Does Rehab Really Work

[Upbeat Guitar Music]

Mike: Welcome, everybody. This is Avoiding the Addiction Affliction, brought to you by Westwords Consulting, the Kenosha County Substance Use Disorder Coalition, and by a grant from the State of Wisconsin's Dose of Reality Real Talks, reminding you that opioids are powerful drugs and one pill can kill.

Mike: I'm Mike McGowan.

Mike: A year or so ago, I had today's guest, Jim Savage on, and we had a great conversation about addiction and the effects on the family. I follow Jim on social media, and he recently did a YouTube video that piqued my interest. He titled it Does Rehab Really Work? We're gonna talk about that today and wherever else the conversation leads.

Mike: Just to remind you all, Jim is the owner of RehabWorks Family Support Program and Jim Savage Consulting. He is the author of RehabWorks: A Parent's Guide to Drug Treatment, and an e-book called Sobriety Doesn't Have to Suck: A Guide to Finding Happiness, Excitement, and Spiritual Fulfillment in Recovery.

Mike: Jim has been helping individuals, families in recovery for over three decades, and he has a wealth of information that we'll link on his website from webinars to blogs to everything else. Welcome back, Jim.

Jim: Thanks, Mike. Glad to be here. I love the work that you do here.

Mike: Thanks. You're one of those guests that I have that I'm like, "Okay, how often can I have you?"

Mike: Because we could literally do it every week. But Jim I talked about where I wanted to start. I had a guest on recently who wrote a book about his journey to getting sober. And in it, he said he took two trips to rehab when he was 17. And then I read a little bit further, and they were both a week long.

Mike: Called it rehab in the book. A week, so let's start here. Jim, what is rehab? Define it.

Jim: Okay. That's a really good question to begin with. I'm glad that we talk about that. The term rehab, formally what we're really referring to with that term is treatment. There are treatment facilities that are designed specifically to treat a medical condition called substance use disorder.

Jim: And so that's what we're really talking about when we say rehab. That's the vernacular term that has become coined. I still use it talking to people directly, because it's familiar, but it is valuable to unpack exactly what's going on. And so rehab is referring to treating a condition, okay?

Jim: And we'll get into that more in this talk, I'm sure, today. What people think of as rehab, I use this term a lot, but again, vernacular and to relate to somebody, getting shipped off to rehab. " I don't need to get shipped off to rehab." And everybody understands what that means, but again, very important.

Jim: No, there is, there's a spectrum that exists for... we'll get into talking about this more probably. Substance use disorder as a condition exists on a spectrum, and there are treatment plans that are consistent with where a person is on the spectrum for their condition. And so the bottom line is, I'll probably share a story.

Jim: One of the most important things, I'll go into it right now. I was working with a kid once who was very resistant to seeing me because, and he told his parents, he said, "He's just gonna say I'm a bad person." And I thought that was an interesting way of putting that and by the time we got done with our first session, where I do education with both the family and the kid, and I taught him, you have a condition that exists on a spectrum.

Jim: And most of us have this idea that there's a line that you cross over, and one side of the line is problem, and the other side of the line, the left side of the line, the mild side, most people, and this is the really unfortunate part, think it means not problem. And so they think that you don't have to be treated if you have the not problem.

Jim: If you're on the spectrum, but we think that just because I'm on that side of the spectrum, so nothing has to happen. And that kid, by the end of the session when I explained to him that there's this condition, I said to him at the end, y our parents told me that you said "All I'm gonna do is say you're a bad kid, and, or a bad person."

Jim: And he said, "Yeah." And I said, "Here's what I think about where you're at with your marijuana use. I think, one, you know it's a problem." I said, "I think you know there's something not right with how you use marijuana." And he said, "Yeah." And I said, "And I also think that you don't believe you're addicted."

Jim: And he said, "Yeah." And I said, "And I think you're right on both counts." Because I had already explained to him that there's this spectrum, and we have this idea. This was the case that made me even do the whole revision of the book that's coming out because this is so important as far as identifying how labels and how we think about stuff, like terms like rehab create stigma and resistance and barriers to treatment. Because this kid didn't wanna see me because he was certain that the big, bad drug counselor's going to say "You're addicted, and we're gonna ship you off to rehab." And on some level, he felt that he didn't qualify for that. And I surprised him when I said, "I don't think you need to be shipped off to rehab."

Jim: And then I pointed out, "We need to treat your condition." And he goes, "Yes, I understand that." And I pointed out, "You're already treating it." He'd been telling himself, "I'm gonna stay away from the upstairs bathroom at my school where the kids hang out and vape." And I said, "That's treating (laughs) your problem on your own, rehabbing yourself.

Jim: But do you need to get shipped off to some place? No. And oh, guess what? He became extremely motivated and enthused about addressing his, quote-unquote, problem. So I would say rehab for some places, they are, it is definitely people need to go to a place to be immersed in a 30, 60, 90-day, place that promotes a recovery culture.

Jim: That's what we think of the inpatient residential treatment centers. That's what most people are thinking of as rehab.

Mike: I think that's such a great answer, because even professionals I talk to, just kinda skip over that. And when somebody says, "Oh, I went to rehab two years ago," I think there's a belief in your head.

Mike: And I think the belief is something you just like, "Oh, so they went somewhere for 30, 60, or 90 days." And you and I both work with kids, and they drop the word rehab it's a universal concept, and a Volkswagen Beetle isn't a Ferrari, right? They're both cars.

Jim: Exactly.

Mike: But, a two-day stay in secure detention sometimes they'll call rehab.

Mike: So I think you have to ask "What do you mean? What did you do there? How long was it?" And Jim, I think it's also important to ask, "Who did the work? Who are you talking to? Who are the counselors that you talk to? Do they know what they're actually doing?"

Jim: Oh, okay. Bring that up.

Jim: This is the second part of that story. Because again, this is the impetus for, you mentioned my book that I wrote in 2014 called Rehab Works, and I'm writing a revision of it now, and this story is really the impetus because there was that one where it got my attention, oh, this is what they mean by labels and resistance and barriers to treatment.

Jim: But here's the second part. He had been seeing a therapist for a year prior to seeing me, and finally the parents talked to the psychiatrist saying, "We don't think there's progress being made, because he continues to smoke marijuana." And that's why... And the doctor said, "Send him to Jim." And the mother then told me she said, "That therapist did a substance use assessment."

Jim: And I was like, "Okay, good." Because some providers, mental health providers outpatient, they don't even know, they don't, they're not trained to do a substance use assessment. That's a specific thing. And that got my attention. Oh, okay, he did a substance use assessment. And then she said, "And he told us he has a mild substance use disorder."

Jim: And I thought, "Oh, good. He knows how to interpret an assessment and he understands the diagnostic criteria, et cetera." And so that got my attention. I was impressed. And then she said, "And so he told us because it's mild, we don't need to do anything different than what we're doing now, a weekly therapy session."

Jim: And that's what got my attention. I realized, I think there's a lot of mental health professionals out there who don't understand this. And again, the culture thinks it, in general, mental health people, he was thinking mild means not a problem. They're aware of this line that you cross over.

Jim: But they're also aware of this, that the DSM-5 spectrum is mild, moderate, severe. And the line is the old version. They changed it. That's a whole reason when I wrote my book in 2014 was supposed to come out in 2013, but they changed the DSM diagnosis right when my book was coming out, and it completely made my book obsolete because I explained that black and white dichotomy of a line that you cross over.

Jim: And what they did is they changed it. And I think that mental health professionals and the culture in general have this indelibly etched image in their mind of line that you cross over. But then especially mental health professionals are also aware of mild, moderate, and severe. And I think that what happens is they're trying to conflate two models that conflict with each other.

Jim: It's not a problem. And so they don't recognize the need to treat it a little bit more seriously. And again, that's what I said with this kid. And when I said, "We gotta treat this more seriously," it wasn't threatening. He was fine. And then, oh, guess what? He became an enthusiastic recovering kid.

Mike: I used to say things like, "I believe your substance use is causing you problems. Here's where I think it's causing you problems. Here's what I think you can do about it." And I would always get the same response, like you're saying "Am I addicted? Have I crossed the line?" And I'm like, "Did you hear what I said? You have a problem," right? On a continuum, here's where it's a problem. Because the minute you say you're not quite addicted yet," they hear that "Oh, I'm okay."

Jim: Exactly.

Mike: And that's not it. I love the line that you used. You used to run a center, right?

Mike: Like I did. And one woman, one time, or one mom said, "What is your success rate?" And you said?

Jim: Oh, you're... Yeah okay. You said one time. Actually, that, that comes from...

Mike: Or standard, yeah.

Jim: That was my standard line, because I would say people talk about success rates. I'll open conversations with family groups, like meeting them for the first time.

Jim: I used to go into treatment centers, and meet and do a special presentation. "How many people here are hoping your loved one's treatment's gonna be successful?" "Oh, of course." "How many people actually did a little bit of searching online for the success rates for this program?" And most of them went, "I did."

Jim: And I'll say, "I used to run my own program, and I used to get that question a lot, what's your success rate?" And I'd look them in the eye and say, "Our success rate's lousy." And I'd let that sink in. These are parent, it was an adolescent program. These are parents checking out my program, considering entering their kid into my program, and I'd say, "Our success rate's lousy." (laughs)

Jim: And I'd let it sink in, and I'd say, "It's not because I think we have a bad program. I think we have a really good program. But the truth is, adolescent success rates are pretty lousy." And then I'd say, "Here's my formal position on our success rate. It's either 0% or it's 100%. It depends on the individual.

Jim: But then I would go on to say, "And you would be well advised to consider treatment success as an interactive process in which the family has much more to do with the outcome than is generally realized." I have that line in my course now.

Mike: Wow.

Jim: And I say, "That's important. Write that down. Tape it on your refrigerator. Treatment success is an interactive process in which the family has much more to do with the outcome than is generally realized."

Mike: That is so good. I have three branches I wanna go down there. Let me go down the first one 'cause I used to get this a lot. What do you then say to a family, whose insurance doesn't cover treatment, about spending a bankroll on their, let's say, adolescent teenager, or even themselves, if the success rate depends?

Mike: 'Cause we all know people, right? How many times did you go to treatment? How many times do you go, "Four, five, six." I think you talked about a woman who just said her daughter went through nine on your latest blog, right? So what do you, what did you say when they said, "Should we take out a second mortgage to spend the money for this?"

Jim: The second part of that conversation is, that comes from the introduction video in my online course where I say, "Is this gonna work?" We have a flat out discussion. Does rehab work or not? And because it's really common, and I'll say understandable when the parents look at me and say, "I don't trust those rehabs. I think they only want your money." And I say, "That's understandable." We all know somebody. Treatment outcome success rates, quite honestly can be egregiously poor. Tragic, experiences of people not getting their needs met. That happens a lot. That's one of the reasons I'm an advocate for helping families at least know there's a lot you can do to help avoid poor experiences like that.

Jim: But I'd also go on to say, yeah, we all know somebody who's been in rehab a bunch of times and it didn't work, and it's unfortunate because when we hear more about failure than we do about success, the public opinion can become tainted.

Mike: Yeah.

Jim: And then it creates a self-fulfilling prophecy.

Jim: There's one of those barriers. Rehab doesn't work, so I'm not even gonna consider going to it. And I point out the other side of that coin is, and any treatment professional knows, there's miracles taking place every day in treatment centers all around the world. Families are healed. People's lives are saved.

Jim: Relationships are restored. That stuff is going on all the time. And then you can make the case for, one, somebody could be successful in the, quote-unquote, "worst program possible," and somebody can be utterly fail in the best program. Again, 0% or 100% depends on the individual. But to answer your question about should we invest in it? I'll say for the first part, when we understand that somebody suffering from a substance use disorder and especially on the severe end when they need to go to a residential facility, which can be really expensive- there are times when, again, every situation is unique in that you take in to account all the circumstances. But there's times when I look a family in the eye and I'll say, "If you gotta take out a second mortgage on your house, blah, blah, blah, I think it's worth giving them a shot."

Jim: A lot of that has to do with their attitude, if they want help, et cetera, et cetera. And because it is a once in a lifetime thing, say, if they've never been in treatment before and a person is suffering. Nobody, signed up to have a severe substance use disorder and be ruining their life as a result of their substance use.

Jim: They're suffering just as much as the people around them. They deserve help. And so that is one thing to be taken into account. And then two, you're framing that in the context of if rehab, if, if it's a good program or not. As I say, there's a lot. There's no way to make guarantees, but there's a lot that can be done to help improve and avoid so many common little stuff.

Jim: That's what I do with families every day is teach them little stuff about what to be aware of as their loved one's going through treatment. If they're saying " I can, I'll quit the hard stuff, but I can still smoke pot." And I teach the families on this end, basically what I do with my RehabWorks program, I basically created a program, an online program that puts the family in the classroom with the treatment patient so the family's learning everything that those patients are learning in treatment, which reduces the gap between communication, between the family, the client, and the treatment team.

Jim: 'Cause that's my whole premise of the work that I do is those gaps are where important stuff falls through the cracks and often sabotage treatment, and they can be eliminated with a little extra help, the family being one major factor by just giving them those tools. I just posted a video today that they said, "Get me out of here. I'm not as bad as everybody else here." And I have this section in my course that's framed, "What do we say when they say blank?" And that's the first one. What do we say when they say, "Get me out of here. I'm not as bad as everybody else here"? And I say to the families, your response is, 'cause I've taught them.

Jim: You can't admit somebody to a intensive substance use treatment program if they don't belong there. They have to have a diagnosis. They have to meet criteria. And the family can say, "If you're in a substance use treatment program, usually there's a reason that you're here." And I teach them what they're talking about is the difference, they're comparing them to the heroin users and the meth users when their drug of choice was cannabis, for example.

Jim: "I'm not as bad as these other people." The uninformed family is like "What do we say?" Maybe, "They're not as bad as those other people." And all it takes is a short conversation teaching the family a little bit. No, a drug is a drug. They got a substance use disorder. That's what's being treated.

Jim: And I say your response, without having to get into the power struggles, you know about the power struggles that happen, is that are so common, especially in that first week of treatment, and but I tell the parents on that one your response is "Tell us what it means to be diagnosed with a substance use disorder."

Jim: That's all, and I say, "Maybe you're not understanding your diagnosis, and it sounds like you better go get some help from your counselor on that. Don't come to us and complain, 'I'm not as bad as these other people.' Go to your counselor and have them explain to you what it means to be diagnosed with a substance use disorder.

Jim: And stay out of the power struggle, but know that then that's an appropriate boundary that you can set to say, "We're gonna support this treatment plan here and we're not gonna engage."

Mike: You've mentioned several times, our whole last podcast we did focused on this, and I'm talking to two groups of people on these podcasts, and we're in a spot now where I'm hearing from therapists and counselors, "Yeah the insurance companies aren't reimbursing at a rate so that I can do couples counseling or family counseling. So my boss says I can only do individual counseling."

Mike: And I'm like okay, with substance use disorder, like you said, that's a hole big enough to drive a truck through. So then all of a sudden somebody comes back and says, "Oh yeah, my counselor says I didn't need to go to those meetings," right? And if the family isn't involved, Jim, how do they know?

Mike: So what you just said assumes a treatment center, a therapist who's, I think you said, alongside of the client is educating them just as I want to say vociferously. That's not the word. Tenaciously as they are the client.

Jim: It's a problem. And that's the second reason when that I'm writing my, revising my book is because I wrote that book, it came out 12 years ago.

Jim: And after I wrote the book, I created this online course, RehabWorks, and I developed it for treatment centers to use to provide additional support to their families. I created this online platform that makes it convenient. What we're doing is we're attempting to solve the problems, the logistical problems that treatment programs have.

Jim: And I've been doing that now for 12 years. And so when I realized it was time to revise my book, I'm talking about what I've experienced and what I've learned. I've learned a lot in these 12 years in terms of what the families need, what the treatment centers are faced with in terms of their logistical problems.

Jim: And so in this revision I'm giving my hindsight. I've got all these hindsight things. But it revealed itself, and I changed the subtitle to the book. It originally was A Parent's Guide to Drug Treatment. Now the subtitle is A Modern Framework for Family Recovery.

Mike: Oh, wow. I like that

Jim: And I'm realizing that, again, I don't know how to... Honestly, candidly, I don't know how realistic this is. I'm gonna lead an advocacy program for saying we've got to start looking at bottom line is if the treatment program really shifts. They all say "We recognize family involvement is important."

Jim: And I'm gonna say that there's a still a barrier because it comes down to budgetary things. Like you say, they don't get reimbursed for family programming. Staff limitations. You know how much time staff has to spend talking to the families? And so again, I came up with this, years ago about at least here's how you can get this information about so they know how to respond in the first couple days when their client comes and says, "Get me out of here, I'm not as bad."

Jim: But now I'm pushing it because I've got the receipts I can bring with me to show how important this is, how valuable it is to think in terms of... not just give lip service that we believe family engagement is important. They all say that, but do we really act and take assertive actions on how do we treat... regard the family, the patient as a unit as opposed to the individual who has this stakeholder support around them?

Jim: And then the second piece that I've come up with and I'm putting in this framework for family recovery is also what I call the paradox of control. And This comes from these last 12 years of working specifically with these families, of teaching them that, yes, this control thing, how do we support and we can't control and blah, and that's this, buzzword that we don't know how to define you know, families are really, puzzled by that.

Jim: And say, "Okay, let's be clear. You can't control their recovery. You can control your own recovery." And I'll come back to that in defining their recovery because I'll say it right now, families are used to treatment centers, they have drive-by ex- interactions with the families.

Jim: And in those short interactions, "Now it's gonna be really important that you work on your own recovery." And I say, and the families, they wanna do everything they can. They, "Okay, I'll do that." And they go home, and they have no idea. They give them a pamphlet. "Now, you go to Al-Anon, and you work on your own recovery."

Jim: And that's what I found, is that they need a lot of help sorting that stuff out and understanding what their own recovery means. But then I'm able to say that the paradox of control is that you doing what you need to do for your own recovery ends up being the best thing that you can do to support your loved one's recovery.

Jim: And I wrote all that in the new version of the book that's coming out, and it's like I've been the frog in the boiling water, not realizing what I've been developing and creating these last few years. And I'm sitting on something. This is some good stuff. This is valuable. The families out there need to hear that.

Jim: But then when you put it all together as a framework, one, families deserve their own help. They deserve their own recovery. And what's very empowering for the families is to hear when I say that their recovery is not contingent on their loved one's progress. They can get, I use the term peace of mind.

Jim: They can get to their own peace of mind regardless of whether their loved one makes any progress. And so that's one attractive, but then that great paradox. But the thing is, you getting to that place ends up being, if you want to think that you have any control over your loved one, it's you getting to that place of your own true recovery.

Jim: We'll help you figure out what that is, but that ends up being the best thing that supports their loved one.

Mike: Oh, that's that's the way I was brought up. That's the way I was college trained. That's the kind of stuff that I used to do. And going back to what you said, not every counselor understands family systems or were trained in it and understands the dynamics and how they interplay, so I think it is important.

Mike: I'm gonna do a little commercial for you, Jim. And regardless of where somebody goes to treatment or what treatment they're getting, your webinars, your blogs are a tremendous supplement to wherever that person is going, if they don't offer a family program, because your stuff does. So somebody could go on your site, and again, we'll link it, take a class, listen to a blog, short YouTube video, and get the information you're talking about even if the center that their loved one is going to isn't getting it there.

Jim: Oh, absolutely. I have, I sit in here and I make webinars all day long. And I love it. A nd I have this plethora of material through the online course that I created. It's a, it's big and robust, and treatment facilities use it. And I actually do go online.

Jim: I hold weekly Zoom calls with the families at the treatment centers that are using my RehabWorks course. I do my own individual family coaching. But here's the big announcement that I have, big news literally this week. I have finally decided to implement the final piece of this. Like I say, I do individual coaching with families, or they can get my RehabWorks material through a facility that uses RehabWorks.

Jim: I'm finally adding my own program for families to go through. It's all virtual. But it's a group process that includes the online education and some individual planning for their specific circumstances. And it's like I just finally realized from all the webinars that I do, I'm just overwhelmed with how much of a need there is.

Jim: Even with the families, I interact every week with families that are at the treatment programs that are using RehabWorks, and they're getting good stuff. I didn't say this. One of my lines at the beginning of when I introduced RehabWorks and why, how I pitched this, I say, "Until they start checking the families in along with the clients," which I don't think is gonna happen anytime soon, there will always be those gaps, even with the best programs.

Jim: There's plenty of programs that have really good family programs, but there's still... I see it day in and day out, these families are desperate for help, and they don't even know the right questions, you know- ... to ask. It's not- And they call the counselor, "I just want some interaction." Yeah. And the counselor thinks they're being a pain and they're again, they're pulling them off their busy caseload and that kind of stuff.

Jim: But so bottom line is, I'm finally opening an eight-week course. It's a group course or a program for families whether they have a, ideally for people who have a loved one in treatment to this. If they have a good program, supplement it or unfortunately, a lot of treatment facilities don't have much at all in the way of family services.

Jim: Or if they're just taking the first steps of addressing potential problem, or there's a lot of them out there that are in the merry-go-round, the revolving door of dealing with relapse, and they're feeling hopeless, and they're exhausted. And there's a lot of folks in that category that I meet on these webinars that I do.

Jim: But bottom line is my YouTube channel has a lot of webinars and a ton of material. Jim Savage Recovery is the YouTube channel. JimSavage.net is where you can find information about my programs.

Mike: And we'll put links to all of that, and then if you contact Jim, he can let you know when the next thing coming up is.

Mike: I think we would both agree, and a good place to leave this is the healthier the family is, the better chance of success for the individual who has a substance use disorder. And even if they don't get better themselves, as you said, I can still find recovery and peace of mind myself.

Mike: I don't have to have the disease along with the other person.

Jim: I'll wrap it up with this story. I had a parent in my parent support group who attended... I treated his daughter when she was in high school years ago, 20 years ago, and he continued to attend my parent support group for a long time. And she had a couple of years of good solid sobriety in those, when I was treating her in late teens, early 20s, and she had a couple in and outs and of relapses.

Jim: And one night he was in the parent group, and he had committed to his own recovery. He was a solid recovering, continued my group. He was going to Al-Anon, et cetera. And one night he shared that, "I got a phone call in the middle of the night last night, and that indicated that she definitely had relapsed and gotten herself in a bunch of trouble."

Jim: And the rest of the parents in that group, most of them brand new in this, they listened in just horror. Oh my God, that must have been so terrible to hear that. How horrifying. And they said, "What did you do?" And he said, "I rolled over and I went back to sleep." It created this moment. Everybody else in the group was like, "Huh?" And they were like, "I want that."

Mike: Yeah.

Jim: And that's what I refer to as this peace of mind. And then I go, I, in the new book, I'm telling this story, and I go into what he was doing on his own recovery to get him to that place of peace of mind. But then I show how that ended up being the most effective thing for eventually intervening on the daughter and getting her back into recovery because he had credibility with her when he did it.

Jim: When he stopped rolling over and get, going back to sleep and realized, "Okay, things have changed. Now it's time to take some action." His recovery helped him make decisions on how to respond at different times. And then one day, we need to take action. And so when it was, she realized he's not a hot head, overreacting, flying off the handle.

Jim: He's solid. He's fair. He was letting me go this whole time, and now evidently he's decided it's time to take a step. On some level she knew he's being fair, and that's what I mean by a family member being in their own recovery being the most effective thing they can do to support their loved one's recovery.

Mike: Outstanding. And those of you listening, we hope you get there, that's for sure. Jim, I'm always glad you're with me. We'll do this again. We won't wait another year to do it though, if that's all right with you.

Jim: Yeah.

Mike: Your knowledge and your work is outstanding.

Mike: For those of you listening and watching, we hope you find courage and love and support wherever you are.

Mike: We thank you for listening and watching. Be safe, be well, and take care of yourself.