Thinking of Working at a Rehab Center? What to Expect

Addiction is among the most common mental health diagnoses, with estimates of 12 month addiction prevalence ranging from 15% to 61%. A 2011 analysis estimates that nearly half of all Americans experience some symptoms of an addiction within a 12 month period. More than 70,200 Americans died from drug overdoses in 2017. Most of those deaths were due to opioids such as heroin and prescription painkillers.

Rehab centers are an immersive and potentially life-changing treatment option for people struggling with addiction. Clinicians and other staff considering working in rehab face a range of challenges, but also have the opportunity to change—and even save—lives. In rehab, people work steadily to get sober, repair broken relationships, and build lives of purpose and meaning.

A variety of mental health professionals, including therapists, psychologists, psychiatrists, and social workers, may pursue careers in rehab. Some rehab facilities also employ lay peer counselors, addiction coaches, life coaches, or certified peer specialists. Addiction is a complex diagnosis, with many potential pathways to recovery, so there’s a potential role for virtually every mental health professional in rehab.

How Is Working in Rehab Different?

People in rehab face many of the same struggles as those in outpatient treatment—family difficulties, impulse control, anger management, self-esteem, body image issues, career frustrations, and more. They may have a range of diagnoses or no diagnosis at all.

What makes rehab different is that people in rehab have all reached a crisis point in their lives.

What makes rehab different is that people in rehab have all reached a crisis point in their lives. Many choose to go to rehab after a catastrophic loss, such as the end of a relationship or job loss. Rehab clients may also struggle with the physiological realities of withdrawal and cravings. This means that the average rehab client may:

• Struggle more with physical discomfort due to withdrawal
• Be adapting to a way of thinking and existing that is totally unfamiliar
• Not know what the future holds or feel much control over their fate
• Struggle with extreme emotions due to a recent crisis and the challenges of reality
• Need support distracting themselves from cravings
• Need psychoeducation about the science and psychology of withdrawal. Admonitions that the cravings will always be there are not helpful.
• Experience periods of suicidal ideation
• Not have the family support they need
• Be radically altering their life path. They may need help deciding what comes next, referral to community resources, and assistance identifying their unique skills and talents.

What Are the Challenges of Working in a Treatment Center?

Rehab, like private practice, presents numerous challenges—transference, separating oneself from a client’s needs, vicarious trauma, feelings of inadequacy, and the difficulties inherent in supporting people through life’s immense challenges.

Working in a rehab facility comes with additional challenges. People in rehab are, almost by definition, often not thinking clearly. That’s because withdrawal alters brain function and causes physical discomfort. They may be more impulsive, more frustrated, and feel more desperate to get better. Even clients who form strong relationships with their therapists may blame or lash out at them.

Some clients feel so overwhelmed by withdrawal that they want to give up. Helping a client see the value of treatment and see a path to a better life is one of the biggest challenges of working in rehab. Clinicians must develop a close and trusting relationship with each client. This relationship offers insight into the unique motivators that can help each client stick with treatment.

Helping a client see the value of treatment and see a path to a better life is one of the biggest challenges of working in rehab.

Depending upon where you work, you may encounter clients who are not voluntarily in treatment. They will need additional support to see the value in treatment and build a path to sober living.

Working in rehab may also involve supporting clients as they develop life skills, including managing serious challenges such as massive debt, job loss, divorce, child custody disputes, and other issues. Therapists should not advise clients about topics they know little about. Instead, they should offer emotional support and a sympathetic ear. In many cases, rehab facilities can refer clients to additional resources, such as attorneys and financial advisers, when they need them. Take advantage of these resources so you can better support your clients.

Are There Any Risks Involved With Working in a Rehab?

The main risks of working in a rehab center include:

• Vicarious trauma due to exposure to clients’ traumatic experiences
• Burnout and exhaustion
• Feelings of inadequacy and frustration when a clinician cannot help a client
• Uncertainty and anxiety when a client leaves treatment

There is also a very small risk of being harmed by clients. People in rehab are facing immense pressure. Some may be unstable or have poor impulse control. In rare cases, this may cause a client to:

• Verbally abuse or harass a therapist
• Stalk a therapist in treatment or after they leave treatment
• Attempt to harm a therapist’s reputation by filing licensing board complaints or leaving negative online reviews
• Assault or attempt to assault a therapist

Before taking a job at a rehab center, therapists should ask questions about:

• How the facility keeps workers safe. Is there security? An emergency panic button?
• Whether the facility screens out people with a history of violence or enacts other precautions when a person with a history of violence is admitted
• How the rehab facility supports the mental health of clinicians
• Work-life balance. Is there paid time off? An employee support program?
• Mentorship and support from more experienced clinicians
• How long the average employee stays with the company
• Whether there are opportunities for career advancement

Why Work in a Treatment Facility?

Addictions are a leading cause of death among healthy young people. Substance abuse destroys families, erodes communities, and undermines public health. Joining the fight against substance abuse can save lives and even reduce health care spending. People with addictions can be functional and happy members of their community. There’s no need for addiction to destroy a person’s life. Proper treatment can help a person restore their family, live up to their potential, and give back to their community.

Working at a drug rehab center can be a rewarding career that opens doors to other opportunities. Some clinicians eventually become administrators, while others publish research based on their work or go on to teach at colleges and universities. For early-career professionals, rehab offers access to clients with a wide variety of needs and challenges. This breadth and depth of experience can be difficult to obtain in private practice.

The work can also be emotionally demanding, and not all clients thrive or even survive. Mental health professionals should practice self-care, seek support from loved ones, and consider attending therapy to cope with the ups and downs of life as a rehab worker.

References:

1. Overdose death rates. (2019). Retrieved from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
2. Sussman, S., Lisha, N., & Griffiths, M. (2010, September 27). Prevalence of the addictions: A problem of the majority or the minority? Evaluation & the Health Professions, 34(1), 3-56. doi: 10.1177/0163278710380124

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