In a previous life, I had a job for a couple of years working as a “clinical counselor” at an alcohol and drug addiction rehabilitation facility – to be called The Rehab for the purposes of this article. This can certainly be included in the list of “toughest jobs you've ever loved” category. While I worked there, I was sure I had fallen into some heretofore unidentified circle of hell and I must be the butt of some supreme galactic joke. But at the same time, I would almost certainly otherwise never have met any of the many urban inner-city men and women caught in the web of drug addiction and the criminal justice system, an entire American sub-culture that is publicly reviled when not being ignored and forgotten. Nor would I have come to recognized myself in their painful and desperate struggles. At The ReHab, I faced and conquered challenges far outside my “usual” experience. Perhaps most importantly, what I learned at The Rehab would later provide the groundwork for some of my greatest professional accomplishments. I now think of myself as uniquely lucky to have had this job.
It is this unique experience I hope to describe with a series of articles I call Working At The ReHab. This series will focus on life at The ReHab, and issues of drug addiction and drug addiction treatment in America. For interested readers, the previous installments can be found here
Part 1: (http://www.dailykos.com/...)
Part 2: (http://www.dailykos.com/...)
Part 3: (http://www.dailykos.com/...)
To anyone interested, I will tell them that addiction is kind of like diabetes. No one wants to get diabetes, no one sets out to become diabetic. And who gets diabetes and how the disease comes about is not well understood. Yes, it is true that science show us that eating sugary foods has something to do with it (but not for Type I diabetes, congenital diabetes or gestational diabetes), but that is not the full story, nor does it explain all cases of diabetes. Unfortunately, diabetes is a chronic disease for which there is no cure. However, by following everyday a course of treatment, someone with diabetes can generally prevent the illness from ruining their health and interfering with all the things they want to do. Should someone be diagnosed with diabetes, we generally accord them some degree of sympathy. So we generally do not blame people for having diabetes. Instead, there is an expectation that once someone has been diagnosed and educated about managing their disorder, they will take responsibility to do what is needed to prevent their illness from wrecking their health and interfering with their plans.
Similarly, no one wants to be an addict. And what causes addiction is not very well understood. Yes, heroin addiction only shows up in people who have used heroin. But there are many people who take opiates everyday for chronic pain conditions who exhibit none of the manifestations of addiction. So simply taking an addictive substance does not fully explain the causes of addiction. Addiction is a chronic disorder and there is no cure. However, there are things that a person with an addiction can do to prevent a recurrence of their symptoms from wrecking their health and their lives
So I tell the addicts I have counseled that they are not to blame for this addiction; that it is not their fault. But, I tell them that now that they know about this problem, it is their responsibility to take the necessary actions that will prevent a relapse. And I stress that these preventative activities have to be done regularly to be effective. That is their responsibility. Just as the diabetic is responsible to check their blood sugar and take insulin everyday, so too is the addict now responsible to regularly take those actions that are recommended as a course of treatment. And fortunately for the addict, none of those treatments involved pricking your fingers, collecting blood, injections, or even taking a medication. But still and all, most addicts fail to effectively manage their illness on a daily basis, and relapse is very common.
This analogy with diabetes was frowned upon at The ReHab. While The ReHab fully recognizes addiction as a disease, their policy was to avoid describing addiction as a medical disorder to the residents of The ReHab. Because addicts are endless adept at rationalizing and justifying their behaviors, the feeling from the front office was that describing addiction as a disease would only give residents at The ReHab another excuse: “Hey, I gotta illness here, there's nothing I can do about it”. Obviously, I didn't agree with this policy. Firstly, because it flies in the face of what medical science knows about addiction. And secondly, many of the residents I met at The ReHab were quite literally crippled with shame and low self-image. Of course, most of them had a lifetime of engaging in all sorts of shameful behaviors, but my own opinion was that they shouldn't also be saddled with the blame of having an addiction. So I tried to walk a fine line, telling the residents that while they were not at fault for having an addiction, they are fully responsible for managing their symptoms and minimizing the fallout of their illness. My purpose was to convey a message of empowerment, not of blame.
For most residents, life at The ReHab is pretty boring. They are awakened at 6 am. They have twenty minutes to get themselves up, straighten up their rooms, and get to breakfast. If they want to take a shower, they are supposed to do it in less than three minutes (to give other a chance to shower and to discourage dawdling). After breakfast comes Morning Meeting, an hour-long discussion primarily focused on the topic of bad behaviors. And after Morning Meeting, the residents go to their various job functions.
Most of the work of running The ReHab is done by the residents themselves. Various teams are drawn up to handle different chores. The newer members – people who have been in treatment 30 days or less – do most of the sweeping, mopping, window washing, dusting, doorknob polishing, etc. After the initial 30 days, residents are then assigned to one of the regular work details. There is a kitchen crew responsible for preparing and serving the meals. They are overseen by a staff member hired as chef to do the meal planning, ordering of supplies, and purchasing, but all the food prep and cooking is done by the residents themselves. Accordingly, the tastiness and edibility of the food varies month to month depending on the how well the Kitchen Team works together and the familiarity of its members with actual kitchen work.
There is a separate crew responsible for doing the dishes and pots and pans from every meal. Many consider the dish-washing crew to be the worst job at The Rehab: there are three meals that must be cleaned up, the work is dirty and wet, the deep sink room is hot and uncomfortable, and the work is done immediately after meals when everyone wants to go outside and have a cigarette. Just like in so many “normal” households, the kitchen and dish-washing room seems to be the place where all the interpersonal aggravations and jealousies find expression. On most days, the dish-washing crew is also augmented by residents who are assigned “pots and pans” as a “clean-up” (a punishment for violation of community rules).
There is a laundry detail that is responsible for all laundry chores. For some reason, all bedding and towels are cleaned by an outside business. Which probably means that somewhere in the dim recesses of history, some resident found a way to get high from the cleaning of bed sheets and towels. There is a supply team responsible for maintaining the inventory of all household supplies (cleaning supplies, soap, shampoo, toilet paper, brooms, scrub brushes, floor polish, buckets, etc). There is a maintenance team responsible for the upkeep of the buildings. They replace light bulbs, fix broken windows, unplug stopped toilets, move furniture, fix broken furniture, and other light repair tasks. Any resident who possesses a valid driver's license without outstanding warrants is given the job of driving the big ReHab-owned 12 person passenger vans that take residents to and from dental and doctors appointments, court hearings, visits to the social services offices, or any other necessary trips. Being a driver is generally considered the best job at The Rehab; being a driver means you get to regularly leave the grounds of The Rehab and all the imposed rules and order. Consequently, drivers are also more likely than other so be involved in serious violations of the community rules, such as getting high.
Residents who have been in treatment for a while will be given jobs supervising the newer community members. These residents are called either “Chiefs” or “Coordinators” These job functions give the older residents a measure of authority and responsibility over other residents, and also brings the resident into closer contact with the staff. Consequently, the jobs of Chiefs and Coordinators are both prized and feared: prized for the extra privileges allowed and feared because of the additional obligations that come with the job, including getting yelled at by the director of The Rehab when they screw something up, or get “shot down” (forced retirement to a lower job position).
So the job functions of the residents are generally menial and boring, but not difficult or dangerous. Around noon, lunch is served and everyone takes a break from the jobs. At 1:00 will either be a seminar lead by one of the counselors, or various group counseling sessions will be held. By mid-afternoon, the seminar or counseling sessions are over and residents return to their various jobs.
As boring and menial as their jobs are, most residents would prefer to go about their job functions instead of attending the seminars and counseling sessions; the seminars are too often simply a long harangue by the unimaginative staff about why the residents are forever screwing up, and the group counseling sessions typically differ only in that the other residents will offer their own take on each others' faults. Hence attendance at seminars and counseling sessions is mandatory. As a staff member, I am constantly being asked if so and so can skip today's seminar because “we'll never get all that laundry done”. I would like to separate the wheat from the chaff, so I'll go with the resident to look at the size of the pile of unwashed clothes, try and figure out how many loads remain to be done, and ask the resident why they have not complained to the Coordinator about their team-mates doing so little work during the morning. My own supervisor tells me that the reason the residents so often approach me with their questions is that I have not yet learned to say “No” quickly and often enough. In this he is correct, I still want too much to be liked.
Around 5 pm, dinner is served. After dinner, there will either be another seminar lead by the staff, more group counseling sessions (typically, group session in the evening will be “peer counseling”, meaning the older more experienced residents will run the counseling sessions without staff in attendance), or the local AA and/or NA group will run an AA style meeting. Again, attendance is mandatory for all meetings.
Around 9 pm, the staff is working to get the business for the day finished up and send everyone off to bed. Before that can happen, all rule violations that are logged “on the books” must be dealt with, and residents who take medications have to be given their pills. The kitchen team will serve a snack around 9 pm, and the staff person will hold one more “house meeting” with all residents to offer words of encouragement, warning, criticism, wisdom, recognition for special achievements, and to orient the residents to any special events occurring the next day. After that, the business of the day is finished and the residents are allowed to go to their dorms.
Two residents are chosen to be “night managers”: they stay up all night to man the telephone and prowl the dorms and grounds to watch for fires, problems, and any unauthorized resident activities. As a staff member, my shift is supposed to end at 11 pm when the night staff shows up. For most of my time working at The Rehab, the night staff person was someone who appeared to me to be an active alcoholic, and as often as not, the night person would call me around 11 pm to tell me they couldn't make it into work for some reason or other. I could get fired for abandoning the residents, so if the night person isn't coming in, I'm supposed to stay on until the morning. Cursing my fate, I grab a blanket and a pillow out of the supply closet and bunk down on one of the couches in the lounge area. The residents are friendly and welcoming; you're one of us now, they say. No one truely wants to be here, it's something we all put up with. And tonight, at the ReHab, we really are all in it together.