“Coining In”

The use of ceremonies has been favored all across the country in marking the completion of treatment for patients. Patients are celebrated as they take these rites of passage in their steps toward lifelong recovery. These ceremonies, however, like the “Coining Out” ceremony that occurs at facilities throughout the nation, are more than just a rite of passage. They should be seen as a patient’s “coining in” to the beginning of their sustained recovery. We always want to keep in mind that addiction is not an acute disease, but rather a chronic, lifelong, and sometimes fatal disease. In identifying this, we as treatment providers may want to begin to change the language we use to support the men, women, and adolescents that we are treating. 

We must be wary of using language both within the ceremony and within day-to-day treatment that might lead patients to believe they have “completed” the recovery process and can now move on to something different. Chronic diseases are debilitating, not only to the sufferer but to their families. They are demoralizing, exhausting and spiritually taxing and difficult to deal with over time. Someone who has diabetes, for example, must live with the fact that on a day-to-day basis, their diet and social life can contain multiple triggers. Even with positive lifestyle changes in place, they will need to continue to monitor their sugar levels and may need to take medication daily. The same is true for patients with substance use disorders. The need to attend daily meetings and to stay spiritually, emotionally and physically fit can also become exhausting and tiring over time for patients and loved ones.

We are all living in a society which triggers our sugar use, our alcohol use, and our prescription medication use. Triggers can include seeing a commercial on television, passing a bakery, passing a billboard or going to a grocery store that sells alcohol. People that don’t live with a chronic illness may or may not grasp how significant it is that other people suffering from chronic illnesses live day-to-day with these advertisements, billboards, or retail options. Day in and day out we are completely surrounded by potential triggers.

Anybody suffering from a chronic illness has to take care of themselves in a myriad of ways (physically, emotionally, and spiritually) on a daily basis in order to ensure their continued wellness. Being in a residential setting is one of the most intensive levels of care that we provide to somebody who suffers from a chronic substance use disorder that needs treatment and attention over one’s lifespan. Too often graduation and “Coining Out” ceremonies do not lend themselves to the understanding that there are actions needed on the patient’s part going forward, every day for the rest of their lives. Patients need to leave with a sense that this is a mere beginning and the completion of their treatment episode is actually the easiest part of their lifelong recovery journey. 

So, instead of having graduation ceremonies or “Coining Out” ceremonies, wouldn’t it be nice to change our verbiage so that those completing this initial episode of treatment leave with an acceptance and understanding of the commitment needed in order to sustain their lifelong wellness? Rites of passage can be wonderfully positive so long as we understand that these ceremonies not only happen once during treatment but need to continue time and time again throughout one’s lifespan. Those in recovery will be utilizing the tools that we have hopefully taught them in all settings of care over a lifetime. With that, I encourage you to invite your patients to “coin in” to the journey ahead as they complete their treatment stay at your facility. 

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