Why Doing Rehab from Your Own Home Might Actually Be Better
by Alastair Mordey
‘Telehealth’, as it is collectively known, is a growing area. Whilst it is pretty clear that large sections of medical practice cannot be done online, mental health is a notable exception.
It has always been assumed that going for inpatient addiction treatment (rather than outpatient or online ‘tele-therapy’) produces the best outcomes for addicted people and people with other mental and emotional health disorders. This is a received wisdom that even I have bought into over the years.
But now during COVID times we have, if nothing else, been exposed to an experiment – one we would never have conducted if it wasn’t for COVID. That experiment has essentially been to see which things work online and which things don’t.
‘Telehealth’, as it is collectively known, is a growing area. Whilst it is pretty clear that large sections of medical practice cannot be done online, such as surgery (as a rather obvious example) – mental health is a notable exception.
Assessments, and the talk therapy itself, are easy to do in any video conferencing platform. There doesn’t appear to be any noticeable different in quality of service provision online versus face to face, and it just might be that the convenience of online therapy will eventually tip this area of healthcare into a predominantly online business.
Multiple research projects (see previous article) have found that online counselling is at least as effective as face to face therapy. So why even bother with all that travel, and the inconvenience of physically going to a therapist or addiction treatment facility, if you don’t have to?
Below are the most often-cited reasons for doing so. We will consider each one in turn and see if it stands up to scrutiny.
- The ‘immersion’ factor.
- Building bonds with others (if it is a group therapy or a residential rehab.)
- Time away from one’s normal (addictive) environment with all its triggers.
- Medical procedures such as ‘detox’.
1. Inpatient Addiction Treatment ‘Immerses’ You in a Healing Community
This is a good argument. At least on the face of it. Being in an inpatient rehab immerses you in a group. You live with the other residents every day and go through the same trials, tribulations and learning curves of detoxification, group therapy, exercise, meditation and other intense experiences. This is undoubtedly a bonding experience.
Then again, you also have to deal with people you may not like, including some people who are disruptive, and who might be much younger than you, or much more unstable than you. So it cuts both ways. Especially in larger rehabs, the behaviour of some individuals can occasionally disrupt the entire program for weeks at a time. Further, in cheaper residential rehabs, many rooms are shared which is often difficult for older adults to get used to, having been living in their own space for a long time.
Obviously, with online rehab options this ‘space’ issue is resolved. People are able to connect with others daily (in group therapy) whilst still being in their ‘own space’. (In the RehabOnline program, group therapy is daily, whilst one to one therapy is twice weekly).
2. Face to Face Talk Therapy is More ‘Real’
This is up for discussion. In our previous article we noted that online therapy is often reported as being ‘at least as effective as face to face therapy’. Ultimately therapy (one on one therapy at least) comes down to what is called “therapeutic alliance”.
A therapeutic alliance is something that exists between a counsellor and a client. If a strong alliance or sense of identification does not exist between them, then the therapy is unlikely to be effective. Meta studies of counselling models and techniques have routinely found that the ‘type’ of therapy is not the main predictor of success in psychotherapy. Most of the main counselling techniques (such as CBT, person-centred therapy, and psychodynamic counselling) have similar outcomes and are pretty equal.
What counts in therapy, is the individual counsellor themselves, and his or her ability to forge a compassionate and professional relationship with the client. One where the client feels ‘listened to’. This, essentially, is the therapeutic alliance. There does not seem to be any noticeable difference between face to face and online therapy with regard to this alliance.
3. Getting Away from Your Addictive Triggers
Whilst it is true that people who are seriously addicted may struggle whilst remaining in their home communities due to the ease with which they can access their drug of choice, it is also true that many addicted people are able to stay ‘clean and sober’ in the short term – they just can’t keep it up over the long term.
A counter argument, and one that I have heard a lot over the years, is that going away to rehab is – in one sense – running away from the ‘real environment’ at home. One that you must inevitably face anyway. And it is certainly true that a lot of people do relapse quite quickly after they return to their home environments.
This is a tricky area. On the one hand, some people are just so seriously addicted that they do need to leave their home area, and effectively be (voluntarily) ‘locked up’ – where they can’t get access to drugs. This is undeniable. Many, many people over the years would never have got clean and sober from their addictions if they had not placed themselves in the safety of a monitored environment like a treatment centre where they removed the possibility of triggers.
But what percentage is this really? How many addicted people fall into this ‘very severe’ category? And could it be that the remainder do not really require such intensive inpatient monitoring as you might find in the typical residential addiction treatment centre.
Further, could it be the case that staying in one’s own environment (if possible) is not only cheaper, but also more effective, because the daily stressors are there all along and you don’t have to be suddenly shocked by them when you return home from the idyllic environment of the rehab?
My professional opinion (after working 15 years in the addiction treatment space) is that something like 80% of individuals seeking private treatment would probably be eligible for some kind of intensive outpatient programme (including online treatment). The main exceptions would fall under the following category.
4. People Who Need Detox
Detoxification is a process which may well be necessary for people who have been using alcohol, opiates or benzodiazepines long term. Detox almost always happens inpatient, although some people who have very understanding and experienced family doctors, or who are under the treatment of a local drug and alcohol service, may be able to access detox in the community (e.g. whilst living at home).
In both cases, it may be possible and indeed appropriate, to bolster that community detox with intensive therapy, and of course online therapy becomes an even more helpful option when that local community is lacking in those counselling services.
In summary then, online therapy is definitely an increasingly attractive option for many. The main arises is whether it is adjunctive (and add-on) to more intensive procedures like detox, or whether it is appropriate as a stand-alone service.
Either way it is important to seek the advice of a medical professional if you have physical drug dependency. In seeking treatment from any treatment agency, you should also be given an intensive assessment by that agency before any treatment option is offered.