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Stopping The Revolving Door Syndrome Of Drug And Alcohol Rehab

Jennifer Cousineau MSCP, LPCI, NCC

Medically reviewed by

Jennifer Cousineau MSCP, LPCI, NCC

March 1, 2019

The revolving door syndrome of drug and alcohol rehabs occurs when an individual struggles with remaining sober after completing treatment. Individuals who experience this syndrome are likely to complete treatment, relapse, and then enter another treatment program. While it may be difficult to stop this dangerous cycle, it is possible with the right treatment program and plenty of support.

Relapse rates are difficult to pinpoint, due to the fact that there exists no standard measure for rehabilitation success and failure. Some treatment facilities, for example, measure only the program completion rates for clients (producing, in some instances, success rates of 100 percent). Others measure the sobriety of program graduates for only short periods of time after release. Additional variables such as drugs of choice, environmental and family factors, co-occurring mental disorders, age, and sex all contribute to success and failure figures.

A relapse rate of 40 percent to 60 percent is often cited for substance abusers who receive treatment and return to active substance use within a year after completion of a program. Those figures are cited by a National Institute on Drug Abuse report and a 2000 Journal of the American Medical Association article.

So: How to avoid the revolving door?

Client Responsibilities

The success or failure of any rehab treatment rests with the user, the medical professionals treating you, the treatment facility itself, and the programs employed. The first step is to carefully research treatment options, seeking professional and trusted advice, and tailoring a program to meet your needs. The seeds of relapse can be planted during treatment if certain criteria aren’t met. Of course, strictly adhering to the program while in rehab also is paramount to long-term success, including developing a realistic and structured post-release program.

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In order to cut the odds against the revolving door syndrome, get all you can out of rehab the first time. Know what to expect. Have an exit plan. Listen. Ask questions. And prepare for life after rehab.

Once rehab is completed, many issues must be addressed. Successful treatment doesn’t end after rehab; the following issues must be dealt with:

  • Commitment — Are you as committed now as you were when you sought help? Are you doing this for the right reasons, or are you trying to please others? Prepare yourself before leaving treatment for some rocky patches.
  • Follow your aftercare plan — You may be feeling good about yourself by this point (as you should) but don’t get overconfident. Stick to the map that you created while still in rehab.
  • Support — This should be a part of your recovery plan. Make sure that, to the degree possible, you surround yourself with positive, supportive friends and family. Attend AA meetings or other support groups.
  • Avoid old haunts — Avoid bars, social events, and old friends with whom you may have nothing in common but drugs or alcohol.
  • Medications — Again, this should be part of your aftercare program. If you’ve been prescribed medications, take them faithfully. Many people who get sober may discover that some underlying medical or mental health conditions may have been long neglected, so keep in touch with your doctor.
  • Avoid the Pink Cloud — Be cognizant of the “pink cloud” of success that may start dissipating once you leave treatment. During treatment, once sober, many people begin feelings better about themselves, gain confidence, and even feel a sense of safety while in rehab. Remain aware of the fact that sobriety doesn’t guarantee that life won’t be difficult at times. As Elizabeth Taylor is quoted as saying on the Changing Lives Foundation blog, “I fell off my pink cloud with a thud.”
  • Prepare for relapse — While relapse doesn’t have to be a component of recovery, realize that it’s a strong possibility given existing statistics (especially if you don’t adhere to your aftercare blueprint). As Robert Parkinson, MSW, writes on the Smart Recovery website, “But try not to get trapped in a revolving door…although repeated relapse can be a normal part of recovery, there can be a limit to how many times a person can repeat this pattern and go on to successfully stay sober.”
  • Stay positive — Just as sneaking a cookie doesn’t mean you’ve blown your diet, a slip doesn’t necessarily constitute a relapse. The 2000 Journal of the American Medical Association article referenced above also notes, “It is argued that when an individual does break the abstinence rule, he experiences a decrease in self-esteem and guilt, and blames himself, which actually leads to further drug usage. This has been called the Abstinence Violation Effect (AVE).” Be realistic, but don’t be too hard on yourself.

Other Triggers

Other than the danger signs just listed, some additional potential relapse triggers to look for include: financial difficulties; smells or sounds, like an old song; visual reminders, or drugs or alcohol images in the media; relationship problems; being criticized by family, friends or a significant other; family troubles; and an anniversary, either of a loss or a (former) happy moment, like your child’s birth or your wedding.

Caregiver Responsibilities

Treatment centers and their professional staffs also share responsibility in fighting against the revolving door syndrome. While the majority of treatment facilities employ dedicated and qualified professionals, many fall short of ideal standards. This is due to many factors, including lack of funding and resources, staffing shortages, and lack of statistical analysis and follow-up research.

When seeking a qualified substance abuse treatment facility, there are some things to look for. Successful treatment facilities typically share common traits. The National Institute on Drug Abuse, in its report “Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition),” outlines some keys for successful drug abuse treatment, including:

  • Recognizing that no single treatment regimen is right for everyone; one size does not fit all.
  • Treatment must address the multiple needs of clients, not only alcohol or substance abuse. Co-occurring mental health disorders must be identified, and treated, early.
  • Staying in treatment for the appropriate amount of time is crucial for success. Again, identifying this factor early on is critical.
  • Common behavioral therapies such as group, individual and family counseling, as well as modalities such as cognitive behavioral therapy, should be available.
  • Medications, when required, are a critical component in treatment, including aftercare. Continuous monitoring also is paramount (as is testing, when appropriate, for illicit drugs).
  • Treatment plans should be continuously reviewed, modified when necessary and, ideally, followed up with after the client’s release.

Evidence-Based Practices

Evidence-based treatment (EBT) also is important. There is no single, recognized EBT, or research-based practice. Rather, EBT modalities are usually independently designed and implemented at individual facilities, documented, and published. Different organizations, such as the Substance Abuse and Mental Health Services Administration, have their own criteria. The University of Washington has an evidence-based practices website for substance abuse treatment, and its requirements for inclusion in its database include research, meaningful outcomes, standardization, replication, and fidelity—or protocol consistency—measures.

These precise parameters often mean that EBT programs can be difficult for some treatment facilities to implement. Policy adjustments may need to be made to implement an EBT, or additional funding may be required for staff training or other resources. A new practice might even threaten or challenge a facility’s existing philosophical stance. But facilities can review existing EBT protocols and pick and choose components from other programs that may be integrated into existing protocols, or even design their own programs.

Staff And Programs Are Vital To Your Success

Ask questions when looking for a treatment facility. There’s no reason to be hesitant about inquiring into staff credentials and experience. You’re looking for help and you want to get it right the first time and avoid the revolving door. Do you know what type of treatment you need, or for how long? Does the facility have the resources to properly treat your needs? Do you have a co-occurring condition, or can the facility diagnose one? Can they cope with it and offer you effective treatment for it?

The National Center on Addiction and Substance Abuse, in a 2012 article titled “Addiction Medicine: Closing the Gap between Science and Practice,” provided a warning for those seeking treatment.

“This report exposes the fact that most medical professionals who should be providing addiction treatment are not sufficiently trained to diagnose or treat the disease” the article reads, “and most of those providing addiction care are not medical professionals and are not equipped with the knowledge, skills or credentials necessary to provide the full range of effective treatments.”

We Can Help

At RehabCenter.net, our professionals are highly qualified to help you on your road to recovery. We’ll guide you in finding the professionals and facilities that meet your needs by helping you to make the right choices to minimize your chances of suffering a revolving door experience. Contact us. The first step may be the most difficult but it also can be the most important.

National Institute on Drug Abuse - Drugs, Brains, and Behavior: The Science of Addiction

National Institute on Drug Abuse - Principles of Effective Treatment

Semantic Scholar - Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation

SMART Recovery - Life After Relapse — How to Bounce Back and Start Over

Evidence-Based Practices For SUD - About Evidence-Based Practices

Center On Addiction - Reports

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