Guide to Understanding Addiction Resources
October 24, 2011
28-Day Inpatient Treatment
Residential 28-day inpatient treatment is the traditional mode of therapy for individuals who are experiencing difficulties related to substance use. This mode of treatment is particularly indicated in cases where individuals have poor recovery environments at home, have difficulty establishing sobriety in an uncontrolled environment, require physical detoxification from the substance(s) they are using, have failed to achieve sobriety in lower levels of care, or require a period of sobriety in order to recover their capacity for judgment. The primary disadvantages of this type of treatment include the high cost, the interruption of normal life activities, and the fact that sobriety is established in an environment different from the one in which it will have to be maintained. For other individuals, 28-day treatment may be too short a time period to establish stable recovery.
Extended care facilities typically provide services to individuals who have completed an inpatient stay but who require longer periods of time to establish a stable recovery. These facilities tend to have the advantage of providing a stable recovery environment while helping individuals to create a healthy lifestyle that can be maintained post-treatment. The primary disadvantages of these facilities are their high cost and the fact that sobriety will again be established in an environment other than the one in which it will have to be maintained. Most inpatient facilities have relationships with an extended care facility.
Intensive Outpatient Treatment
Intensive outpatient treatment is typically an intensive group therapy treatment that provides care on an outpatient basis for a minimum of nine hours weekly. Pioneered by the Kolmac Center as a substitute for inpatient treatment, intensive outpatient treatment serves as an effective intervention for individuals with significant substance-related use who wish to obtain care without the interruption of important daily life activities. The advantages of this type of treatment are that it is statistically as effective as inpatient treatment, it is much lower in cost, and it allows for recovery to occur in the environment where it will be maintained. The primary disadvantages of this type of treatment are that it requires a high level of motivation, and it may not provide a sufficiently stable environment for individuals who have poor recovery environments.
Outpatient treatment is typically a less-intensive type of group therapy that meets for fewer than 9 hours a week. The advantages of outpatient treatment are that it does not create significant interruptions in important daily life activities; it does not require the degree of motivation necessary for intensive outpatient treatment; it provides social support and allows for group process to normalize issues of shame and guilt; and it allows for recovery to occur in the environment where it must be maintained. The primary disadvantage is that it may not be intensive enough for individuals who have serious substance abuse issues.
Family units are almost always an important component in substance abuse treatment. Typically, family members are the ones who provide support to someone who is actively using a substance, and the family members themselves may actually be more in need of emotional support than the person with the substance abuse problem. To the degree possible, all families of individuals abusing substances should be involved in the individual’s treatment when appropriate or should seek treatment themselves. This is particularly true in cases where the individual who is being treated is ambivalent about ceasing use and is living at home.
Individual therapy generally consists of individual counseling sessions held on a weekly basis with a practitioner who specializes in the treatment of addiction. The primary advantages of this type of treatment are that it allows for treatment of individuals with low levels of motivation for change or who are unwilling to participate in group therapy; it provides effective guidance for families; it can help facilitate entrance into higher levels of care; it is relatively low-cost; and it allows for recovery to occur in the environment where it must be maintained. Individual therapy may also be appropriate for individuals who need continued support following discharge from a substance abuse facility or who need to address other personal issues that contribute to maintaining sobriety. The primary disadvantages are that individual therapy may not be intensive enough for individuals with serious issues, nor does it allow for group process to deal with issues such as shame, guilt, and the need for social support.
Detoxification facilities provide physical detoxification from substances such as sedative/hypnotics, alcohol, and opiates which create strong physical dependence. Detoxification may be a key requirement for some individuals to be able to engage in sobriety without the risk of death. The advantages to detoxification exist primarily in its medical necessity, its minimal interruption of daily life activities, and the limited degree of motivation necessary to engage in treatment. The disadvantage is that it is a highly ineffective way to establish recovery, as it only deals with the physiological aspects of substance use and does not address psychological factors.
Addiction psychiatrists are a rare and precious commodity. These professionals specialize in the treatment of individuals who have co-occurring substance abuse issues. Such treatment is essential in helping to ensure that individuals with histories of addiction are treated effectively, and extreme care is taken with medications that have addictive properties. In addition, some addictions psychiatrists may be licensed to prescribe buprenorphine on an outpatient basis, which can allow for the effective treatment of individuals with opiate dependency. The primary disadvantages involve cost (if the psychiatrist does not accept insurance) and the fact that treatment may not be intensive enough with individuals who have serious issues with substances. It should also be noted that treatment with medication alone is rarely enough to create long-term sobriety.
Recovery houses are living facilities specially reserved for individuals who are in the process of recovering from substance use. Typically, these facilities will require a minimum of 30 days of sobriety prior to admission, will require complete abstinence during an individual’s stay, will provide drug and alcohol testing, and will require attendance at group counseling sessions or sober support groups. These facilities are a fantastic resource for families who wish to support a loved one’s sobriety without allowing him/her back into the home. The primary disadvantages to these facilities are the cost and the fact that individuals must be sober for 30 days prior to admission. Also, these facilities fluctuate significantly in quality, so it is useful to do some research prior to sending someone to a recovery house.
Interventionists assist families in encouraging individuals who are suffering from substance use problems to seek treatment. This can be extremely helpful for families who are feeling helpless in their ability to address their family member’s substance abuse problem. The biggest concern regarding this service is that the profession is somewhat unregulated; if done poorly, it could become destructive. Look for individuals who are certified interventionists and who have mental health credentials to help ensure the quality of services. Also, depending on the person providing this service, it may be costly.
Because social aspects are so crucial to treating substance use, self-help groups are an extremely important resource for individuals with substance use problems. Twelve-step groups have helped countless individuals obtain and maintain sobriety for little or no cost to the individual seeking services. Twelve-step groups have the advantage of being widespread; they can be found in nearly any city, nearly any time of day, anywhere in the world, and they provide an instant social network of individuals who will be supportive of sobriety. For people aversive to the 12-step model of care, other groups, such as SMART Recovery, offer an effective alternative approach. The primary disadvantage to self-help groups is that they can vary in quality depending on the group; clients should be encouraged to keep looking for a group until they find one in which they feel comfortable.