# Drug Rehab Centers Rules & Policy?



## Click For Horror (Jan 9, 2014)

Happy Thursday, Writers!
Do you have personal experience or knowledge of drug and alcohol rehabilitation centers' rules and policy? My novel is a suspenseful horror thriller set in the American southwest, dealing with a group of recovering drug and alcohol addicts on a group outing from hell. In attempts to ensure my research is accurate and airtight, I need some more information about the type of regulations in such establishments. 

_*If you have any valuable relevant info about drug and alcohol rehab centers' rules and policy, or could point me to such a resource, please respond (or message me) and I will be muy grateful*_ :joyous: _*--Zeke*_


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## tabasco5 (Jan 9, 2014)

I would think they would all have similar but slightly different policies based on the center's environment, staff, mission, location, budget, facilities, etc.  I would say to read around the websites of actual centers and come up with one that your story needs, or just base yours off an actual center.


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## Nickleby (Jan 9, 2014)

Kind of a vague question. Do you mean the policies about who they will admit, which impacts the people who could go on this "group outing from hell"? the policies about taking such a trip? the policies about what they can wear, eat, do?

For starters, these people will have zero access to anything that might include a narcotic, including mouthwash. No cell phones. No shoes with laces. No belts. Any items brought to them by outsiders will be examined. I'd be very surprised if they could leave the facility for any reason.


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## ppsage (Jan 9, 2014)

First place, this is the sort of question which will probably elicit much better information as a draft posted in a creative forum, where the exact situation is detailed. You're not giving a lot to go on, in a topic which can be pretty broad. 



> a group of recovering drug and alcohol addicts on a group outing


So obviously your dudes are all detoxed. They're past the strap em down and scream out the poison stage. If they're a tiny and rich minority, they might still be in some kind of residence program. More likely they're outpatients. For all of them there will be mandatory counselling, probably in group. Anger management's real popular right now. Social interaction, self worth, trust building, all those other twelve step things. A main reason for outings is group therapy. Usually the idea is to build community in the group, so people will know how to do that. Testing will be mandatory except usually for alcohol and nicotine. That's probably about it for outpatients, unless there are criminal justice, parole type things, which are beyond the drug program scope. If they're inpatients, and not criminal inmates, they will still have a lot of freedom, but a curfew probably and house rules stuff to get along. A really tight place might restrict communications some, but a lot of times reintegration is a goal. These would probably be in effect on all outings too, inpatient or not, but testing maybe not. It might be useful to keep in mind that all such programs can usually do is kick you out, if you break one of their rules, which is failure for them. Sometimes there's outside sanctions to getting kicked out, by family or court or employment.


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## dale (Jan 9, 2014)

the rules may differ from institution to institution.....but the rules are sobriety, of course. a structured physical environment, as far as
bedtimes and rec-times, although these are usually set up on a point system, where the more you progress within the program, the 
more privileges you have. a big emphasis on group fellowship is incorporated in the treatment. a big emphasis on psychological openness. 
you could probably google one of the major rehab centers in your area and get a list of the actual listed rules, though.


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## Blade (Jan 9, 2014)

fenbields5 said:


> I would think they would all have similar but slightly different policies based on the center's environment, staff, mission, location, budget, facilities, etc.  I would say to read around the websites of actual centers and come up with one that your story needs, or just base yours off an actual center.



If you are a stickler for accuracy picking a particular institution would be the safest bet. I think there is too much variety in centres available to simply make something up.




dale said:


> you could probably google one of the major rehab centers in your area and get a list of the actual listed rules, though.



Right. I know a guy who runs a local rehab facility that is simply a converted house with four or five residents. Obviously you can go into huge variations from there.


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## Click For Horror (Jan 9, 2014)

ppsage said:


> First place, this is the sort of question which will probably elicit much better information as a draft posted in a creative forum, where the exact situation is detailed. You're not giving a lot to go on, in a topic which can be pretty broad.
> 
> So obviously your dudes are all detoxed. They're past the strap em down and scream out the poison stage. If they're a tiny and rich minority, they might still be in some kind of residence program. More likely they're outpatients. For all of them there will be mandatory counselling, probably in group. Anger management's real popular right now. Social interaction, self worth, trust building, all those other twelve step things. A main reason for outings is group therapy. Usually the idea is to build community in the group, so people will know how to do that. Testing will be mandatory except usually for alcohol and nicotine. That's probably about it for outpatients, unless there are criminal justice, parole type things, which are beyond the drug program scope. If they're inpatients, and not criminal inmates, they will still have a lot of freedom, but a curfew probably and house rules stuff to get along. A really tight place might restrict communications some, but a lot of times reintegration is a goal. These would probably be in effect on all outings too, inpatient or not, but testing maybe not. It might be useful to keep in mind that all such programs can usually do is kick you out, if you break one of their rules, which is failure for them. Sometimes there's outside sanctions to getting kicked out, by family or court or employment.



Thank you ppsage, the tip about posting a draft in a creative forum is very appreciated and I will keep that in mind for relevant future postings. You have also provided a good deal of detail here that is a useful starting point for my more general questions. *To give an example of exactly what type of information I am looking for (the tougher, more specific questions),* I would like to know if a person can be prescribed anti-depressants or anti-anxiety medications in therapy. I would also like to know, if a person is taking anti-depressants or anti-anxiety medications pre-therapy, can he / she continue once therapy commences? Also, what (specific) different types of programs / centers exist, as classified by inpatient or outpatient, court-mandated, cost-effectiveness, etc? *Hope that clarifies a bit -- would love a response to any of these questions.*


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## Click For Horror (Jan 9, 2014)

Blade said:


> If you are a stickler for accuracy picking a particular institution would be the safest bet. I think there is too much variety in centres available to simply make something up.
> 
> 
> 
> ...



Hi Blade, thanks for the response! Do you think that for my genre being a "stickler for accuracy" is a necessity, or is a little creative flexibility and camp acceptable?...I have been wrestling with this idea.
Also, without intentions to pester or ask rude, intrusive questions, would you be able to inbox me an email address for the guy who runs the local rehab facility so I can ask him a few general questions about his line of work?
Thanks! --Zeke


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## Morkonan (Jan 10, 2014)

Click For Horror said:


> Happy Thursday, Writers!
> Do you have personal experience or knowledge of drug and alcohol rehabilitation centers' rules and policy? My novel is a suspenseful horror thriller set in the American southwest, dealing with a group of recovering drug and alcohol addicts on a group outing from hell. In attempts to ensure my research is accurate and airtight, I need some more information about the type of regulations in such establishments.
> 
> _*If you have any valuable relevant info about drug and alcohol rehab centers' rules and policy, or could point me to such a resource, please respond (or message me) and I will be muy grateful*_ :joyous: _*--Zeke*_



I worked in a mental hospital, during my college days. We didn't deal directly with such things, but we did have several units that worked with such patients. We were a state-run facility and, basically, the only way anyone was admitted and treated was by a judge's order or if they had no financial means to pay for treatment. (I worked directly with patients with mental illnesses that were either too violent, too unstable or had yet to be assessed. I also worked with patients in less secure units.)

From my experience in such a facility, I can give you a few pointers if you're looking at a State Run facility:

*1) "Outings"* typically involved the patients on completely supervised day-trips to State Owned land, typically a park, that was specifically set aside for that purpose. (Usually) For instance, both drug rehab patients and criminal patients being evaluated (Those claiming mental defect or criminal insanity) used the same facilities, but at separate times. The one that we took patients from my unit to was by a lake and had several activity areas which included volleyball, arts and crafts and even "teepee building." (The patients from the criminal unit had built that one.)

There is little in the way of "security" precautions for this particular area. There is no fence that surrounds it. Guards (or people like me) are expected to watch patients and, if one wanders off or runs, chase them down. There is to be no opportunity for one of them to "run off", in other words. Staff are supposed to "see all" at all times... They don't, but that's another story.

(If you're translating this to a private facility, then it would be much the same, I would think.)

2) Patients are counted, everywhere. There is no transfer point that doesn't involve counting patients and ensuring that you haven't lost one or one hasn't wandered off. 

(A private facility would do the same.)

*3) Patients are transported *in vans or buses that load within the secure areas of the home facility and then disembark passengers at the destination. (Two Counting Points, by the way) Patients can not access Emergency Exits within the bus, either. Similar to a Prison Bus, in that regard.) Staff is expected to be dedicated to the patient's safety in all things.

*4) Patients are "searched"* before they leave the recreation area. For mental patients, this isn't really a huge issue. Basically, a visual search is all that is necessary, maybe a small pat-down, just to be sure they're not carrying a sharpened stick. For criminal patients, though, it may be more severe. But, I wouldn't expect anything like a strip search. Most patients in the "criminal" wing are either axe-murderers who never get to go anywhere, much, or patients currently involved in court trials or who are trying to avoid harsh prison sentences if they can, instead, be admitted to a psych ward. (Most of them aren't suffering from a mental disorder and guards generally know who is truly a problem case.)

(This would probably be similar to a private care sponsored trip.)

5) A few things about *how patients live in a State Facility *that may be of interest or useful for you. A Private, Voluntary, Facility may be different in many respects that involve personal "Freedoms." -

Patients are entitled to personal belongings, but only a few things. A few clothes, some personal care items (NO RAZORS!) like toothpaste and maybe a toothbrush, and one or two other items, like a book, notebook or the like. That's it. There's simply no room and not enough resources to track many personal effects. Any more personal effects than that are housed in a warehouse and kept under the patient's name, for when they're discharged or they need to access them. ie: Patients can request to obtain specific personal effects in storage, but the transaction is handled by staff.

Patients live in a dormitory environment. There are usually anywhere from two to six beds per room, each bed with space reserved in a closet for clothes and the like. There is a communal bathroom with several stalls, sinks and a couple of shower stalls. Each "Unit" houses around twenty-five patients at full capacity, in the facility that I worked in, IIRC. However, that was a "closed" unit and "open units", for stabilized patients who are capable of doing things like walking to the cantina without trying to "escape" or are there voluntarily might house 35 or more.

In high security "closed" units there are at least two "Seclusion" rooms where patients who are violent can be put for a limited time. (Generally, no more than several hours, until the unit physician can sign off on them or determines they should stay longer.) The doors on these rooms lock, unlike other bedrooms in the unit, and the beds are set up for leather restraints, which are almost always required. Every fifteen minutes, one of the staff physically views the patient to be sure they are not in any distress. If the patient has to use the bathroom, staff give them a bedpan. If they need something to drink, staff let them sip through a straw. Meals are not provided to the patient while in Seclusion unless it's a particularly dire situation. At all times a Restrained patient is kept under restraints. (Leather straps, locks, etc..)

Staff are trained on how to subdue patients without hurting them, how to protect themselves, physically, without hurting the patient, how to "talk down" patients that can be reasoned with and how to safely intervene between patients who are fighting/arguing amongst themselves. The training is effective and, generally, works well.

Patients are taken to three meals a day, served in a separate cafeteria environment from the living area. Patients in the "Closed" units are allowed outside to enjoy a fenced-in recreation and sitting area for one hour per day. Patients in an "Open" unit can move around the general, unrestricted, grounds of the entire facility, at will, and can go to recreation areas, like the gym, or to the cantina, which serves light food and beverages, during operating hours. (However, at no time can patients leave the grounds of the facility. 

*6) Outpatient Services*

In my unit, we didn't have "outpatients." But, in the rehab center, they did have outpatients. I don't have intimate knowledge of their rules, but they were much the same as a parole-office - The whereabouts of patients were known at all times, within reason, and patients who either failed to show for a scheduled appointment or patients who did not willingly participate/obey during treatment sessions would be kicked out of the program and, thus, violate the order that sent them there, which would likely involve the police and a jail sentence. Outpatients would likely be on their own recognizance at all times and not under the supervision of a guardian, but some might be if they had other problems. (Mental retardation, handicap, etc..) In these cases, guardians could be held partially, but not criminally, responsible for the patient's absence, but not responsible for their actions or participation in the programs.

On translating some general experiences to a private facility, if needed:

At no time can anyone give up their "Rights", regardless of any signed agreement. In other words, if a patient voluntarily admits themselves, they can voluntarily release themselves. Yes, they may have to abide by certain restrictions, like waiting a few minutes for the paperwork to be completed, but they can never, ever, be held entirely against their will without a court order signed by a judge. (In the U.S.) A private facility with voluntarily admitted patients can never violate a person's Rights, no matter what they may have signed and no matter what Rights that patient may wish to exercise.

(In the State-run facility that I worked, this was not the case. All patients had been placed their by their legal guardians or by court order. They had no ability to exercise any individual Rights that could put themselves at risk or could enable them to exit the facility on their own. However, the facility took great care in order to preserve their dignity and any Rights available to them that did not potentially place the patient at risk of injury.)

Staff at a private facility will be trained in various sorts of ways regarding patient interaction. That would likely include limited self-defense and "take down" measures to be used with patients who get violent. But, it's also likely that violent private patients will be evicted from the facility, no matter their reason for staying there. In the facility that I worked, we were surrounded by patients who would/could become violent. You grew eyes in the back of your head...

*FIRE! *- A word about fire.... In both sorts of facility, an outbreak of fire is a concern. That's because 

A) Lots of people are sometimes locked within an enclosed space and 

B) Patients with mental disorders or addictions sometimes like to start fires....

For instance, we had institutional cigarette lighters in my unit. They're wall units with a hot wire mesh that a patient could use to light a cigarette. (Back when smoking was allowed in these units.) Patients had to smoke their cigs in front of the nurse's station, in view of staff. They couldn't keep lighters, for obvious reasons, and their cigs were kept at the nurse's station. (To prevent them from being stolen.) In this era, the State actually provided mental patients with cigarettes, since most were indigent. That was much better than having a bunch of nicotine addicts with mental disorders from going berserk...

In a private facility, I would think the rules and lifestyle would be much the same regarding smoking. Smoking, in this age, would probably be prohibited within any internal space and there might be one small area, outside, where a patient could smoke, and it would have an institutional lighter mounted securely on a wall and powered by the same electrical system the facility used. Do not underestimate the need for patients with addictions or mental disorders to smoke, for those who do smoke. Just keep that in mind. There might be "smoke free" private facilities, but that is going to be known by the patient beforehand and smokers wouldn't willingly go to such a facility unless they also wanted to stop smoking.
*
Conclusion* - Just be advised that no citizen of the United States can willingly give up their Rights. If you have a private facility with voluntarily admitted patients, any of those patients can leave that facility at any time that they wish. None of their Rights can be violated or suppressed in any way. Any patient admitted to a private facility and who is supposedly under a "court order" is likely only "ordered" to seek treatment and not actually being unwillingly placed their by the State. If they're being court-ordered to be admitted to a drug/addiction treatment facility, it is either going to be a full-fledged facility, like the mental health one I worked at, or a private contractor.

*
For followup* - Almost all private drug and addiction rehab facilities will publish their full Patient rules and restrictions, as well as admission requirements, online. You may not have access to their internal procedures, but these sorts of things can give you a good idea of how they operate.


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## Click For Horror (Jan 11, 2014)

Morkonan said:


> I worked in a mental hospital, during my college days. We didn't deal directly with such things, but we did have several units that worked with such patients. We were a state-run facility and, basically, the only way anyone was admitted and treated was by a judge's order or if they had no financial means to pay for treatment. (I worked directly with patients with mental illnesses that were either too violent, too unstable or had yet to be assessed. I also worked with patients in less secure units.)
> 
> From my experience in such a facility, I can give you a few pointers if you're looking at a State Run facility:
> 
> ...



Morkonan, I can only express my gratitude for such a detailed, thoughtful response. It must have taken an extensive period of time to compose all that. I've only had the chance to skim your post as of yet, but again, thanks and I hope to return the favor someday. Below is a pasted response from an earlier post I made in this forum, dealing with my most specific questions linked to this topic. I apologize if any of my below questions have been addressed in your posting, but I will go back and read your post in its entirety now. Thanks again! --Zeke*
To give an example of exactly what type of information I am looking for (the tougher, more specific questions), I would like to know if a person can be prescribed anti-depressants or anti-anxiety medications in therapy. I would also like to know, if a person is taking anti-depressants or anti-anxiety medications pre-therapy, can he / she continue once therapy commences? Also, what (specific) different types of programs / centers exist, as classified by inpatient or outpatient, court-mandated, cost-effectiveness, etc?*


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## Morkonan (Jan 12, 2014)

Click For Horror said:


> ...Thanks again! --Zeke


*

*You're very welcome!*




			To give an example of exactly what type of information I am looking for (the tougher, more specific questions), I would like to know if a person can be prescribed anti-depressants or anti-anxiety medications in therapy.
		
Click to expand...


*Absolutely! Anti-depressant/anxiety medication is often paired with cognitive behavior therapy and other sorts of therapy options. It would generally be prescribed by the attending psychiatrist/physician or signed off on by the head of the department, who would also be a physician.



> I would also like to know, if a person is taking anti-depressants or anti-anxiety medications pre-therapy, can he / she continue once therapy commences?



As long as the attending/responsible physician signs off on it, sure. However, it's important to note that most insurance is only going to pay for medication dispensed by the treating facility (That includes Medicare/Medicaid). Any drugs prescribed and obtained outside of the facility would have to be covered by a separate drug plan or, if the patient couldn't pay, subsidized by medicaid in some cases, IIRC.
*



			Also, what (specific) different types of programs / centers exist, as classified by inpatient or outpatient, court-mandated, cost-effectiveness, etc?Ab
		
Click to expand...

*
A hard question and outside the scope of my knowledge. I can tell you that every state has a state-run mental health-care system. These facilities are specifically designed to diagnose, house and treat mental patients. Patients are often shuttled between facilities, depending upon what is called their "catchment area." (ie: Where it has been determined either their residence exists or their guardians live.)

Court mandated therapy is either of the criminal or civil sort. 

Criminally, a judge may sign a document that requires the patient to undergo review by mental health professionals. This is after the patient has been involved in a crime, disturbance or has otherwise come under the care of law-enforcement. (This is, by far, how most patients are admitted to State hospitals.) They are then transported to a suitable state-sanctioned/run facility and evaluated, usually within 1-3 days. However, if the patient doesn't get there until Friday afternoon, they can look forwards to five days of eval, since the docs aren't there on Saturday's and Sundays, aside from a skeleton crew of paper-pushers. 

Civilly, a relative (Sometimes two are required, State law differs), in concert with a judge, can demand that a person be admitted for diagnosis by the State. In this case, no criminal action by the patient need be necessary. This is simply a case of a relative, caregiver, guardian, etc, desiring that a person be admitted and diagnosed due to erratic behavior or the like. A Judge must hear the case and, usually, will sign off on forcing the person to be admitted if there is obvious evidence that there is a problem. Again, it takes about 1-3 days or so, depending upon when the patient is admitted.

Mental Health Patients are released on an Out Patient basis only if they are stabilized on their medications and can either be released on their own recognizance or under the supervision of a guardian. Mental Health Out-Patient treatment is notoriously... bad, in my opinion. Basically, they pat the person on the butt and send them home, with full knowledge that they will likely be back in ten days (Or whenever the weather turns bad) and with the knowledge that their "Guardian" will often steal their welfare/social-security check at the first opportunity and dump them out of the car as soon as it is cashed. (I know this because I have seen it happen.) However, that is not to say that all out-patient situations are the same and I am certainly a bit biased, since I dealt with situations in State facilities where the support system for the patient outside of the facility was usually absent or lacking. In private facilities, this would likely be reversed, with voluntarily admitted patients usually not having a recurrence as long as they were stabilized on their meds, had outside support, and visited their therapist on a scheduled basis.

Centers:
Local General Hospitals - They receive mental health and substance abuse patients, but they only act to stabilize and treat physical problems. They do not frequently do any sort of mental health or addiction "rehab." If this is ordered by a judge, they will coordinate with the State-run facility to transport the patient there, once they have been treated for any physical problems.

State Mental Health Hospitals - Generally, large facilities with many residents and patients, each covering a significant "catchment area." (This is the type of facility in which I worked.) There will be lifelong patients there, child patients, elderly and hospice (dying) patients and temporary patients, just waiting to be stabilized and released. In general, and IIRC, most states have separate facilities for the "Developmentally Disabled" and "Mentally Dysfunctional" patients. IOW, you would not typically find a person suffering from extreme Down's Syndrome in the same facility/unit as a person suffering from Schizophrenia. Patients are separated by age group, in the long-term care facilities, and by the severity of the problem and combative nature (For all patients). I worked in the primary "Closed Unit" for the facility, where we received extremely violent patients and patients who had not yet been stabilized on their medication or had yet to be treated/diagnosed. It was an interesting job, no doubt about it.

Private Care Facilities - It comes to mind that some patients in my State facility were sometimes transferred to a private care facility, depending upon the nature of their admission and that patient's (or family's) ability to finance private care (Or their insurance's ability). However, that was never for patients that had been "criminally" admitted unless the head of the Unit decided that it was best for their care and that they were no longer a danger to themselves or others. In general, our head of unit was a great guy and always served in the best interest of the patient. But, sometimes, his hands were tied.

Private Care Facilities do have residential and restricted areas. But, remember - No private care facility can take away a patient's Rights without a court order. For instance, a "Nursing Home" can do this if the patient is judged incompetent, but a "Retirement Home" can't do this if no such judgement has been rendered or order exists. For a Private Rehab Facility, this sort of order would stand as well - If the patient is not under the orders of a judge or judged incompetent, the treatment facility can not hold them against their will. I know I'm harping on that subject, a bit. But, that's only because it's one that is not generally fully understood and I don't want you to end up writing yourself into a logical corner. 

Private Care Facilities do have Out-Patient programs and many of them operate at this level. For instance, a State Approved DUI Clinic may have patients that go there on an out-patient basis under a judge's order. The same could be said for "Anger Management" clinics/programs and "Drug/Alcohol" rehab programs, all of which may have patients ordered to attend out-patient meetings by a judge. Typically, these are private contractors and are not a part of the State run health system. They would also admit voluntary patients, though that may differ between facilities.



For cost-effectiveness, you're going to have to look up some studies on mental health, typically conducted by Sociologists, Psychologists or Medical groups, in that order.


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## Darkhorse (Jan 13, 2014)

If you are visiting, I have found them quite slack. They request all the standard things: please don't bring any cigarettes, money, sharp objects, alcohol etc. into the facility. But they make no effort to search you or prevent you doing so.

Something that was interesting to me was: a patient seems to be able to do anything they like there as long as they don't sleep with another patient. They are really big on this for some reason and will ban the patient who initiated it.

Other than that, the atmosphere and routine of the place varies greatly depending on what type of facility it is.


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