Expensive Rehab Stays... Again and Again. Time to Hit Rock-Bottom?

Your wife’s sister may be eligible for county or federally funded drug treatment. Most people don’t realize that more than 80% of drug and alcohol treatment in the US is paid for by government funds. Treatment is provided by licensed or certified residential and outpatient programs and while the facilities will not be glamorous, she would likely get responsible care. There are a few things to know about these programs before getting started. First you have to be financially eligible. This often means little or no income or property. As the budget crises have worsened as a result of the recession, funding for many of these programs has been cut back, and criteria have become more stringent. Second, there is often a waiting list and it can take weeks to months to be admitted. Finally, these programs are typically best suited to individuals whose drug or alcohol problems are not complicated by other psychiatric diagnoses since it many cases they may not have a psychiatrist available to consult with clients.

There is considerable data that shows that many people who do not achieve stable abstinence after one treatment episode are successful later on. There may be several reasons for this. When they enter treatment again they may be at different juncture in their lives and may have suffered more losses from the substance misuse (fired from work, left by spouse, homelessness). Second, the treatment approaches may differ. Someone who did not benefit from Cognitive Behavioral Therapy may do well with Motivational Interviewing instead. People with co-occurring problems such as Post-Traumatic Stress Disorder, Major Depressive Disorder, Bipolar Disorder or anxiety disorders, will have much better outcomes when these other conditions are treated. For example, clients with Major Depression at the end of rehab are 4-12 times more likely to relapse in the next year than those who are not depressed.   Remember that there are many major diseases that require continued treatment - not just one hospitalization, and it is now well accepted that addiction is a disease.

The fact her mother convinces her to go is not unusual - no one wakes up in the morning after a binge and tells themselves that today would be a good day to quit. It is very rare for people to seek treatment on their own without external pressures and there is considerable evidence that when people are coerced into treatment (as in court ordered) they do just as well as those who ostensibly chose treatment for themselves.

In order for your sister-in-law to succeed in treatment, she needs to come to belief that her life would be better (happier, more fulfilling, more meaningful) without drugs than with them. This realization usually comes after someone has been in treatment, not before.

The problem of waiting for someone to ‘hit bottom’ is that you can only know what their bottom was after the fact, and never before. It doesn’t make getting additional treatment a waste of time, but that doesn’t mean that you and your wife should continue to carry the responsibility for her. I am sure both your wife and mother-in-law are desperately afraid that that her sister will die on the streets of an overdose, assault or suicide attempt and these fears are not unfounded. Suicide is the leading cause of death among individuals dependent on drugs or alcohol.

I think it may be time to conserve your resources by looking for less expensive or publicly funded programs and to use your funds to pay for ancillary services that may be needed.