At Evo, during sessions with families and loved ones, we often do an exercise where we map out expectations for treatment. On a large whiteboard, we write what the group thinks treatment is supposed to do according to different groups: insurance companies, families or friends, and clients.
Inevitably, as we do this we uncover common assumptions and myths about recovery and what it should look like. For us, as an alternative treatment program, it is important to deconstruct these dominant ideas about the problem and the process of recovery. This way everyone is on the same page.
Here are some common myths about rehab that we hear:
1. Behaviors are the primary issue
People often enter rehab because they want the drinking or drug use to stop. So naturally, one common assumption is that the way to solve the problem is to just get people to stop doing these behaviors.
Really, addictive behavior serves an important purpose in the person’s life. There is a reason why substance use persists despite negative consequences—such as losing a job, putting important relationships at risk, or threatening personal health. Addiction is a coping mechanism in response to things people feel they can’t control. Looking below the surface, trauma or pain is often at the root.
Treatment, then, needs to address the issues that cause people to misuse substances. Many programs focus almost exclusively on substance use, working with people to identify triggers and develop ways to resist these triggers. Yet, these behaviors are almost secondary to exploring the underlying causes of addiction. If a person can make these deeper changes, it will have a lasting impact.
2. Someone is to blame
When things are tough, there’s inevitably a lot of blame to go around. Friends may think it’s really the client’s fault that they are behaving this way. Clients sometimes blame their parents for the way they were raised. Parents might blame bad influences or each other. Everyone at some point blames themselves. The instinct to point fingers particularly arises if things are not working quickly—and things rarely work quickly.
The reality is that problematic substance use arises as a response to dynamic personal and societal factors. Sometimes it is even difficult to pinpoint how or when substance use shifted to becoming problematic.
More importantly, of course, blaming others doesn’t solve the problem. Instead, it’s important for clients to address underlying trauma or pain and create a path forward.
3. Therapists are responsible for fixing problems
When a person is in a difficult situation, it’s common to wish for a “miracle” to happen. The hope is often that someone else can come in and fix things. In addiction treatment, clients sometimes enter rehab with the expectation that therapists know all the answers and can make the changes.
The reality is that the real work of overcoming addiction is a collective effort - on the part of the person dealing with addiction and also their supportive community. This means that everyone has to put in the work. Therapists work side-by-side with clients as they identify goals and face challenges along the way. Family and friends stand with their loved ones even when it is challenging. And people going through treatment have to do some deep introspection, face fears, and unlock their dreams for a better life.
Contrary to popular thought, we don’t see people as “powerless” to addiction. Often, part of our work with clients is helping them realize that they have agency to change their lives. People do have the power to address adversity that they face. In fact, people facing addiction have taken many brave steps to survive despite the odds already, despite the way it looks on the outside. The challenge is to hone these skills positively.
4. Success equals sobriety, period
What success looks like differs for each person, depending on how addiction manifests in their life, and what they would personally like to achieve. Some people may find that abstinence is a necessary solution for them because any substance use is too triggering. Others may decide that they want hard drugs out of their life, but that drinking is not a problem.
Taking this further, the truth is that recovery is not just about substance use. It’s about addressing what's really driving the addictive behaviors. Success then, is people improving relationships with themselves, with substances, and with the world. Shifting focus away from just the substances opens up a multitude of conversations about the person’s life. What are their fears, desires, dreams? What is their relationship to community, to work, to sexuality? What goals would help them live their best lives?
The conversation becomes less about just a substance, and more about the person. It allows them to connect or reconnect with their purpose in life and begin to live with a greater sense of meaning. Read more about why sobriety shouldn’t be the only option.
5. There should be no relapses. Any gains should be final.
From movies and pop culture portrayals of addiction, we closely associate relapse with failure. Yet, the journey that a person takes to renegotiate their substance use is sometimes rocky and it is definitely not linear. It takes time and often involves making mistakes.
As humans, we are complex beings. Some people take longer to work through some issues than others. Each person has their own particular “life factors” that can add stress or pose as obstacles along the way. It’s challenging to work through deep issues when you also have to worry about things like holding down a job, paying the rent, taking care of kids, or dealing with difficult people around you.
This is also why one approach doesn’t work for everyone. In 12-step programs, sometimes if people don’t find that the program is working for them, one explanation they hear is that they didn’t correctly follow the steps. Instead, alternative treatment meets clients where they are and understands that one size does not fit all.
For family members and loved ones, sometimes it’s hard to watch the ups and downs of a person struggling with addiction. If the expectation is abstinence, any time there’s a “relapse,” it may seem like proof that the person isn’t succeeding. However, like any journey, overcoming addiction is not a straight line—it’s a process.
It is difficult to stand by loved ones in these times—and sometimes friends and family members need a break to take care of themselves. (This is a big topic in and of itself and deserves its own piece.) It’s important to know, though, that people who are going through this process need the support of other people more than ever. An understanding community makes all the difference.
Some ideas from this piece come courtesy of Ali Borden, who has played a huge role in helping Evo shape its program. Read Ali’s article, "Every conversation is an opportunity: Negotiating identity in group settings," about her work with eating disorder issues as Clinical Director at The Eating Disorder Center of California in Los Angeles, California.