What Admissions Won't Tell You

💡 Insight

People rarely leave treatment in the first week because the treatment failed. They leave because the gap between what they were promised on the phone and what they walked into was wider than they could stand — and nobody warned them it would be.

So here is the warning. Nine things worth knowing before you go, so that when they happen you can recognize them as normal instead of as a betrayal.

1. Say goodbye to your phone.

On top of detoxing from your drug of choice, you will almost certainly detox from your screen. Most facilities now limit or eliminate phone access, and they're right to. Work the problem before you go: sit down with your case manager and make sure the bills that must get paid get paid, and the life issues that genuinely require your signature get handled. Then accept that the world will carry on perfectly well without you. Being unreachable isn't a punishment. It's the condition for getting better.

2. Bring a book, and a small reading light.

You will probably have a roommate. If you read to fall asleep, a paperback or a Kindle and a clip light will do more for your first two weeks than almost anything else you pack.

3. It will be different from what admissions described.

Admissions staff say what they need to say to get you in the door. Phone access, who can visit and when, what the food is like, how the days are structured — expect all of it to be more restrictive than the version you heard on the phone. This isn't necessarily malice. Rehab is a business, and admissions is sales. Their job ends the moment you're admitted.

4. Your medications stop being your medications.

You will not keep your prescriptions or your supplements. The facility's doctors and nurse practitioners will assess you and prescribe what they think you need, which may not match what you have been taking or what you think you need. Bring your bottles and an accurate list anyway — it makes the assessment better — but go in expecting to be re-evaluated from scratch.

5. Your toiletries get vetted.

Mouthwash, hand sanitizer, some perfumes and hair products contain alcohol, and some people will drink them. Aerosols get restricted for similar reasons. Assume anything on the list gets held at the door and that you'll be using what the facility provides for a while.

6. Don't bother folding your clothes.

At many places everything you brought goes straight into a wash before you ever see it again. The point is almost certainly bed bugs and lice, not tidiness. Pack in a bag you don't mind having emptied in front of you.

7. Your privacy and your agency will feel violated.

You are used to doing what you want, when you want. That stops. When you sleep and when you wake, who you can talk to and when, where in the building you're allowed to be, what's for dinner — all of it belongs to someone else now. Every hour of this you spend fighting is an hour you don't get back. The faster you stop negotiating with the schedule, the easier the whole thing becomes.

8. You're expected to participate — and to speak up.

Facilities get paid for delivering rehabilitation services, which means attendance at groups isn't optional. It also happens to be the part that works. Surrendering to the routine will leave you calmer than resisting it for thirty days straight.

But surrender is not silence. If you aren't getting something you actually need — a medical issue, a med that isn't working, a safety problem, a discharge plan nobody has started — say so, clearly, to a named person, more than once. It's easy to disappear into a large patient census. Nobody there is walking around thinking about your case as much as you are.

9. Not all of them are the same.

Quality varies enormously. Every facility is a revolving door to some degree; some far more than others. And there are genuinely good people working inside even the mediocre ones — you will meet a tech or a counselor who changes something for you. More on this soon, when we talk about how to choose the right rehab for you.

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✦ Quote

"I said to my soul, be still, and wait without hope
For hope would be hope for the wrong thing; wait without love
For love would be love of the wrong thing; there is yet faith
But the faith and the love and the hope are all in the waiting."

— T.S. Eliot, "East Coker," Four Quartets (1940)

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◎ Prompt

Write down the three things you are most afraid of losing control over if you go — and next to each one, the name of the person who could actually handle it in your absence. Most of what feels non-negotiable turns out to be delegable. The list of what genuinely requires you is almost always shorter than the fear says it is.