Destination treatment trappings. Why is treatment more effective close to home?

Destination treatment centers are in large part very similar to destination weddings. They are often located in very desirable areas and offer many attractive amenities that are not necessarily connected to therapy or the treatment process. If you have ever received care at one of these centers and felt appreciably better by discharge only to return home and find yourself struggling with the same old issues, you are not alone. For many, this experience is similar to returning to Chicago in the middle of Winter from a fabulous vacation with family. Reality comes crashing down even as you are still taxing on the runway. The phone explodes with hundreds of emails that suddenly require immediate attention.

Often people are lured to destination centers simply by the thought of getting away from home and perhaps even using insurance benefits to take a type of vacation.  Certain programs capitalize on this temptation.  Regrettably, what is missed in many of these critical decisions is that home, with all its stress and pressures, is still going to be there when treatment is concluded. The truth is, care that is close to home is often the best way to ensure a long-term recovery trajectory. 

One of the few benefits of not traveling this Holiday season is that I am not experiencing the typical post-holiday vacation depression.    As part of our standard holiday festivities, my family usually travels out of town the last week of December through the first of the New Year.  As such, I have been blessed to spend many holiday weeks in toasty climates with lots of coconut trees, swimming pools, warm winds and blue ocean.  Of course, the very best aspect of the holiday travel is having consolidated and undistracted time with loved ones.  In today’s hectic world of jobs and children and all sorts of other distractions and responsibilities, we never get to see enough of one another.  Going away together has always been a little slice of heaven, reminding me of the days when I was a child and we spent time at the family summer home. In those days, I felt safe and life seemed to be manageable. 

Getting away from daily reality with family, possibly in another country, staying in a lovely hotel on the beach can be such an extraordinary escape.  Having the grandparents around to help with the little ones  and lounging around a pool,  reading a  novel or reminiscing about old times, is idyllic.  Having dinner together every night for a full week and watching dad or grandpa grab the bill the second it arrives on the table reminds us of when we were young children.  Time away from the rat race of life, gives us the opportunity to reflect, recharge and reset.  Formulating New Year’s resolutions while relaxing on the beach, listening to the sound of waves crashing and young children laughing, creates an environment where resolutions truly seem attainable.  Being around family gives us a sense of strength, invincibility, and hope that we don’t always have when home on our own.  On so many levels, these holiday times are genuinely special.

The depression referred to above would generally start to set in one or two nights before the vacation ended.  Thinking about returning to freezing weather in the “windy city” on January second or third with a full winter ahead and little to look forward to until the spring and summer months was difficult. The sense of depression would be fully realized during the descent into O’Hare airport.  Once the jet door  opened and that frigid air spread through the entire airplane, the anxiety of returning to a dark house and climbing back onto the chaotic hamster wheel of life the following day set in. Trying to conjure any of the New Year’s resolutions I had made a few nights earlier under the stars, was nearly impossible.

The warm blanket that I feel wrapped around snugly when on these trips with my family is very similar to how I felt when I checked into and spent four months at the Michael Reese Hospital inpatient unit.  I was 16 and struggling with a nasty bout of anorexia.  I felt taken care of and safe from the world’s temptations and pitfalls. I was surrounded by others in similar situations and whose job it was to help me. 

I experienced something similar when I went to what was then the Betty Ford Treatment Center in Palm Springs.  My father was in treatment for alcoholism and drug addiction. I attended family week with my step -mother, participated in groups and emotionally connected with my dad for the first time in years. I stayed at a hotel close by with views of the mountains and the desert. The week was intense and challenging in many ways, but it was indeed a special time, despite the fact that my dad relapsed a week later on the flight home.

When people return home from treatment located in vacation-settings such as Florida, California or Arizona, there is always the risk of hitting that proverbial wall when walking off the airplane in Chicago. Reorganizing, recharging, getting perspective, healing and planning for a healthy future when far away from home can be relatively easy.  Sustaining those gains when fully ensconced in the realities of home and daily life is the more challenging part.  Just as most of us in America cannot stay in vacation mode indefinitely, those in treatment must return home at some point—there is simply no other option. 

Leaving the safe environment of care without proper support systems in place is nearly always a recipe for a relapse.  This is why participating in treatment away from home is for many suboptimal.  These situations can’t include core components of therapy such as the inclusion of the family; they can’t provide patients with the opportunity to process their real-life experiences every day in treatment.

We see the consequences of this all the time at SunCloud Health.  The rate of discharging against medical advice (AMA) and the relapse rate for our patients is significantly higher for those who admit directly from an out-of-state residential level of care. Further, we see that this population makes less improvement when in treatment with us, as compared to our other patients. Additionally, we see the benefit of being able to meaningfully include the family in our patients treatment.  We get to support our patients in building a healthy recovery network outside of treatment which they will be able to maintain when they are done with treatment, many times through local support groups. Lastly, we are able to essentially merge in to our patients lives while they are in treatment with us meaning they continue to be exposed to home environment triggers, relationships and memories which likely play a major role in their experience and which will still be around even if they go away for 30 days.

All of this is not to say there are no excellent, high-quality treatment facilities in states other than Illinois, because certainly, there are.  And many are not only clinically qualified, but could be easily mistaken for a luxury hotel, if one knew no better. No doubt there is a solid place for these facilities, especially for those who live close by or who might require some extra motivation to seek help. Yet most of the time, we believe the closer the treatment, the better. 

This is precisely why we are currently building our 21-bed residential facility in a suburb of Chicago. Not only due to the clinical advantages of staying close to home, but we want to spare those in early recovery from experiencing that mind-numbing blast of frigid air when returning home from a temperate climate.