Detox, rehab, sober living home, halfway house, group home...what's the difference, what's it all mean?
"Detox" (detoxification, literally a "de-poisoning") is a three to five day program, usually medically supervised, to get someone off of the immediate physical addiction of the drug, or rather, at least through the worst part of the withdrawals from the drug. Or in some cases, the alcohol. I've heard of classy programs involving doctors and nurses in nice one person suites...and then there's Cousin Jim's basement and he's not letting you out till you've stopped throwing up.
If done medically, there are usually some medicines involved to ease the transition, like sleep aids to help you sleep through the worst, or some withdrawal pain relievers like Suboxone or such. These can be stand alone programs, at a hospital or clinic, or they can be the start of a larger rehabilitative program.
"Rehab" (rehabilitation, literally a "making yourself whole again") is a 28 day to 90 day program where you are given a safe, clean and sober environment in which all your needs are met to varying degrees of luxury. While in it, you attend everything from group therapy sessions to AA meetings to even religious services, according to which rehab you are in.
Cost varies widely from the very expensive ritzy ones with mints on pillows such as the movie stars go to, to free ones such as a Salvation Army in which they will have you work - often times long hours - in exchange for a cot and meals.
As mentioned, some rehabs include a detox. Detox must always come first. Because if you're stopping, then it will come first whether you are technically in one or not!
"Sober Living homes" are a legal construct created in the 1970s so that a facility could cater to men and women coming out of a rehab and give them a place to get back on their feet. And, at the same time, retain the right to kick them out over any rule breaking or relapse, while forgoing the usual landlord/tenant laws that involve "notice".
They are chiefly distinct in that they are not only under a special section of Federal law, but have various restrictive rules pertaining to what substances and activities are forbade, and what meetings or such are required. Such rules can vary quite wildly from house to house, but at the least involve no drugs or alcohol.
Other than that, you may find almost any kind, from secular to religious, LBGTQ or any, all men or all women, or mixed.
It is hoped that besides having an opportunity to get a job, save money and get a car and place to stay of their own, that they will also be learning to build up a "habit of sobriety" that will serve them well when they are on their own.
"Halfway houses" are primarily places where those who have been released early from prison (paroled) stay while transitioning into society.
This may be mandatory, and they may be required to spend a given amount of time, from a few weeks to the rest of their original sentence there. Or it may be a place that they need only stay in long enough to find their own place, and then, with the permission of their PO (Parole Officer) move to that.
The rules there are usually at least as restrictive as Sober Living homes, but the focus is far more on them just staying legal and in keeping with their conditions as opposed to learning about maintaining sobriety. In some cases, in fact, the simple act of having legal alcoholic beverages would not be forbade.
"Group homes" are a more broad categorization that among other types, includes halfway houses and sober living homes. They are any home in which you have a variety of people who are not all related, but brought together by some commonality of purpose. They include homes that are used as shelters for the homeless. Or for runaways. Or battered women. Or those in the LGBTQ community. Or undocumented immigrants. Or almost any other type of group you can think of, in which a shelter is being provided, but not in an institutional fashion of a 100 bed dorm room but instead an otherwise normal house converted to taking in as many as possible in as pleasant a fashion as possible.
They may have one person per room - or even four per room in two bunk beds. It depends on demand and upon local ordinances.
There are different laws for each of these, oddly enough, and the same law that would let me, for instance, ask a drunk at the sober living home to leave at once is not the same law that lets someone running a rehab have a disruptive person leave, or having someone violating parole leave a halfway house, or having a runaway pilfering leave a group home.
And NONE of these are of a necessity "communes", though a commune could decide to cater to any of these groups - save halfway houses which have state mandated rules. A "commune", while outside the scope of this article is simply a group of people of some commonality of interest that has decided to pool their labor, capital and resources to make a go at living in the same home, usually a large structure, but sometimes several structures on one piece of land. The hallmark of them is that they are usually run upon principles usually described as "Marxian", though many religious communes refer to it as "the law of consecration".
I am aware of no type of house - at least successful ones - that do not have a "decider". Or leader. Or arbiter. Or program supervisor. Or guru. Or State worker. Whatever the title, there is always one who decides who stays and who goes. Sometimes houses - particularly communes, but many sober living homes - fall prey to the democratic fallacy and usually explode or fizzle.
The democratic fallacy is that somehow all this stuff can be voted on. In the case of sober living homes, that comes up more often because it pertains to some of the laws that cover them. A subset of sober living homes are democratically run, and while some succeed, some of them sink so far that their charters are revoked. Or they go bankrupt. And the ones that succeed? It's usually due to there being a guy who can over-ride the local house vote and threaten to yank their charter.
In communes, it fails when the non-workers out vote the workers. In sober living homes, the lax will out vote those trying to do better. In halfway houses, the State makes no pretense of democracy, you obey your conditions of parole or go back to prison. In group home "shelters", of any type, there's usually a supervisor of some title or the other to enforce the rules, rules in theory agreed to by your presence there. Voting, in the case of all well-run houses, is only for inconsequential matters.
Back to the distinctions between detox, rehab and sober living homes - what's that mean for our sober living home?
Well, we're not a detox or rehab, for starters. We usually receive guests from the ARC - the Adult Rehabilitative Center of the Salvation Army. They'll have any where from 30 to 90 days of sobriety, and will then be pushed out the door and told, "Succeed!" Not being able to instantly get a job, car and place, they often times fail. Having burnt out their family and friends before recovery, and having no place to go.
Our sober living home - and other sober living homes like Oxford House - pick up the slack and aid people in transitioning from that rehab to independence. But we don't detox anyone, we have no medical staff, no counseling. We don't rehab anyone, other than in the sense that there are AA meetings available within a block and a half of the home and "free rides to church"! There is employment advice, and actually all manner of advice available, and even some of those who have been there longer have aided those who only just arrived, but at this point, some "self-motivating" is now expected.
There are idiosyncracies due to that. Sometimes a beer has got a person kicked out - if it's a repeated offense or if there's a bunch of other stuff attendant to it, or if they seem recalcitrant. Other times even more than a beer has still had us work with a person who may yet be helped. One guest is here on his third try (and as of writing this, was just asked to leave this morning). It is always case by case. But it always surprises some, who apparently reading of such homes somehow are picturing bars and guards and cups to collect random samples of urine to insure compliance.
Most of the time, a relapser is NOT caught by a urine test - though we have used those before, and have some tests available. Most of the time they are caught by - well, by it being obvious. It's a little known fact, but a cop doesn't need a drug or alcohol test to arrest you for a DUI - and a sober living home does not need a test to kick some one out for drinking or drugging. And let me tell you, that was one wise Federal law, or everyone would claim, "Yeah, that test will say I took opiates, but it was just this pill my doctor gave me, so it doesn't mean anything."
We don't need the test, and so don't need to worry about which opiates - or which methamphetamines or which coca plants may make a test positive! The behavior can be sufficient. Peace must be maintained. For the sake of those who are serious about sobriety, if nothing else.
This morning, for instance, a conversation took place like this:
Me: You're going to have to find another place to stay today.
Relapser: Why?
Me: Because you've been using heroin.
Relapser: No, I haven't! You can drop me, I'm clean!
("Drop" - urine test)
Me: If you bring me a clean test result from a lab, I'll not only let you stay, but give you a month for free.
Relapser: Well, I can't afford a lab test right now.
Me: You were paid $350 yesterday from your roofing job.
Relapser: But my phone bill...
Me: That's a mighty expensive phone. But okay, have your PO call me about sending me a copy of the drug test you said he gave you last week.
Relapser: It was actually more than a week ago, and I'm not sure if I can reach him.
Me: Okay, I've one $29 drug test left. If you'll pledge your X-box for collateral, I'll give you that test. If it's negative, I'll give you a free month here. If it's positive, you go, and I keep your X-box.
Relapser: I'm not putting up my X-box, who ever heard of that?
Me: Who ever heard of collateral? Plenty, I'm guessing. And as you're clean, why worry? But if you won't take a drug test, then I guess you'll have to go.
Relapser: This isn't fair!
Me: Why get angry? You say you're clean - take any of the tests, throw the clean results in my face and have a month stay on me. I'd be happy to be wrong. You act like I'm not offering enough! You need two months free?
Relapser: No, you just don't want me here. And if you don't, you should just say so.
Me: Ever hear of that thing where "admitting you have a problem is the first step"?
Relapser: I don't have anything to admit.
Me: Then take the drug test I have here.
Relapser: I would, but come to think of it, I've been on Suboxone, and that will probably make it test positive.
Me: That's for getting over heroin withdrawal, why would you need that?
And on and on. He had, of course, an answer for everything. Like why it made perfect sense to be on Suboxone though he had allegedly not done heroin for months.
The funny thing about sober living homes is that all those in them were at one point otherwise responsible adults. And having achieved a remarkable accomplishment - their sobriety - they figure they are ready to run their own life and forge their own destiny and don't need any real rules. Or at least not all of them! Thus an addict will think that a "few beers" is okay, as he "never" had trouble with alcohol, "just" crack! Or some former alcoholic will figure that he's got his drinking down to "social" levels and doesn't need any more aid.
Some always think marijuana is okay, you know, because it's legal in Colorado, or "non-addictive" or medicinal. It's not okay. Not in any sober living house I'll ever run, even if it's decriminalized Federally!
And some, like the person asked to leave today, will think that Suboxone or methadone or various other pain-killers, opioids, etc., are perfectly okay. Though in this man's case, while he was no doubt taking all manner of pharmaceuticals, he was actually shooting up, too. I've noticed that about heroin users. Any opioid will do in a pinch. And any pain killer in a pinch of the pinch. When you're addicted to heroin, its not about the high, because there is no more high. It's about not getting sick. "Sick" being what they call withdrawals.
Relapser: Do you see any track marks on me? You can look!
Me: I will never know you well enough to look all the places I know those can be!
The young man had plenty of tattoos, and could skin pop it any where there, or under his hair even, or between his toes, or various other places far more private. Places I'm not paid enough to look at, since, oh yeah, I'm not paid at all! He was finally packed up, and I was ready to take him any where he wanted to go.
Relapser: Let's go to Monster Pawn.
Me: Why not leave your X-box and everything with me, let me drop you off at ARC, and after a 90-day rehab program, I'll take you back with a whole month for free?
Relapser: Because I'm not going to lie and tell them I'm an addict when I'm not!
Me: Ever wonder why everyone lies about you and says you use?
Relapser: I don't know why others have it in for me. But *blank* and *blank* are using, and *blanks* been drinking!
Me: Do you need me to bring another bus by, so you can throw some more of your friends under it?
As I've mentioned in past articles, almost all guests made to leave have much to say about the sins and failings of others. It's to deflect from themselves being punished. Later, after we went to Monster Pawn, we went down town to drop another guest off at the library, so he could get a library card. I told that guest I'd be back in a few minutes. Then driving off, I asked the relapser where he wished to be dropped off. Though I kind of already knew.
Relapser: County Market on Carpenter.
Me: Isn't that the County Market right across the street from the heroin dealer you're facebook friends with?
Relapser: No, I just want to go to County Market to get something to eat!
Me: I could take you to St. John's Breadline, they're serving now, and it's free.
Relapser: No, County Market has good food!
I was tempted to say, "Is that what you kids are calling it these days?", but refrained. I dropped him off in the parking lot of County Market. I waited for him to go around my van and in the door. Instead, he started heading over to the street. Where a certain person lived just across that street.
I shook my head and went off to the library to pick up the guest who's doing well. One wins some, and one loses more. But the guest I was picking up had no job and was estranged from his family July of last year, when I first met him.
Now, he's been with us almost a year, and will be leaving in a week or so. He has a full time job, and visits his family regularly. All is well with him. While many have come and gone since he first came here July 17th of 2015, he will be "graduating" very soon, that is to say, leaving on good terms, and with everything better that needs to be better.
And that's what it's all about, past the definitions, past the failures, past the lies and past the silliness. That of over two dozen aided, he will be the third to succeed.
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