5 Reasons why Rehab “graduates” bust

Over the past 20 years I have tracked a number of client’s pathways both in and post Rehab. A review of the case notes have revealed the following 5 reasons why patients leaving a rehab might bust within 180 days. I have deliberately left out the group who were either forced or coerced into admitting themselves and who did not embrace the sessions or therapy available.

1.      Over confidence

3 or 4 weeks of healthy eating, exercise and intense daily group meetings can have the patient feeling on top of the world. They have not felt this good in years. They know what they have to do and in their own mind they feel ready to go. The transition plan is in place and they are totally committed to it.

As they leave the structured environment of the Rehab and say their tearful goodbyes to the “very best friends” they have made since arriving a few short weeks ago their level of excitement and expectation of what lays ahead is coloured by an almost overwhelming belief they have won the battle over their addiction.

This is an extremely dangerous mindset. Quite simply the battle with addiction has not been won. The journey of recovery has barely begun. There are a myriad of obstacles, hurdles and issues they will encounter in the days and months ahead and if they are going to overcome these a “steely resolve” and clear understanding their time in rehab was the start of the battle will be required.

2.   Emotionally unprepared

“Kylie you’re doing great, it’s been 10 days since you last used here’s your 10 day chip” following this presentation there was lots of clapping and well wishes from all the group at the rehab.

Continual positive reinforcement from both staff and patients is common practice in almost every rehab and in the short term it can have significant impact; however, in the long term it can be counter-productive.

When an alcoholic or addict arrives at a rehab they almost inevitably have had no positive input from anyone for a long time. Indeed, they would have endured quite the opposite from partners, family, friends and employers. “You useless drunk,”  “your nothing but a thieving junkie”  and it goes on and on; so when they arrive at Rehab and start to receive all the positive reinforcement they actually become addicted to it and crave daily reinforcement of how well they are doing. In their small groups during breaks they constantly cheer each other up, act as a shoulder to cry on and form very close bonds with their fellow patients.

This is all very good until such time as they leave rehab and head back into the real world………. back to reality.

The positive reinforcement abruptly stops. The shoulder to lean on is no longer there. Daily chats with people “who understand what I am going through” are craved but not available. The friendships formed are quickly broken as each patient goes his/her own way.

The pain, anxiety, depression return and the best way to deal with it is……!!!!!

For some the rehab becomes a haven, a place where they are understood, a place where they form friendships with people on a similar journey, these patients  become addicted to being in a rehab. It’s a place where they can communicate, it’s a place where they feel self-worth, it’s a place where they are understood.

3.   Missing the highs!

Many in the early days of recovery long for the buzz and excitement that was part of their life. For the addict every day was a challenge, from finding money to scoring created a lifestyle of drama, of ups and downs and highs and lows  During their time in rehab these highs and lows were replaced by daily group therapy and one on one sessions however, once they are back in “normal world’ they have neither.

Similarly the alcoholic misses the high they get from the drink or the opportunity to blot out their troubles and problems. Either way their early days post rehab can easily see them longing for the effect the alcohol had on them.

4.   The props/enablers are still in place

“If you are prepared to face the music one day you might lead the band”

For many facing the music is continually deferred because their addiction is being and continues to be propped up by a partner/parent/employer. These people leave rehab with the best of intentions only to bust within a short period of time because there is a safety net for them to fall into. They know either consciously or subconsciously if they pick up a drink or start using again someone will be there to save them, they will still have a roof over their heads, they will still have someone to turn to.

Where there is an enabler in the family their role needs to be clearly defined prior to the patient leaving rehab to remove the likelihood of the alcoholic/addict relapsing

5.   They get too well too quickly (This is similar to but not quite the same as the group in the “overconfident” category above).

Within two weeks of an addict or alcoholic completing their initial detox in rehab their physical condition generally shows dramatic improvement. The combination of a good diet, physical exercise, better sleep patterns all contribute to the client enjoying a sense of well-being they have not had in years. This dramatic physical change when combined with the group and individual counselling can and often does lead to the client feeling they have overcome the addiction and are ready to go. They feel they are properly equipped to deal with life and their addiction.When this occurs what has actually happened is the physical recovery of the client has got way ahead of the mental recovery and this newfound physical wellness can be intoxicating and easily lull the client into a false sense of where they are actually at in their recovery. The critical importance of the emotional and mental hurdles they will need to address over the coming months/years in their minds have been removed or downgraded in importance to such an extent they are delusional about where they are actually at. This can and often is the precursor to busting soon after they re-enter the real world


The degree of Mental Focus a client possesses when they leave rehab has a direct correlation to their chances of overcoming the hurdles they will encounter in their first 180 days back in “normal world”.

Over the years I have found those who leave Rehab with a clear understanding of what lays ahead and who have a “Steely Resolve” to tackle the issues and stay with their treatment plan are the clients most likely to succeed.


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