Why Rehabs dont work for everyone

In my 30 years on this planet, Iv'e been to rehab nine times...

Ive done just about every possible detox from opiates over the years, NA twelve step programmes, cold turkey, drug assisted detox (methadone/subutex reduction, benzodiazepine,clonodine)

To complete a detox programme you need to be 'ready', it's the most horrendous experience you will ever go through, and to get through it you need to be so determined to succed it will override the physical and psychological torment of opiate withdrawls..

The problem with acute opiate withdrawl is that not only it's physically uncomfortable (to the extent you want to kill yourself) but it throws up a lot of physological stuff from your past.

The first time I went into a residential rehab I had no clue really what I was doing, I was on 100mls of methadone daily, a large dose by anyones standards, I was also taking prozac and valium,
I was reduced from the methadone over five days and the prozac was stopped along with valium.

It hit me like a ton of bricks!

Not only was I in the most physical pain I've ever experienced, I was suddenly having to deal with issues from my past which I had succesfully blocked out with drugs since I was seventeen..

I started having mini seizures and had to be givven rectal diazepam on a few occasions

I think, looking back now, I had a mini nervous breakdown, I was self harming quite badly, cutting and stubbing cigarettes out on myself.
I became suicidal, and just couldn't deal with it.
I ended up discharging myself and coming straight back to London and scoring some Heroin.

This understandably put me off rehabs for years, when I eventually cleaned up I was 26, and was by this point at my rock bottom, it's cliche but true, it takes getting to a point where you are so low, so sick of the lifestyle to have the determination to get clean.
I actually threw the last bit of heroin I had down the toilet and decided to go for it.
I did it on my own, It took me three years to taper down my 80mls methadone daily down, at around 1ml a week to 6mls, at this point I switched onto 8mg of Subutex (Temgesic/Buprenorphine) - A partial opiate agonist/antagonist with a much shorter half-life than methadone, I reduced my Subutex dose down to 0.2mg and then stopped.... I waited for the withdrawls but they didn't come!  was actually clean, opiate free for the first time in ten years!

The only real symptoms I suffered were insomnia (for around six months) and I fell into quite a bad depression, I was actually suicidal for around 12 months after.
I researched appropriate anti-depressants that work for people that have had a long term opiate addiction (opiates really mess with dopamine and seratonin re-uptake, and it can take around six months for the brain to repair itself to a point where the seratonin and dopamine are absorbed normally again.

I started taking Venlaflaxine, it helped slightly, it took the edge of the depression anyway, I wasn't suicidal at least.

Anyway, my opinions of rehabs,...

 they tend to use a 'one size fits all' treatment modality.

You are generally thrown in with a bunch of people you wouldn't normally associate with, at clouds house for example, we had people ranging from a fifty-six year old woman who had become addicted to tramadol after a hysterectomy to a twenty something man who had been sent to rehab on a court order, he would be sent to prison if he did not complete, he didn't want to be there and he made sure he made the process as difficult for everyone else he possibly could, (sabotaging your own and others' detox is a common behaviour observed at residential rehabs).

My main issue with most of the rehabs i've been in however is my sexuality, as a gay man I suffered homophobic abuse at nearly every one I went to.

When people are detoxing they tend to be very defensive and can revert back to adolescent behaviours from childhood.

It's almost like a school!

Being continually bullied is obviously not conducive to recovery when you are feeling low and struggling anyway and it was one of the reasons I didn't ever complete my treatment.

I really think to aid an individuals recovery a holistic view needs to be taken.
It's not just about physically detoxing someone.
I believe treatment needs to be individually tailored for each persons needs, post-detox treatments are as if not more important than the actual detox itself.

Even with ibogaine, probably the most powerful 'addiction interruptor' we have, post-detox therapy has been shown to be useful if not essential and the majority of people that have maintained abstinence have used therapies such as counselling, physical therapies like acupuncture, exercise, yoga, or thai chi.

I honestly believe that if a treatment is going to be succesful, it doesn't matter where the person is, if one is determined to clean up they will do it whether they are at a £30,000 private holisitc rehab or on their friends sofa doing a DIY Ibogaine treatment.

I think in the future we will see patients having more input to their detoxification process and a focus on aftercare.