Rehabilitation means enabling the addict to reintegrate himself into society. Rehabilitation for addiction includes physical, social and emotional rehabilitation of the addict. Addiction impairs several areas of an addict’s life. Rehabilitation is a holistic approach of treatment for addicts who have suffered physical effects, socio-economic or work impairment, legal complications and/or severe relationship issues during the period of addiction.
In India, there are several models of rehabilitation available for addicts. It is important that the rehabilitation is picked out according to the patient needs and budget to maximize compliance to treatment. Mere abstinence by locking a patient away from substance does not yield results.
Rehabilitation of an addict aims at holistic growth of the patient. Thus, rehabilitation programs try to include group therapies, individual counselling, spiritual programs such as yoga/meditation, art based therapies and role-play along with supportive medications. All rehabilitation programs work closely with patient and the family. Relapses after rehabilitation is not uncommon but rehabilitation programs work towards fixing problems that are arise each time an addict relapses by forming trust bonds with the addicts and providing them hope about their recovery.
Types of Rehabilitation
- Outpatient with support groups
- Short-Stay Rehabilitation
- Day Care
- Sober home/halfway home
- In-patient Residential Rehabilitation
Outpatient with support groups
Patients with less severe addiction problems are encouraged for follow-ups in outpatient setup for counselling and therapies. These patients are encouraged to join support groups and recreational activities. Support groups such as Alcoholic Anonymous and Narcotic Anonymous help the patient find peer encouragement from fellow addicts. Recreation activities help an addict fill the free time in their sober phase. See chapter on ‘Support Groups’
Short Stay Rehabilitation
There are several short-stay rehabilitation or detoxification facilities available in hospitals and non-governmental organisations. Short stay rehabilitation is recommended for addicts who have insight into their addiction and are willing to try abstinence on their own. Short stay serves to manage a patient through his substance withdrawal by managing his physical cravings. Short stay helps a patient overcome his physical needs for the substance by managing his irritability, insomnia and other physical after effects of addiction. Psychological counselling is provided to gain insights and motivational interviewing is done to prevent future relapses. Follow-up counselling helps fix immediate problems.
Day Care
Day Care centers are meant for working professionals who have less severe addiction and addiction related problems. Addicts are expected to visit the daycare facility daily and several times in a week. Day care programs follow the holistic method of treatment with yoga, meditation, art based therapy, group sessions etc along with individual counselling. Day care facilities aim at targeting real time problems that are faced by an addict in day-to-day affairs. Day care is ideal for patients who have undergone residential rehabilitation (short or in-patient) before but relapsed.
Sober homes/halfway home
Sober homes serve as a place where an addict can stay overnight if he fears he might relapse in an unmonitored environment such as his home. Addicts usually go to work during their work hours and come to spend their nights and free time at a sober home. Halfway home is recommended following a residential rehabilitation. Addicts starting new jobs or returning to old jobs are encouraged to stay overnight and during holidays in halfway homes. This helps the addict ease into the society after a long residential stay in rehabilitation.
In-patient Rehabilitation or Rehabs
In-patient treatment is usually recommended to individuals in whom outpatient treatment and other methods are failed. Severe substance addiction, socio-psychological impairment and severe addiction related problems validate admission to rehabilitation. It is advised to conduct an intervention leading to self-admission of an addict into rehabilitation. In cases of severe addiction, ambulatory services may transport a patient to rehabilitation.
This is a coerced form of abstinence where the addict is initially locked down and not allowed out of the facility until a prescribed period of time. Structured therapy is given where timely food and activities help the addict regain his natural rhythms of sleep and appetite. Each in-patient facility has it’s program for the holistic growth of the individual addict. Most programs in India follow the twelve step program prescribed by Alcoholic or Narcotic Anonymous. Some of the common treatment methods that included in the in-patient facility are:
- Group Sessions: Educational sessions are provided to the group of addicts on topics such as the twelve step program, anger management, relationship goals etc.
- Individual Counselling: One to One counselling are provided for the addict to gain insight into his addiction and addiction related problems
- Role play sessions: Addicts are encouraged to act out scenarios from real life or imagined situations and then explained about appropriate behaviour.
- Confrontation sessions: Addicts help each other point out character defects and help the addict correct his response to adverse situations.
- De-sensitisation: Events which are triggers for addiction are exposed to the addicts and stepped up to achieve desensitization. This may include playing music such as psychedelic trance (psytrance), electronic dance music (EDM) or social gatherings for new year, christmas, birthdays etc.
- Thought Inventory or diary writing is encouraged as a part of the treatment
- Spiritual programs such as yoga and guided meditation are conducted to gain holistic growth.
- Art-based Therapy sessions are conducted as a means of alternative communication technique for addicts who might not be able to express themselves adequately by using words.
- Vocational training is provided for addicts who may have work impairment.
- Community work programs help addict learn responsibilities. In-door duties are assigned to each addict to encourage individual responsibility and to learn team work .
- Tree planting, volunteering in animal shelters help the addict find a social cause he can enroll him
Each rehabilitation facility has its mix and match of the above mentioned treatment methods. The length of rehabilitation is a maximum of three months according to limits set by the mental health bill. This period may be extended after consultation with the patient and family according to the need of the case.
In India, most patient family are concerned regarding “chaining” or “restraining” of addicts. Restraining of the addict is uncommon occurrence limited to incidents of self-harm or injuring others. Restraining of a patient needs psychiatrist evaluation each day, hence never for long length of time. There is a ban on restraining jackets currently. The other concern of most patient family is treatment using electro-convulsive therapy (ECT). ECT is an outdated therapy method for treatment resistant schizophrenia and depression. Although the current mental health bill in India has put a ban on ECT, some centres do practice it. However, there is little indiscriminate use of ECT without informing the family. Family consent is required for ECT. There are frequent media outrage on in-human practices of beating or hitting patients in rehabilitation. There are very few rehabilitation centre that indulge in these inhuman practices. If there are any, this is problem that needs to be addressed and reported to human rights authority. The media outcry on the in-human practices of chaining and beating has distorted the image of rehabilitation for the general population. People are afraid to admit their loved ones in rehabilitation facilities. One way to deal with this, is to burst the myths using social media and helplines. Muktaa Charitable foundation is working on a free helpline to provide all necessary unbiased information to the layman who are in need.
Written by Dr.Narayan Perumal. For corrections/comments write to http://drnay.in or drnarayanperumal@gmail.com or contact 9967536664. We need your support to make our programs better.