Drug Rehab

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Types of Drug Rehab Programs

It’s important to note that medical detoxification is not substance abuse treatment and rehabilitation; rather, it is part of a continuum of care consisting of various levels of treatment. Clients enter treatment according to the appropriate level of care as recommended by their clinician. At any point during drug rehab, clients can transfer up or down to more or less intense treatment as needed. Per the American Society of Addiction Medicine (ASAM), five main levels have been established in the continuum of care for substance abuse treatment (1), which are as follows:

• Early intervention
• Intensive outpatient (IOP)/partial hospitalization services
• Outpatient services
• Residential/inpatient services
• Medically managed intensive inpatient services

Early Intervention

The most effective way to help a friend or loved one who may be developing a substance use disorder is to intervene early before the condition progresses, according to research (2). Early detection of substance abuse may take place in general health care settings where patients are seeking medical attention for physical ailments. However, family members, friends and other significant relationships also play an important role in detecting signs of substance use, and they can stage an early intervention with the assistance of an experienced clinician from a drug rehab center. The goal of early intervention is threefold: 1. to minimize harms associated with chemical dependency and to reduce risky behaviors; 2. to improve health and social function, and 3. to prevent the condition from further progression that may require more intense treatment (and subsequently, incur higher costs). During early intervention, clients receive services such as information sessions about risks of substance use and strategies for reducing and eliminating substance misuse altogether. If necessary, the clinician will try to engage the individual in addiction treatment.

Medical detoxification

The purpose of medical detoxification is to safely manage acute intoxication and withdrawal symptoms by clearing the patient’s body of toxins produced by drug and alcohol abuse. (3) Depending on the severity of chemical dependence and history of drug use, withdrawal symptoms could be life-threatening, but under medical supervision, patients can safely withdraw with pharmacological interventions such as medication-assisted treatment (MAT). Withdrawal symptoms vary, depending on the type of drug and history of use, but they generally include the following symptoms: hallucinations, dizziness, twitches, tremors, shaking, sweating, tingling, diarrhea, nausea, heart palpitations, breathing difficulties, heart attacks, strokes, and delirium tremens (DTs). Often the first step in substance abuse treatment, medical detox alone is insufficient for long-term abstinence from drug abuse.

The three essential components of detoxification – evaluation, stabilization and patient readiness for treatment — can take place concurrently or as a series of steps. During evaluation, a client is screened for the concentration of toxins in the bloodstream and for co-occurring mental, emotional and physical disorders. A comprehensive assessment of the client’s medical history and social environment is taken into consideration when determining the appropriate level of treatment.

During stabilization, the client goes through the medical and psychosocial processes of acute withdrawal under medical supervision to achieve a substance-free state. This may or may not include medication-assisted treatment (MAT). During this stage, clinicians ask the client’s loved ones, employers and other significant relationships to participate as the client learns what to expect during and after treatment. The client is then prepared for entry into treatment as the clinician advises him or her of the importance of staying in the program until completion. If the patient shows a history of dropping out of drug rehab in the past, the clinician asks the client to sign an agreement prior to treatment. The contract is not legally binding, but it is a voluntary contract signed by the client when he or she is stable enough to make an informed decision and commit to program completion.

Intensive Outpatient (IOP) Treatment

IOP programs are wide-ranging and adaptive according to the diverse needs of the drug rehab’s clientele. It is considered an intermediate level of care where it could serve as an entry point of treatment or a step down from more intense care such as residential treatment. At this point of drug rehab, the client is considered to be stabilized but in need of intensive treatment to maintain abstinence. Although IOP treatment programs vary in clientele, program philosophy and comprehensiveness, the general goals of IOP are as follows:

• To help clients achieve abstinence
• To effect change in behavior leading to abstinence and a new lifestyle
• To help individuals address issues in housing, employment, probation, etc.
• To encourage clients to engage in community-based support services
• To improve clients’ problem-solving skills and coping strategies

Intensive outpatient treatment is offered in a variety of settings, including drug rehab facilities, large hospital settings, correctional facilities, and other locations where community members can receive services for drug and alcohol dependency.

IOP programs are broken down into sequential stages as clients graduate from each stage with tapering intensity and increasing responsibility. If the client indicates any lack of progress, the intensity of treatment is adjusted to meet the client as needed.

Outpatient Services

Outpatient treatment follows intensive outpatient (IOP) services for clients who step down from IOP. Outpatient services provide ongoing support to help individuals develop relapse prevention skills, conflict resolution skills, and assistance with employment, legal and other problems that the client may be facing.

Outpatient treatment differs from IOP treatment in intensity and duration. IOP programs provide more substance abuse counseling than outpatient programs, whereas outpatient services provide more assistance with setting up medical appointments, family therapy sessions, employment counseling and psychotherapy. (4)

Residential/Inpatient Treatment

What’s the difference between residential treatment and inpatient treatment?
The main difference between the two lies in the treatment setting. Clients receive residential addiction treatment at a drug rehab facility whereas individuals receive inpatient treatment in a hospital setting.

The residential facility is described as a dwelling where clients (residents) stay for the duration of the drug rehab program. Some drug rehab facilities closely resemble actual residences where individuals receiving addiction treatment can feel like they are “home away from home.” Residential facilities provide safe housing for clients away from their home environment that may be riddled with distractions and temptations. Though housing models may vary from one drug rehab to another, residential treatment facilities have a 24-hour on-site medical team that monitors and manages any crisis that might arise in the recovery environment. Residential treatment can be further broken down into residential intensive and residential transitional treatment. As the titles suggest, residential intensive treatment is a more structured program focusing on stabilization and helping clients develop recovery skills; residential transitional treatment focuses on helping clients assimilate back into society.

Individuals with substance use disorders receive inpatient treatment in large hospital facilities that provide drug and alcohol treatment, pharmacological interventions and other therapies for chemical dependency. Patients receive round-the-clock constant medical attention, and the settings are much more clinical than residential treatments found in drug rehab centers. Patients do not leave the treatment settings until they are deemed stable enough to do so.

Is inpatient care the same as partial hospitalization (PHP)?
The level of intensity provided by partial hospitalization (PHP) is synonymous with intensive outpatient (IOP) care and day treatment after an individual is discharged from the hospital. IOP programs are available at drug rehab centers as well as other locations that are licensed and/or certified to provide Alcohol and Other Drug (AOD) treatment.

Medically managed intensive inpatient services

How is inpatient treatment different from medically managed intensive inpatient services?
The main difference lies in the type of patient population receiving addiction treatment. Medically managed intensive inpatient services cater to individuals who require acute care for severe mental, emotional and behavioral problems. This type of service delivery may take place in freestanding detoxification centers or psychiatric hospitals. This phase of treatment utilizes more force and intensity than other levels of care in order to prepare the patient for entry into addiction treatment. (5)

Continuing Care Addiction Treatment

Continuing care, also known as aftercare, refers to the stage of treatment that follows after more intensive care. When a client completes an addiction treatment program at a drug rehab, continuing care provides recovery support services consisting of follow-up extended monitoring, individual and group counseling, phone counseling, brief check-ups and community-based groups such as self-help meetings and twelve-step fellowships (6). An example of extended monitoring would be the collection of urine samples, which would indicate the alumni’s substance use status. Urine samples would not be necessary if an alumnus admits to recent substance use.

The duration of continuing care programs has been associated with high success rates of continuous abstinence after drug rehab. The longer the alumnus stays in the continuing care program (a minimum of one year or more), the more likely he or she will maintain a substance-free life. The structure and accountability provided by alumni aftercare programs help drug rehab graduates to maintain lifestyle changes, coping skills and strategies learned in addiction treatment.

Specialty drug rehab programs

Specialty rehab programs are addiction treatment approaches that focus on the needs of a particular group. They may be categorized according to gender, background and lifestyle, such as those listed below:

Trauma-informed care
In a drug rehab setting, the clinician examines how trauma and trauma-related stressors have played a role in the client’s substance abuse addiction. Clinicians who provide services in this capacity have been trained in trauma processing therapy, which aims to reduce re-traumatization in clients while they receive addiction treatment. For more on trauma-informed care, click here.

LGBTQ+
Family is a major theme in drug rehab for the LGBTQ+ population, considering how much of the stigma stems first from the home environment. Clinicians provide resources for clients and their families to learn about each other as they address the societal stigmas that individuals face regarding their identity, gender, and substance abuse addiction. For more on LGBTQ+ drug rehab, click here.

Dual diagnosis treatment
This specialized drug rehab program concurrently treats substance use disorders and co-occurring disorders, which may include mental health disorders and physical conditions associated with substance use. Bipolar disorder, depression, anxiety and attention-deficit hyperactivity disorder (ADHD) are common co-occurring conditions that lead to or result from substance use. Many patients with a dual diagnosis go untreated due to fragmented client care, but thanks to drug rehabs that offer dual diagnosis treatment, clients can receive care for both substance use disorders and other co-occurring disorders under the same roof. For more on dual diagnosis treatment, click here.

Gender-specific care for women
Gender considerations are important in drug rehab, as men are more likely to have a substance use disorder whereas women are prone to medical and psychosocial effects of substance abuse (7). Variables that affect addiction treatment for different genders include hormonal factors, stress and cue reactivity, and brain activation in response to perceived stress. According to research funded by the National Institute on Drug Abuse, studies show that women who receive gender-specific addiction treatment are more likely to be employed within 12 months of treatment admission compared to traditional drug rehab programs.

Holistic therapy
Used as an adjunct form of therapy, holistic therapy utilizes non-traditional approaches to provide comprehensive care for clients, healing the person as a whole – mind, body and spirit — rather than just treating the individual for his or her substance use disorder. Common holistic therapies include nutritional counseling, surf therapy, art therapy and more, and they have proven to be effective for clients who are resistant to traditional treatment such as talk therapy. Holistic therapists find ways to connect to their clients who are otherwise unable to respond to treatment. For more on holistic therapy, click here.

Residential treatment, sober living and halfway houses

The terms residential treatment, sober living, halfway houses and group homes can be very confusing for those who are not familiar with the drug rehab industry. Here we will shed some light on the differences between each type of housing.

Sober living homes offer transitional housing for residents who have completed residential treatment but are not ready to return to independent living. Residents are encouraged to participate in community-based support groups such as 12-step fellowship programs. Some sober living homes are affiliated with drug rehab centers while others operate independently. Unlike halfway houses, sober living homes do not place a limit on the length of stay, provided that residents pay their rent on time, abide by the house rules, and live in harmony with the rest of the household.

Residential treatment provides intensive on-site drug rehab for clients who need a higher level of addiction treatment. This is determined when the clinician is taking an assessment of the client’s drug use, family environment, and medical history. Clients stay at a residential treatment facility that closely resembles a house but is staffed with a 24-hour medical team and other drug rehab staff members. The duration of the stay ranges from 30 days to 90 days. Residential treatment facilities must be licensed, whereas sober living homes are not subject to the same regulations.

Halfway houses and sober living homes both offer types of housing for individuals who are in transition, but halfway houses are more akin to dormitories, whereas sober living homes are structured like private residences. More crowded than sober living homes, state-funded halfway houses have fewer amenities and typically house residents who have recently been released from jail or prison; they may also serve as transient housing for the homeless. Because halfway houses are funded by the government, they are vulnerable to budget cuts. After a few months, residents are required to move out whether or not they are ready for independent living. (8)

Family Involvement in Continuing Care

Individuals who return home from drug rehab will benefit greatly from family involvement as part of their continuing care. Loved ones can show their support by any of the following ways:

• Ensuring that alcohol or drugs are nowhere to be found at home
• Respecting boundaries that were established during Family Group Therapy
• Learn how family dynamics play a role in their loved one’s recovery
• Gain a better understanding about triggers that lead to relapse
• Adjust the living environment to be more suitable for someone in recovery
• Stay in touch with the loved one’s recovery community, which may include peers, substance abuse counselors, and clinical directors
• Seeking individual or family counseling as needed
• Providing continual love and support without judgment

What does it mean if a drug rehab is accredited?

Being an accredited drug rehab means that the addiction treatment provider has met the standards of excellence set forth by an accrediting agency. The Commission on Accreditation of Rehabilitation Facilities (CARF) International and The Joint Commission are two gold standard accrediting agencies that evaluate and monitor drug rehab programs for their therapy practices, credentialing of therapists, and quality of care. The process of accreditation can take months to complete, during which on-site visits and evaluations are made by the accrediting agency’s auditors. The auditors examine the facility’s policies and procedures, residential treatment sites, safety plans, therapy programs, program schedules, and consumer services. Having met the accrediting agency’s standards, the drug rehab demonstrates to the community its commitment to ethical business practices and high-quality care.

How is drug rehab success determined?

Measuring drug rehab success in terms of treatment outcomes is a difficult feat, because currently there is no standard definition of what “success” means for addiction treatment. SAMHSA’s National Survey on Drug Use and Health (NSDUH) measures the demographic data of those using illicit substances and receiving treatment, but current research on short- and long-term outcomes of those who have completed a drug rehab program is limited on a national level. One of the reasons for such limited data is the absence of standardized measuring tools for addiction professionals in the United States. (9)

Drug rehab success can be predicted by the presence of evidence-based therapy. With limited access to evidence-based interventions such as cognitive-behavioral therapy, individuals are less likely to experience a full recovery from substance abuse addiction, which potentially increases their chances for relapse. Findings from a study conducted by the Center on Addiction and Substance Abuse at Columbia University reveal that one in 10 people needed addiction treatment but did not receive it, and of those who did receive any kind of treatment, few received anything close to evidence-based treatment for alcohol and illicit drug use, compared to 70% to 80% of those who receive evidence-based care for hypertension and diabetes. In addition, the report states that most medical professionals who should provide addiction treatment have received insufficient training in treating substance use disorders. The incongruent consensus about the nature of addiction, coupled with the lack of knowledge of best practices, among health professionals, has eroded the quality of treatment for individuals with substance use disorders.

One of the most powerful indicators of drug rehab success is the outcome of someone’s life after the individual completes a drug rehab program that incorporates all of the Principles of Effective Treatment. Given the limited research literature on long- and short-term post-treatment outcomes, it is vital to find a drug rehab that provides continuing care for its alumni. Individuals in recovery are much more likely to succeed if they receive continual evaluation, monitoring and treatment modification (as needed) from the drug rehab’s continuing care program, also known as an aftercare program. Extended aftercare that lasts for at least a year or more increases chances for success, and oftentimes program graduates are encouraged to stay active in the recovery community.

References

1. Center for Substance Abuse Treatment. Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2006. (Treatment Improvement Protocol (TIP) Series, No. 47.) Chapter 3. Intensive Outpatient Treatment and the Continuum of Care. Available from: https://www.ncbi.nlm.nih.gov

2. Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health [Internet]. Washington (DC): US Department of Health and Human Services; 2016 Nov. CHAPTER 4, EARLY INTERVENTION, TREATMENT, AND MANAGEMENT OF SUBSTANCE USE DISORDERS. Available from:https://www.ncbi.nlm.nih.gov

3. Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2006. (Treatment Improvement Protocol (TIP) Series, No. 45.) 1 Overview, Essential Concepts, and Definitions in Detoxification. Available from: https://www.ncbi.nlm.nih.gov/
4. McLellan A.T, Hagan T.A, Meyers K, Randall M, Durell J. “Intensive” outpatient substance abuse treatment: Comparisons with “traditional” outpatient treatment. Journal of Addictive Diseases. 1997;16(2):57–84.

5. Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2006. (Treatment Improvement Protocol (TIP) Series, No. 45.) 2 Settings, Levels of Care, and Patient Placement. Available from: https://www.ncbi.nlm.nih.gov

6. McKay J. R. (2009). Continuing care research: what we have learned and where we are going. Journal of substance abuse treatment, 36(2), 131-45.

7. Polak, K., Haug, N. A., Drachenberg, H. E., & Svikis, D. S. (2015). Gender Considerations in Addiction: Implications for Treatment. Current treatment options in psychiatry, 2(3), 326-338.

8. Polcin, D. L., Korcha, R., Bond, J., & Galloway, G. (2010). What did we learn from our study on sober living houses and where do we go from here?. Journal of psychoactive drugs, 42(4), 425-33.

9. Sanghani, R. M., Carlin, A. L., & Moler, A. K. (2015). Assessing success–a commentary on the necessity of outcomes measures. Substance abuse treatment, prevention, and policy, 10, 20. doi:10.1186/s13011-015-0017-2

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