The Bubble

As a patient nears the end of a stay, usually 28 days, in rehab a feeling of increasing anxiety overtakes them. After having gone through the period detox required to start to feel normal again, and going through the routine structure available at the facility, the time to graduate draws near. Patients at that point have spent dozens of hours with therapy staff, peers, and they’ve had the opportunity to watch the process of people come in and go through detox as they had a few days prior.

The person can see they’re going to have to leave the facility at some point. Sometimes if relationships have been formed with more senior clients in a treatment facility a report comes back from the outside world. Invariably that report goes something like this:

I got out here back in my life and I thought everything would be better. I mean I feel physically better but all my problems have continued. My spouse seems especially angry with me. It’s almost like once they could see that I was sober and safe then they really let me have it. Also my coworkers are not receiving me as warmly as I thought they would.

This information makes its way through treatment facility and the feeling of fear becomes quite intense. Usually this has followed a period during which the patient has coughed up substantial details of their life to staff and peers and they look at the calendar to count the remaining days. If they have only another week to go they usually can hang on that much longer and they stop giving up any more information.

In the few days prior to discharge people get very anxious. Some of this anxiety is simply the normal fear of change and transition. But really what they fear is life outside the facility. What they have learned in the preceding month is how to manage life in the bizarre world of rehab. The rules there are much different than outside. There typically is an entry-level technician, someone whose credentials may only be “a sober person,” often wielding tremendous power. The faculty and professional staff of most facilities are not visible after 5 PM. Even less likely are they there to be on the weekends.

These support staff and relationships that had been formed are all about to change. One’s counselor, therapist, chef in the kitchen, exercise specialist all are going to be left behind with the ringing of the bell or the hitting of the gong. People know that their primary support is going to be left behind and that whatever problems they had been avoiding are going to be present when they leave. Who wouldn’t be anxious?

Not only are the problems present when they return but many times they are much worse. They have been allowed to sit for the last month while the patient has been in treatment. Furthermore the crisis that drove a person into rehab in the last few weeks prior to admission was obviously building for a long time before they came in. The difficulties in their life took on a momentum of their own.

The feeling of being protected and safe inside the treatment facility is referred to as ‘the bubble’. The expression comes from the sense of being encased in a thin protective wall that will soon rupture. It’s also from professional racing to describe the experience of being in the pole-position and all other racers are trying to overtake you.

When graduating from a treatment facility people are thrown back into their prior lives with not many more skills than they had before admission. The idea in theory sounds good: dip you in recovery and teach you how to be sober. We know that the brain is still a jumble for months after stopping drugs and alcohol. The idea usually does not pan out first go around. Or the second.

So you can see why relapse rates are so high following traditional treatment. A recent Cochrane review of treatment efficacy concluded that psychosocial treatment alone was inadequate to treat people with opiate dependence. The coping skills are barely coming on and the problems are as big or bigger than they were previously. It is no surprise. More, the medication for managing life’s pain has been removed. The management strategy for feelings of dread and fear is now gone as well with abstinence. There is no way that a person can feel comfortable fresh out of treatment returning back into life.

This also leads to recommendations by many facilities that people stay longer than planned. The implication is simple: if you don’t want the experience of discomfort by reentering your own life after treatment, stay in treatment longer. There is also invitation to return if life is “too hard.” I believe this entire approach does a disservice to people with addiction. What they leave with is a feeling of inadequacy, and success really only within the confines of the facility. Stories of relapse trickle back and instead of feeling confident about their ability to make healthy choices in the world outside of the facility they’re often riddled with further doubt.

The only way to prevent the phenomenon of the bubble is to avoid forming one in the first place.  If people make healthy choices in their normal life, then they will progressively grow stronger in their ability to make more good choices. It is much harder to deny a feeling of personal growth if the evidence of doing the right thing, the healthy thing in one’s own life. The trick is to build a strong and flexible support network of experienced people that you will actually rely on. They are in your community right now and you will surely meet some of them as you return to Haywire.


Category: History, Neuroscience, You Don't Need Rehab

About the Author: Dr. Jason Giles is certified by the American Board of Addiction Medicine and the American Board of Anesthesiology. He is a physician specializing in the treatment of drug, alcohol, and behavioral addictions. He is the founder of Haywire.

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