When they come to rehab, they tell counselors they’re going to die without change.

They have nothing: No job, no spouse. Their kids have been taken to foster care.

But Jack Gaskill, director of the Idaho Falls Addictions Rehabilitation Association, tells people with addictions, “you’re not dead yet. What are you (going to) do about it?”

While it is difficult from the start, addiction recovery is a lifelong battle. It’s a fight to get their lives — and the people in their lives — back.

A lifetime of conscious changes is the only path to sobriety.

Getting clean is the easiest part of sobriety, said Aishie Lindula, treatment supervisor for the Addictions Rehabilitation Association.

Staying clean is the real challenge, she said.

Rehabilitation options for Idaho residents addicted to drugs and alcohol often are in short supply. Available substance abuse treatment may come through outpatient treatment, inpatient treatment or the Idaho Department of Correction.

Gaskill said his inpatient center houses clients with substance abuse problems in residential settings and a more restricted halfway house environment. Treatment is optional and clients are not forced to stay.

About 90 percent of those in halfway housing are directed there by a specialty court for felons with substance abuse and mental health issues.

With about eight residential clients and 25 people in the halfway house, Gaskill said only about 7 percent of addicts are a good fit for inpatient treatment.

Outpatient treatment is the most effective choice for most people suffering from addiction, he said. It can come from a variety of counseling services, including single, group and family counseling.

“Outpatient treatment, when it works, is always better because they’re still connected with their real world and they could be at home,” Gaskill said.

Outpatient treatment is cheaper as well, he said. For the state to pay for one inpatient client, the price tag is about $168 per day. Residents who pay their own way face a price tag of $150 per day for the first 30 days. That’s $4,500 for one month of treatment.

Due to limited space, the association is forced to turn people away who want to come to the treatment facility.

Some people with addictions can’t afford it. Some don’t know where to go. Many don’t know who to ask for help.

Others simply don’t want help.

“I don’t know if people understand how many people need help and never get it,” Gaskill said.

Idaho Falls-based Human Dynamics and Diagnostics treatment supervisor Jana Pickering said a vicious cycle is created if people don’t have access to detoxification center during their treatment process.

“Our biggest problem in Idaho Falls is there’s not a detox center here or close to here,” she said. “Boise has one. Gooding has one where some clients go if they’re able. That’s essentially it.”

Many of her clients are so physically addicted to their substances they’ll go back to using drugs because the withdrawal symptoms can be so severe, she said.

Withdrawal symptoms vary from drug to drug, but can include increased irritability or anxiety, headaches and muscle aches, diarrhea, sweating, nausea and vomiting.

The Walker Center, licensed by the Department of Health and Welfare, is one of the few detoxification centers in southern Idaho, with locations in Boise, Gooding and Twin Falls.

“When these addicts are going through detox, it’s so painful,” she said. “It really is a horrific event these people are going through. But if we can get clients to the Walker Center, if we can immediately get them into outpatient treatment, it makes a huge difference.”

Pickering said there’s no question more people would be successful at managing their addiction if detoxification treatment was more accessible.

“We see a higher success rate if people are able to go through (medically monitored) detox,” she said. “But again, if these people are parents, what do they do with their kids? … How do you get to 28-day treatment and be away from kids or job that long?”

While outpatient treatment often is beneficial, many addictions do lead to criminal behavior, Gaskill said.

The Idaho Department of Correction offers rider programs that provide judges with an alternative sentencing option for felons who need intensive treatment.

A rider program allows an inmate to participate in intensive treatment while incarcerated, then go back to the judge, who will decide whether they must serve the rest of their sentence in custody or be released on probation. Rider programs last from 90 days to one year.

“Rider programs have proven to be beneficial because it deals with an individual who truly is a felon, yet the court believes this person needs one more chance,” Department of Correction Director Brent Reinke said.

Bruce Wells-Moore, re-entry manager for the Department of Correction, said one of the goals for rider programs is to teach inmates to look at how their actions impact others.

“Addiction is a very selfish condition,” Wells-Moore said. “We try to get them to realize the ramifications of their behaviors.”

The rider programs, with as much as six or seven hours of treatment every day, are more intensive than their counterparts in prison, where an inmate would typically receive three to four hours of treatment a week -- and not until they were nearing freedom.

“If you were sent to prison, we won’t start programs (on substance abuse) until within 18 to 20 months of release,” Reinke said.