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Deciding to go to rehab for a drug or alcohol problem is a commitment. The same is true for those who may have been struggling with their mental health and choose to enter inpatient treatment. The journey to that decisive moment can often look more like a squiggly line than a straight trajectory, because almost any time a commitment is involved, there are going to be excuses.
FHE Health Professional Relations Manager JD Page has a front-row seat to the common excuses people make when they’re considering whether “now” is the time for treatment. Page works closely with a number of Employee Assistance Programs (EAPs) around the country that regularly refer people to him for consultation regarding treatment. In a recent interview, Page shared the most common excuses that people make when considering inpatient rehab, as well as ways to gently but firmly debunk these rationalizations.
“People Don’t Need Residential Treatment.”
As Page described it, this excuse commonly manifests as follows: He might get a call from someone exploring inpatient rehab, followed by an extended period of radio silence. The reason: “The person will try to go the route of outpatient treatment, but it’s just a matter of time before you get a phone call 30 days later, saying that it didn’t work.”
“There’s a continuum of care for a reason,” Page explained. “The beauty of residential treatment is you’re in a secure environment, and there’s medical care at will and access to supports and resources that you don’t have in outpatient care— so the level of treatment efficacy is much higher if you start with residential treatment.”
Research vindicates Page’s claims, revealing that participation in a formal, residential rehab program and longer time in treatment are key to successful, long-term recovery. While it’s therefore tempting to think that outpatient treatment is all that’s needed to overcome alcoholism or a drug addiction, most people who are serious about getting and staying sober find they do need residential rehab first.
“I Haven’t Hit Rock Bottom.”
“That’s loaded and it’s very common,” Page said, with a knowing laugh, because “there’s no real definition of rock bottom. It’s something that’s unique to the individual.” In other words, “rock bottom” is “a subjective measure 100 percent.”
As illustration of just how subjective a measure “rock bottom” can be, Page contrasted the “people out there who have been addicted for five years, living on the streets, without a dime to their name, and who have had countless overdoses, with the “suburban soccer mom who is drinking a bottle of wine a day and has just had enough.”
That’s a pretty wide range of so-called rock bottom, which is why Page finds it more helpful to translate a person’s “rock bottom” as their capacity to tolerate pain and suffering. Some people have a really high pain tolerance, while others— not so much.
“Rock bottom is the toll [addiction] takes on you emotionally,” Page explained. “It’s when someone has had enough of their threshold of pain.”
When a person needing treatment tells Page that they haven’t hit their rock bottom, he asks them how much pain they can take and whether they are tired of the pain. “Have you had enough of what you’re currently dealing with? … Have you had enough that you’re willing to do something? I can guarantee you it will get worse; this is progressing.”
The harder cases can be those where “it’s a court order or Mom and Dad are asking for it … If [the addicted person] not willing to do it then the chances of this being effective are minimal, because you have to want treatment.” Even in these circumstances, though, the excuse that “I’ve not hit rock bottom” has some pretty big holes in it.
“Addiction Can’t Be Cured.”
The rationale of this excuse is not just false but rooted in despair. Here’s how Page debunks its misguided logic:
No, cancer can’t be cured, but it can be treated. Cancer can be put into remission to the point where it’s hardly there. People view addiction as a moral problem— that this person lacks self-discipline, has poor morals, etc., and that’s not the case at all. [Addiction] is a genetic predisposition that’s accentuated by environmental variables. Yes, there’s not a magic medication to eradicate it completely from the body, but this is a brain disease, and we treat it so that it can be put into remission and a new way of life can be started.
What’s Page’s response when he hears someone try to deflect treatment with the excuse that addiction can’t be cured? He offers the person a crystal ball view of a future where their addiction has gone untreated: “If I told you there’s a way to live without addiction completely, would you take it? Go ahead and keep drinking and see what happens— either you will die, go to jail, or end up in a state-run facility or another place against your will. The consequences are going to compound. They always do.”
“This Isn’t a Good Time for Rehab.”
To this excuse, Page will often reply, “Okay, if not now, then when?” He said that “nine times out of 10 there’s no excuse to not come [to rehab] right now.”
People give all sorts of reasons for why it’s not a good time for rehab. One of the more common is who will take care of a pet, according to Page. Someone even asked him who was going to feed their fish.
People also worry about traveling for rehab and leaving their family or loved ones. They may say, “I’d rather do rehab at home,” when what they really need is “a hard reset” that requires “changing your environment and the people around you”— to get away from those familiar triggers.
When you go rehab, “you’re also getting out of that comfort zone and comfortability,” Page said. Sadly, sometimes this ask is too big for people, because “people in active addiction are comfortable in misery; they don’t like to feel miserable but that’s a comfortable spot.”
In cases where someone protests that they “can’t be gone from my husband for 30 days,” Page will often ask, “Well, are you really there right now? Are you really present? Yes, you’re there physically, but what about emotionally? Are you actually showing up?”
There are also those times when people have legitimate concerns about going to rehab, such as worries about job security or family responsibilities that are impossible to ignore: “If you’re a single mom, you can’t just up and leave. If you’re a caretaker of an individual, you can’t just up and leave.”
In these situations, “we try to take off their plate what we can,” Page said. He cited some of these supports, such as help with documentation for the Family Medical Leave Act, short-term disability, and other job protections. (Naturally, people worry about losing their job; and FHE Health regularly works with EAPs and other entities to ensure that people can access confidential, job-protected time away from work for treatment.)
Sometimes every effort to provide support and debunk excuses is not enough to move a person from the hard line they’ve drawn in the sand— yet the hope is always that they’ll come back at some later time, having rethought their excuses. Page gave the example of a guy “who had fought me” for some time. He had been “giving every excuse in the book [not to go to treatment] and he had finally lost his job because of his addiction; and his girlfriend had left him, and he was about to lose his house; so finally, he said, ‘I don’t have anything to lose.’”
Today that guy is three years’ sober.