Treatment Options for Addiction

Detoxification helps people safely withdraw from drugs or alcohol until it is no longer present in their system. It is often the first step in treating individuals recovering from moderate to severe levels of addiction. Medical assistance may be necessary for detoxing from certain substances like alcohol and benzodiazepines, which may cause life-threatening withdrawal symptoms such as seizures. Even when withdrawal is not life-threatening, medical detox is often necessary to help ease the severity of withdrawal symptoms. Detox protocols sometimes include prescription drugs that are tapered down until the patient is no longer physically dependent on the addictive substance. Although detox alone is rarely sufficient to help addicts achieve long term sobriety, it is often a necessary precursor to an effective treatment program.

Inpatient rehab programs offer structured treatment regiments designed to address all facets of addiction including current use. Medically assisted detox is sometimes offered in these treatment facilities for those currently drinking or using drugs. Once medically stable, patients stay 24-hours a day in a substance-free facility and receive round-the-clock care and therapeutic support. This is often the highest level of long-term treatment since it involves total immersion in a recovery community and severs any access to addictive substances. For that reason, the time immediately after leaving residential treatment can pose a high risk for relapse, so it is recommended that you not be alone during that time and that you transition to outpatient treatment immediately. It takes time to gain consistent internal motivation for recovery, so an abrupt shift out of a safe external environment can be dangerous if there isn't a clear plan for what's next.

Sober living houses (sometimes called halfway houses) are facilities that provide housing and supportive living conditions for people in treatment. They often serve as a bridge between residential treatment and the "real world." Sometimes, it isn't safe for a person in recovery to move back into their original living situation, and so halfway homes keep us safe from toxic environments while empowering us to reinforce the lessons learned while in treatment.

Residents in sober living can come and go as they please, but have to abide by house rules such as staying sober, abiding by curfews, and attending support groups and/or outpatient treatment. Sober living allows residents to build structure and social support after leaving inpatient treatment so that they can increase their chances of success as they transition back everyday life. Sober living homes can also help residents with a number of things such as find a job, locate housing after treatment, and adjust to living in an unstructured environment.

There are some recovery residences out there that are poorly run and risky, especially if there is poor accountability and the residents are able to go back to using. Make sure to do your research so that you find a good option. Watch for the following red flags:

• Rundown or unsafe building, or unclean living quarters (make sure to tour the home first).

• Does not have admission requirements or house rules.

• Does not require abstinence or regular drug testing.

• Has no safety or privacy provisions.

• Employs untrained or uncertified staff and does not submit to regulatory inspections.

• Claims to be free.

A good sober living home is in an area that is as free from triggers as possible, has built-in accountability mechanisms through its rules and expectations (e.g., random drug testing, location tracking, etc.), and has ample amenities and activities for you to accomplish your daily tasks and support you throughout your stay. Though not an option in every state, the National Association of Recovery Residences (www.narronline.org) can help your search.

An intensive outpatient program option is designed for motivated patients who meet certain criteria that indicate they can be successful in sobriety by attending 9-15 clinical hours a week for 8-12 weeks. The focus is on cognitive behavioral therapy, contingency planning, establishing healthy habits, and developing a routine of social support. Such programs consist of 3-5 sessions per week. The number of sessions and length of treatment depends on patient progress.

Typically, patients learn about the neurobiology of addiction, how addiction affects one's thinking and relationships over time, and how to change such patterns with dedicated and repeated practice. Patients also have opportunities to share and learn with others in group settings, and will be encouraged to attend support groups to help with transitioning back to everyday life. Many programs also offer sessions for family members. Patients often transition back to work during IOP or balance their time in treatment with their existing employment.

"Partial Hospitalization" is something of a misnomer, as no actual hospitalization is involved. PHP is designed for those in need of a more intense treatment option that borders a medical setting. It typically is an extended version of an IOP that requires more hours of the day, typically 6-8 hours per day for 5 days a week. Many patients entering outpatient will start at this level and then step down to IOP. This level is for patients who do not require detox or have completed detox prior to admission. This is an intensive level of care that provides tremendous support and education in early recovery. PHP and IOP programs usually feature random drug testing so that patients can stay accountable while in treatment.

If you are motivated towards recovery, then you will accept that the work doesn't stop after completing a treatment program. It is crucial to maintain the gains made in treatment so that you don't risk slipping back into old situations and rationalizations that can eventually lead back to relapse. For instance, overconfidence in one's length of sobriety can cause Pink Cloud syndrome, a sign of which is thinking that you don't need help anymore. Before you know it, you stop going to meetings, and start thinking that you can control your use. And maybe there is some illusion of control for a little while, but experience tells us that eventually, the addict ends up back where they started or worse.

Remember that long-term substance abuse hijacks the normal functioning of the brain, and that the pleasure and reward areas of the brain are accustomed to having their way over the rational decision-making areas. This can literally take years to reverse, and in some cases it might never happen. These neurological changes impact our thoughts, feelings and behaviors long after we've gotten sober, and for that reason, we need to stay vigilant and keep applying the lessons we learned in early recovery. In the words of the Big Book, "Remember that we deal with alcohol -- cunning, baffling, powerful!"

Long-term recovery includes weekly therapy sessions with an addictions counselor and/or addictions coach, as well as attending support groups, and practicing mindfulness meditation and/or yoga.

Support groups and social networking offer the ongoing accountability and encouragement needed to help us continue staying sober in the long run. These groups include other people who are going through or who have gone through the same sorts of experiences. Many outpatient programs can help you find and meet people in support groups while in treatment. Options for support groups include 12-step, SMART Recovery, Dharma Recovery, and Y12SR. Find a meeting near you:

If you are wondering about the length of rehab, it's important to recognize that recovery is different for everyone. There is no magic number, but generally you should try to stay in treatment as long as you can. Studies have shown that the greatest chance for relapse is within the first 90 days, and for that reason 90-day or longer treatment periods are ideal. Unfortunately, many health insurance policies only cover 28 or 30 days, which are acknowledged by many in the treatment industry as insufficient.

Confidentiality is integral to any counseling process. All treatment programs, including private therapists, are bound by a federal privacy law known as the Health Insurance Portability and Accountability Act (HIPAA). HIPAA ensures that any information regarding your treatment, including your identity, must be kept private and confidential. For instance, if an employer contacts your treatment center and asks if you are there, the staff is not allowed to say whether they even know you. Therapists and treatment staff are not allowed to release any information about any patient unless a consent form has been signed by you, or in certain rare circumstances such as: you disclose child abuse or elder neglect, you are determined to be a danger to yourself or others, by court order, involvement of DCSS, or by a request for information from the parent of a minor.

There are a lot of things to consider when choosing a treatment program. You'll want to consider your specific addiction, the severity, the type of treatment program (inpatient vs. outpatient, etc.), the location, the price, and your insurance eligibility.

Many treatment programs offer financing or sliding scale fees and accept certain insurance plans, but this depends on the particular program you are interested in and whether treatment is deemed medically necessary based on your initial evaluation. The price range for addiction treatment depends on the length of stay, the location, the amenities provided, and whether the program is inpatient or outpatient. How much your insurance pays towards treatment depends on the specifics in your plan, but generally you should expect to cover the costs until your deductible is met. Thanks to parity laws, most private insurance plans must cover mental health treatments as though they were any other health treatment (read more about parity here).

When figuring which treatment center to go with, you may want to also ask about their visitor policy, what types of therapies are used, whether 1-on-1 time with a therapist is offered, whether they treat dual diagnoses (such as anxiety, depression, trauma, etc.), whether they treat other medical conditions, what kind of aftercare and sober living options do they offer, is the facility gender specific, whether there is programming for family members, what accreditation and licensing the program has, and what the credentials of the staff are.

Every treatment center is different, and what makes a place well suited for treating one person may not be good for someone else. But with tens of thousands of licensed centers in the United States, chances are pretty high that there is a good treatment center that will work for you.

Here are some other important things to consider:

• Specialization: What kinds of addiction do they treat? Recovery can look quite different for the alcoholic compared to the heroin addict, which looks different for the sex addict or gambling addict. To improve your likelihood of success, it is important to find a treatment center that specifically works with your addiction type. This is especially true for addictions that require specialized detox procedures.

  • For instance, many treatment centers may claim that they can detox a person off benzos, but is there a taper protocol?

  • Sexual addiction can carry a heavier stigma than substances, so it is important sex addicts to be in a safe space with others who will not judge.

• Success Rate: How does the treatment center define success? Is it the percentage of clients who complete their program? Percentage who maintain sobriety a year later? Consider also that the success rate varies by addiction type and co-occurring conditions.

• Focus on Underlying Issues: There are typically very good reasons why a person becomes addicted. It doesn't happen randomly. If underlying issues are not addressed during treatment, they will continue to be a problem in recovery. The difference between sobriety and recovery is that recovery encompasses all aspects of a person's life. Recovering addicts with unaddressed concerns are more likely to relapse since the reasons they became an addict in the first place are still causing them problems. This might be practical concerns like employment and living condition, other mental health conditions, or physical or emotional trauma earlier in life. The best treatment centers make sure to attend to these issues.

• Bumps in the road: The road to recovery is not always smooth. It is not unusual for clients to slip back into old behaviors while in treatment or after treatment. Your counselor should be understanding and non-judgmental when these bumps occur in order to effectively help you address the issues that led to relapse.