Here’s What Really Happens Inside Rehab
I've been there, and it ain't pretty.
By Zachary Siegel

A muggy May morning at my parents’ woody home outside Chicago, after a months-long heroin binge landed me back in my childhood bedroom. A morning I’d been dreading. Within a few hours I’d be in Minnesota, the Land of 10,000 Treatment Centers, at a residential facility for the next 30-to-90 days.

First I had to finish up my heroin. Why deal with feverish aches of dope-sickness on an airplane? That sweaty morning I learned that doing a big shot right before a flight is about the closest you’ll get to time travel.

An older man with thick grey hair and black sunglasses intercepted me at baggage claim. I’d told the treatment center what to look for: a lanky, emaciated 22-year-old white guy wearing long sleeves (to cover my tracks). He must’ve picked up hundreds like me.

We left the airport in a minivan. The driver asked if I’d ever been to Minnesota before.


The one-word answer wasn’t meant to be rude, but I was trying to enjoy the tail-end of my shot. I knew I’d suffer withdrawal soon, because this facility, like roughly 80 percent of US rehabs, was abstinence-only. That means meds proven to quell cravings and keep patients engaged in treatment—treatment retention being a tremendous problem for people with opioid addictions—are shunned.

Clean Living

So chemo-phobic are some of these rehabs that they cruelly serve up decaffeinated coffee, as if we’re there to become Mormons. As I looked out the van’s window at endless green hills and sunshine, I couldn’t help but feel depressed.

The secluded, wooded campus at our destination contained what looked like a hospital with a lake-house aesthetic.

But the vacation vibe quickly gave way, as I was brought into a small room to be searched by a young man with too much gel in his hair. His form of small talk, while emptying my bags, was asking if I liked to fight. “No,” I told him. But I did ask what he was doing with all my books, which he stacked away. He said they didn’t allow personal books, and that I’d be reading recovery literature instead.

The “lodge” presentation of the place, I would later learn, is as much a part of its philosophy as confrontation and group therapy.

“The grace of a beautiful environment promoted respect, understanding and acceptance of the dignity of each patient,” reads a 1997 article by a former vice president of Hazelden Foundation, an organization famed for birthing the Minnesota Model—to which most US rehabs, like mine, adhere. The article describes what’s expected of patients: “Make your bed; comport yourself as a gentleman; attend the daily lectures on the 12 Steps; and while sitting around, talk with one another.”

Does it get any simpler?

AA and Group Therapy

The treatment principles are firmly rooted in Alcoholics Anonymous, a spiritual self-help program founded in 1935. Many of AA’s ideas were poached from the Oxford Group, an earlier organization tinged with evangelical protestantism, which posited that all human problems stem from fear and selfishness.

Given the Minnesota Model’s reliance on a mutual aid fellowship that’s freely available in most communities, attending rehab typically means that your health insurance (if you’re lucky) pays $1,000 a day or more for you to help yourself.

“A healthy dose of finger-wagging and humiliation is often thrown in.”

But a healthy dose of finger-wagging and humiliation is often thrown in. From the get-go I was told that my heroin addiction stemmed from character defects of a spiritual nature. Counselors who had spent only a few hours with me called me “self-serving” and “egotistical.” Whenever I began a sentence with, “I think…”  they automatically retorted: “Didn’t your own thinking tell you doing heroin was a good idea?

Undermining us, filling us with doubts about our sanity and own ability to reason, calling us names, were routine. Like the drunkards of the ’30s, we needed moral re-armament. Yet treatment was delivered in modern-sounding forms: individual homework assignments, group therapy, lectures and AA meetings.

I was assigned to read and reflect on “King Baby,” a 28-page pamphlet describing the traits of an adult with the maturity of a selfish infant. (Women get to read “Queen Baby.”) Having reflected on my own King-Baby traits, I was to tell a “tech”—a vaguely defined staff position not requiring a college degree—who would then quiz me about my selfishness. What better way for a 22-year-old to kick heroin?

I sat in enough group therapy for two lifetimes—at least two hours daily except Sundays. A handful of us young men, aged 18-to-23, sat sullenly in plastic chairs in our counselor’s office. He typically brought up the consequences stemming from our drug use, and this constant emphasis—as if it would be enough to deter us—seemed counterintuitive when addiction is, by definition, compulsive use that persists despite negative consequences.

But a more insidious problem with group therapy is a little-known phenomenon called “peer contagion” (or “deviancy training”). It happens when negative behaviors—like how I stole to make money to buy heroin—are subtly reinforced by the group. When a group of young people tell war stories, we inadvertently egg each other on, sharing tricks for future use. One guy in my group was a freshman in college: His parents forced him into treatment for smoking cannabis and getting bad grades. My story probably taught him plenty about how to support a covert heroin habit.

Each night came AA meetings and lectures. About 30 of us sat in lecture halls for at least two hours a day, five days a week. Subjects included triggers and “signs of relapse,” as well as more abstract topics like “a spiritual disease.”

Setting aside the merits of the content, stand-and-deliver lectures are a poor way to teach young people anything, partly because they’re boring. Staffers, clearly having delivered the same weekly talk for years, just stood in front of a whiteboard and lectured, like depressed comedians recycling tired material. I’d look around the room and see people drawing on their shoes, twirling their hair, picking their ears and noses.

An Unaffordable Delusion

I wound up spending 90 days there. It really does a number on your psyche. You may leave indoctrinated into AA. You may leave with the belief that you are “spiritually diseased.” But you won’t leave with your addiction “treated” in any sense that stands up to scientific or medical scrutiny. Studies (at least for alcohol) find no overall advantage for residential rehab over cheaper, outpatient settings—and 40-60 percent of people treated for substance addiction relapse within a year, according to the Journal of the American Medical Association.

Yet applying scientific approaches is a matter of life and death. Researchers who analyzed data from over 150,000 people treated for opioid addiction found that patients given medications like buprenorphine or methadone had half the death rate compared with those given the abstinence-based treatment I received.

The notion that a short stint inside an abstinence-based facility clinging to folk wisdom will treat this chronic, complex condition is desperately flawed. And when we consider the human cost—never mind the billing—that’s a tragedy.

Zachary is a Chicago-based journalist covering drugs, criminal justice and public health. His work has appeared in the New York Times Magazine, Slate, WIRED, New York Magazine, the Daily Beast, VICE, Salon, The Appeal, The Fix, AlterNet and many other publications... read more >>

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1 year ago

I’d say this sounds about right based on my experience. good article, thanks for sharing

Kevin mcDougal
1 year ago

This is rough shit

Should someone you know read this article?

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