you will undergo as an inpatient varies from person to person, as the facilities tailor treatment plans to each individual’s needs. There is a common misconception that inpatient treatment is more restrictive than outpatient when it comes to treatment options.
In reality, they offer the same amount of flexibility, and you can access all the same therapies that you could as an outpatient.
The major difference is that you are taken out of your usual environment and spend your time living full-time in the rehab centre. Many people find that this is preferable to remaining at home, as the detoxification period, in particular, can be extremely difficult, and even dangerous, without the proper support.
Living in rehab also temporarily removes you from the triggers that would usually worsen your mood or tempt you to abuse drugs or alcohol. While you are away, you learn to recognise those triggers and become more resilient to them.
If you are employed when you enter rehab, you will need to book time off work for the entirety of your stay, as you will spend the majority of your time at the centre. You will have a bed, and all meals will be provided for you, but you will occasionally get the opportunity to go out for shopping or medical appointments.
As an inpatient, you will be encouraged to take part in both group and independent therapy. You will also be set a fairly strict daily routine, with the majority of your time being spent focusing on addiction recovery and improving your overall wellbeing.
Physical Therapies in Residential Rehab
Many people who have had an addiction for a long time will have developed a physical dependence, and can experience uncomfortable withdrawal symptoms as a result. As an inpatient, your physical health will be monitored throughout your treatment and you will have access to regular medical appointments, nutrition guidance, and supportive medications.
1. Detoxification
For long-term substance use disorders, medication-assisted detox is typically the best course of action. At the start of your inpatient treatment, a GP who works with the rehab centre will examine you, ask you a series of questions, and ultimately determine which medication – if any – you will take during detox.
You will then have regular check-ups during the detox phase, with adjustments being made to your treatment plan as necessary.
2. Medical appointments
During treatment, regular contact with a GP is extremely important. Depending on where your rehab facility is based, you might not be able to see your own GP, but the upside to that is that the doctor you see during treatment will have a close working relationship with the rehab centre and extensive experience of helping people to overcome addiction.
3. Medication-assisted therapy (MAT)
As well as those you may need during detox, you might be prescribed additional medications to manage any co-occurring mental or physical illnesses. Many people become addicted to drugs or alcohol after trying to self-medicate for problems like anxiety and depression, which still need to be managed while you undergo addiction treatment.
Medication-assisted therapies (MAT) are regularly used during inpatient treatment and, in some cases, you might remain on certain medications for some time after leaving the centre.
4. Chemical health assessments
The purpose of detox and medication-assisted therapy is to rebalance your brain chemistry and improve your health. Chemical levels will change throughout the course of your treatment, meaning that you will need regular assessments to check how you are responding to different medications and to keep an eye on any withdrawal symptoms.
5. Wellness, fitness and nutrition support
A balanced diet and regular exercise can be difficult to maintain when we’re not feeling our best, either physically or mentally. While living as an inpatient, you will have a nutritional assessment to check if you are deficient in any key vitamins or minerals, and a healthy diet will be curated to suit your needs.
Deficiencies in B vitamins, for example, can cause depression and anxiety, which will make you feel less motivated to exercise and take care of yourself, and might even be contributing to your addictive behaviour. By correcting these imbalances, you will become physically healthier and should see an uplift in your mood.
A multitude of studies has proven that exercising makes us happy2. Sticking to an exercise routine creates a regular influx of natural ‘happy’ hormones, such as endorphins, which will make withdrawal symptoms more manageable and make you less drawn towards harmful mood-altering substances.
Keeping active can also be a great distraction during inpatient treatment, and can help to clear your mind after an in-depth therapy session.
Mental Health Therapies in Residential Rehab
A key component of any rehab treatment is mental health therapy, where you work to uncover the cause of your addiction, learn to recognise your triggers, and improve your mental resilience.
1. Individual and group therapy
Addiction is deeply personal, and the cause is entirely unique to each individual. One-to-one therapy provides a confidential environment in which you can speak with a trained therapist and discuss your relationship with addiction.
For many people, this will be first opportunity you ever have to talk about your problems in-depth with someone who understands.
It can be daunting at first, but the more you put into therapy, the more you will get out of it. Some therapies will have ‘homework’, where you use some of your spare time to continue to practise what you have learned.
As well as individual therapy, residential rehabs run group therapy sessions. These give you the opportunity to hear from other residents and share your own experiences so that you can all learn from each other.
Developing a sense of community with the people you live with will not only help you to settle into rehab, but can also add extra motivation during treatment.
2. Cognitive behavioural therapy
There are a number of talking therapies on offer in rehab, and you will usually attend a combination of these. Cognitive behavioural therapy (CBT) is the most popular form of therapy for those undergoing addiction treatment, and has been proven3 to be especially effective for those with an addiction and co-occurring mental health problem, such as depression.
CBT helps patients to objectively analyse the negative thoughts that lead to their addictive behaviour. By understanding these thoughts, it becomes easier to combat them and replace them with healthier ways of thinking and behaving. CBT is typically undertaken in a one-to-one setting, as it encourages the individual to reflect upon themselves and learn to be more mindful.
3. Acceptance and commitment therapy (ACT)
Acceptance and commitment therapy (ACT) is similar to CBT in that it employs mindfulness strategies to teach patients how to remain cognisant of how they are feeling in the moment. Rather than teaching the individual how to eradicate or avoid negative feelings, ACT teaches them how to confront them, and work towards a solution.
The basic principle is that negative feelings should be accepted and that we should allow them to be a natural response to certain situations, but they should not prohibit us from enjoying life.
4. Contingency management
Contingency management (CM) has been found to be extremely effective for treating addiction and co-occurring mental health issues. Compared to CBT and ACT, this type of therapy is less common4, but many rehabilitation centres now offer it to their inpatients.
Like the other therapies mentioned here, its basis is in behavioural analysis, with a focus on positive reinforcement. As an inpatient, you will be having regular urine tests, and also possibly blood tests, to ensure that you are remaining abstinent during your stay. CM therapy adds a rewards system to these tests, so that the longer you are able to abstain, the greater the rewards you will receive.
5. Family and interpersonal therapy
While staying in rehab, you can choose to have visits from friends and family, and even have them attend therapy with you. It’s important for them to understand how addiction has affected you; equally, it is important for you to understand how it has affected them.
Addiction takes its toll on families and friends in a different way than it does to the individual, and being able to discuss it openly can improve your relationship.
Inpatient Rehab Aftercare
Inpatient rehab is temporary, with a maximum limit usually set to 90 days, but treatment does not end when you leave. The routines you have adopted during your stay should be continued, and support will be given along the way. You might remain in touch with the consultants you saw at the centre, or be referred to some more local to you, so that you can continue your therapy.
An aftercare plan will be discussed with you so that you can leave rehab with confidence. Your therapists will work to make sure that the transition out of rehab goes smoothly, so as to avoid unnecessary stress.
Life at home could never replicate rehab exactly, but you should be left with all the necessary skills and support to continue on the path that’s been set.
References
1: https://link.springer.com/article/10.1007/BF01065868
2: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061837/
3: https://link.springer.com/chapter/10.1007/978-3-030-36391-8_25
