Levels of Treatment

There are several phases of substance abuse treatment. When a patient seeks treatment they will typically be evaluated by the medical staff to determine the most appropriate level of care. This can be done at a hospital emergency room or treatment facility.

The first step is usually detoxification, or detox. Detox is the process of letting the body remove the drugs in it. The purpose of detox is to safely manage withdrawal symptoms when someone stops taking drugs or alcohol. Everyone has a different experience with detox. The type of drug and how long it was used affects what detox will be like.

The United States Department of Health and Human Services acknowledges three steps in a drug detoxification process:[1]

  1. Evaluation: Upon beginning drug detoxification, a patient is first tested to see which specific substances are presently circulating in their bloodstream and the amount. Clinicians also evaluate the patient for potential co-occurring disorders, dual diagnosis, and mental/behavioral issues.
  2. Stabilization: In this stage, the patient is guided through the process of detoxification. This may be done with or without the use of medications but for the most part the former is more common. Also part of stabilization is explaining to the patient what to expect during treatment and the recovery process. Where appropriate, people close to the addict are brought in at this time to become involved and show support.
  3. Guiding Patient into Treatment: The last step of the detoxification process is to ready the patient for the actual recovery process. As drug detoxification only deals with the physical dependency and addiction to drugs, it does not address the psychological aspects of drug addiction. This stage entails obtaining agreement from the patient to complete the process by enrolling in a drug rehabilitation program.

Because it is often accompanied by unpleasant and potentially fatal side effects stemming from withdrawal, detoxification is often managed with medications administered by a physician in an inpatient or outpatient setting; therefore, it is referred to as “medically managed withdrawal.” Medications are available to assist in the withdrawal from opioids, benzodiazepines, alcohol, nicotine, barbiturates, and other sedatives.

Commonly used medications in opiate detox include clondine, buprenorphine, and methadone. Methadone is most typically used in inpatient treatment settings and with intravenous users. While it does not negate withdrawal symptoms completely, it does help a user get off heroin and resume a relatively normal lifestyle. Other medications like buprenorphine can shorten the length of detox and be used like methadone in long-term treatment plans. Naltrexone is another medication that is used for addicts but, as noted by the Substance Abuse and Mental Health Services Administration, it is typically administered after detox as it helps prevent relapse.

Long-term residential treatment provides care 24 hours a day, generally in non-hospital settings. The best-known residential treatment model is the therapeutic community (TC), with planned lengths of stay of between 6 and 12 months. TCs focus on the “resocialization” of the individual and use the program’s entire community—including other residents, staff, and the social context—as active components of treatment. Addiction is viewed in the context of an individual’s social and psychological deficits, and treatment focuses on developing personal accountability and responsibility as well as socially productive lives. Treatment is highly structured and can be confrontational at times, with activities designed to help residents examine damaging beliefs, self-concepts, and destructive patterns of behavior and adopt new, more harmonious and constructive ways to interact with others.

Partial hospitalization, also known as PHP (partial hospitalization program), is a type of program used to treat mental illness and substance abuse. In partial hospitalization, the patient continues to reside at home, but commutes to a treatment center up to seven days a week.  PHP or Partial Hospitalization Program, the next phase in treatment, following detox begins the foundation of recovery. Patients who still need direct medical supervision, but who do not need to stay overnight in a hospital setting, can move to PHP. Medical services provided by nurses and or physicians monitor client progress as the client continues addiction treatment. Sometimes, individuals will enter PHP after returning from a relapse. PHP treatment provides a highly structured treatment alternative to inpatient treatment and is more intense than those of IOP or OP in order to stabilize the client’s physical, mental, and emotional state.

Intensive Outpatient Program (IOP)

The typical IOP program offers group and individual services of 10–12 hours a week. Usually, 3 days a week for 3 hours each. IOP allows the individual to be able to participate in normal daily living, such as work, and then participate in treatment at an appropriate facility in the morning or in the evening.

The typical IOP program encourages active participation in 12-step programs in addition to the IOP participation. IOP can be more effective than individual therapy alone for chemical dependency

Sober living houses (SLHs) more commonly called sober homes and sober living homes and more rarely sober living environments, are facilities used by people recovering from substance abuse that serve as an interim environment between rehab and mainstream society. Transitioning to a halfway home is a beneficial step after completing inpatient treatment , or while enrolled in an outpatient treatment program. Halfway houses are usually more affordable than residential rehab programs, offer peer support and other services, and can be a bridge between the support of a treatment center and the temptations of the “real world.” Halfway houses or sober living homes can range from inexpensive ($100-$300 per month) to expensive (over $2,000 per month). Most sober living homes cost the same as renting an apartment.

Outpatient Treatment

Outpatient treatment varies in the types and intensity of services offered. Such treatment costs less than residential or inpatient treatment and often is more suitable for people with jobs or extensive social supports. Typically, outpatient treatment should consists of regular meetings (Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, etc.), individual and/or group therapy with a therapist and psychiatrist for medication management.

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