american addiction centers photo
We’re here to help 24/7!
american addiction centers photo

The Journey to Sobriety

Rehab and treatment are proven to help people beat addiction and, if applicable, any co-occurring mental illness that contributes to the person’s drug and alcohol abuse. If you are concerned that you may have a problem with drugs or alcohol, you may be wondering about rehab. This article will help you learn how to find the right rehab facility and explain what to expect when you enter rehab.

If you think you may have an addiction and/or a mental health issue, you should know that you’re not alone. Addiction and mental health disorders are serious concerns in the United States.

In 2018, an estimated 47.6 million adults aged 18 and older experienced mental illness, while around 20.3 million people aged 12 and older had a substance use disorder involving drugs or alcohol. In addition, approximately 9.2 million adults aged 18 and older had a co-occurring mental illness and substance use disorder.1

Finding the Right Rehab Facility

When it comes to treatment, there’s no one-size-fits-all approach. Treatment facilities can vary widely by the levels of care and services they offer. As you research treatment, remember to take into account different facility options to ensure that your needs are met. Ideally, your treatment approach should be tailored to meet your specific requirements.

two people holding hands in sunset

You may want to consider cost, location, insurance coverage, types of treatments offered, amenities, and the level of care. Some facilities only address specific parts of the recovery process (such as detox), while others offer a complete approach that covers the entire spectrum of care, from detoxification through aftercare. In addition, certain facilities may provide comprehensive forms of treatment to address specific needs, such as dual diagnoses (a co-occurring substance abuse disorder and mental illness), or the needs of veterans or first responders.

Make a list of questions and call different facilities you may be considering so you can ask about their approaches, services, and amenities. You may even wish to schedule a tour of the facility, if possible, to help you choose the rehab that is right for you.

Medical Detoxification Process

For many people, medical detoxification is the first step in their recovery journey, but it is not a form of treatment. Instead, detox provides a set of interventions, including an evaluation to determine the appropriate level of care, and stabilization.

The goal of detox is to help you to safely and comfortably stop using a substance as it is cleared from your body so that you can enter formal addiction treatment.2 At the end of detox, you should receive help in selecting an appropriate treatment program.

In medical detox, you will receive medical supervision and monitoring from doctors and other professionals while you undergo withdrawal. Medications and other supportive interventions may be used to help minimize withdrawal symptoms which, depending on the specific substance, can range from mild to extremely unpleasant or even life-threatening.

Co-morbid physical symptoms (such as medical issues) that may arise will also be addressed and managed during the detox process to ensure patient safety.

Medical detox is specifically recommended to manage withdrawal from substances such as opioids (including prescription painkillers like Oxycodone and illegal substances like heroin), sedative-hypnotics like benzodiazepines, and alcohol.2

However, medically supervised detox can also be used to treat withdrawal from a variety of other substances and is preferred over quitting “cold turkey” in almost all situations. At professional detox and rehab centers, medications are available to treat withdrawal from opioids, benzodiazepines, alcohol, nicotine, barbiturates, and other sedatives.3

Detox can be medical or nonmedical with different levels of care that take place in different settings. Medical detox includes medication, while nonmedical detox relies on social support. The level of detox you require is based on your specific needs.

Detox levels and settings outlined by the American Society of Addiction Medicine:4,5

  • Level I-D: Ambulatory Detoxification Without Extended Onsite Monitoring. This is a form of outpatient care that may take place in a physician’s office or be provided by a home health care agency.
  • Level II-D: Ambulatory Detoxification With Extended Onsite Monitoring. This is a step up from level one and takes place in a day hospital, with care provided by credentialed and licensed nurses.
  • Level III.2-D: Clinically Managed Residential Detoxification. This is nonmedical residential detox that offers 24-hour social support and is not intended for people who require 24/7 medical care.
  • Level III.7-D: Medically Monitored Inpatient Detoxification. This involves 24/7 medical care and supervision in a residential setting, such as a freestanding detox center.
  • Level IV-D: Medically Managed Intensive Inpatient Detoxification. This is the most intensive form of residential detox, offering 24/7 medical care in acute care inpatient settings, such as a psychiatric hospital.

The length of time you spend in detox depends on a variety of factors, including the type and severity of your addiction, whether you have other medical or psychiatric concerns, and your overall health. People usually spend anywhere between several days and a few weeks in detox.2

Medical detox is a beneficial and sometimes crucial first step, but is not stand-alone addiction treatment. Once you have completed detox, you will need to transition to an addiction treatment program to continue your recovery and learn the skills you’ll need to remain sober and prevent relapse.

Partial Hospitalization Program (PHP)

A PHP offers intensive outpatient treatment for people with severe addictions who are stable enough to live at home but still require a high level of support. It is useful because it provides a high level of care and a variety of services to help cement your sobriety.

People may enter a PHP as a step down from inpatient treatment or they may enter a PHP directly after detox. PHPs generally involve daily treatment for 4 to 6 hours per day.Some of the services you may receive in a PHP include:6-8

  • Assessment. This step involves gathering psychological, biological (medical), and social information to help formulate a treatment plan.
  • Treatment planning. Rehab therapists use the information gathered during assessment to establish the overall structure and goals for treatment.
  • Group therapy. This is one of the most commonly used treatment modalities. You may participate in psychoeducational, skills-development, support, or interpersonal process groups.
  • Family therapy (if applicable). This is used to address issues within the family unit that may contribute to or be affected by substance abuse.
  • Individual counseling. While not the primary form of treatment, it is used as an adjunct to group therapy so you can work one-on-one with a therapist as a way to obtain additional support.
  • Medication management. You receive supportive medications and are medically monitored to see if medication adjustments need to be made.
  • Relapse prevention education. This helps you learn skills you will need to stay clean and sober as you progress through recovery.
  • Self-help groups, such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or SMART Recovery. AA and NA are based on the concept of surrendering to a higher power and working through the 12 steps of recovery, while non-12-step groups like SMART Recovery are secular and focus more on individual responsibility and empowerment.

Inpatient Drug Treatment

Inpatient rehab is usually the first step after detox and the most effective form of care for people with severe addictions. Inpatient rehab offers different levels of care; highly structured rehabs may offer intense programming to help make recovery possible for those who have very severe addictions, whereas others may offer a less intense level of care and provide more free time.

The level that is appropriate for you depends on your specific needs. In either case, you will receive 24/7 monitoring and care for the addiction and support for any other medical or psychological symptoms you may experience.

People may have long- or short-term stays in inpatient rehabs, depending on their specific needs. Long-term stays can last up to 12 months, while short-term stays may last up to 6 weeks.3

Services offered at inpatient treatment centers are similar to those offered by PHPs and include:

  • Initial assessment.
  • Treatment planning.
  • Group therapy.
  • Family therapy (if applicable).
  • Individual counseling.
  • Medication management.
  • Self-help groups.
  • Relapse prevention education.

Depending on the specific focus of the rehab facility and amenities offered, some inpatient treatment centers offer additional services, such as:

  • Vocational rehabilitation or educational services. These services are designed to help you learn the skills you’ll need to re-enter the workforce.
  • Recreational therapy. This is a system that uses recreation (such as games and sports) to promote well-being and address specific goals, such as improving self-esteem and developing coping skills.
  • Music, art, or other creative therapies. These treatments help increase relaxation, help you manage stress, and improve overall wellness.
  • Nutritional therapy. As many people with addictions develop unhealthy ways of eating, nutritional therapy can help you learn better eating habits and improve your diet. This therapy often involves tailored diets to address specific nutritional concerns.   
  • Holistic services, such as yoga, massage, meditation, or other mind-body treatments. These services are not only intended to promote relaxation, but they can also help you manage stress, develop mindfulness, and allow you to cultivate a healthier relationship with your mind and body.

Patients often transition to outpatient programs after an inpatient stay, to extend their total time in rehab treatment and strengthen their foundation in recovery. The longer a person participates in addiction treatment, the better chance they will have at maintaining long-term sobriety.3

What Is Intensive Outpatient Program (IOP)?

Like PHPs, IOPs are a form of outpatient treatment; however, IOPs are less intensive than PHPs. You live at home but travel to a treatment center regularly for a specific duration of time. People usually attend IOP treatment for at least 9 hours per week spread out over 2 to 5 days per week. IOPs generally last 90 days.9

IOP treatment may be better suited for people who require a lower level of care than offered by PHPs or inpatient treatment, but who still need a relatively high level of structure. It is often ideal for people who have a safe and supportive home environment free of substance-use triggers.

People may step down from a PHP to an IOP and then continue to outpatient treatment. Conversely, people who have been unsuccessful in outpatient treatment may step up to an IOP for increased support and structure. The level of care you receive and the number of hours in treatment is adjusted depending on your needs.9

The types of services offered in an IOP are similar to other types of treatment and may include:6

  • Initial assessment.
  • Treatment planning.
  • Group therapy.
  • Individual counseling.
  • Family therapy.
  • Medication management.
  • Vocational and educational services.
  • Self-help groups.
  • Relapse prevention education.

Outpatient Rehab Programs

Outpatient addiction treatment is the least intense and therefore least supportive form of treatment. It is mainly appropriate for people who have completed other forms of treatment or for those who have less severe addictions and do not require a high level of care and monitoring.

There are different levels of outpatient care; you will usually begin with a higher frequency of sessions that gradually tapers off as you progress through the program, so you may only attend treatment once a week toward the end of the treatment process. People generally remain in outpatient treatment for at least 60 days.9

The services provided in outpatient care are similar to those offered in an IOP and include:9

  • Initial assessment.
  • Treatment planning.
  • Group therapy.
  • Individual counseling.
  • Family therapy.
  • Self-help groups.
  • Relapse prevention education.

Outpatient treatment can be considerably less costly than inpatient treatment, and this can play an important role in your decision as to what type of treatment to attend, depending on your insurance coverage and finances.

Generally speaking, an inpatient stay can cost between $14,000 and $27,000 per stay, whereas outpatient treatment can be free (in some cases, depending on your financial situation and the specific program) or up to $500 per session.10

Other Drug Treatment Options

Once treatment is completed, it’s important to have some form of support in place to prevent relapse and maintain sobriety. Continuing community care is one way of helping to rebuild a stable and healthy life, which can take months or even years in some cases.

Aftercare involves ongoing support, such as alumni meetings that are arranged by many recovery centers, 12-step or other types of support groups, periodic telephone support from counselors, and/or engagement with other community resources, such as vocational training or recreational therapy.9 Additionally, some people may choose to receive additional support through individual psychotherapy, marital counseling, or family therapy.

In particular, many people benefit from 12-step groups such as AA, NA, non-12-step groups like SMART Recovery or, for family and friends of people with addictions, groups like Al-Anon or Nar-Anon as ways of obtaining support, staying connected with others, and maintaining long-term sobriety and recovery. 

Addiction recovery is a lifelong process. Participating in support groups and other forms of aftercare can provide a strong sense of community and a support network as you continue on your recovery journey.

References

1. Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.

2. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment.

3. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Types of Treatment Programs.

4. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45.) 2 Settings, Levels of Care, and Patient Placement. Rockville, MD: Substance Abuse and Mental Health Services Administration.

5. Center for Innovation to Implementation. ASAM Pyramid.

6. Center for Substance Abuse Treatment. (2006). Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. (Treatment Improvement Protocol (TIP) Series, No. 47.) Chapter 1. Introduction. Rockville, MD: Substance Abuse and Mental Health Services Administration.

7. National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: Treatment Settings.

8. Center for Substance Abuse Treatment. (2006). Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. (Treatment Improvement Protocol (TIP) Series, No. 47.) Chapter 4. Services in Intensive Outpatient Treatment Programs. Rockville MD: Substance Abuse and Mental Health Services Administration.

9. Center for Substance Abuse Treatment. (2006). Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. (Treatment Improvement Protocol (TIP) Series, No. 47.) Chapter 3. Intensive Outpatient Treatment and the Continuum of Care. Rockville, MD: Substance Abuse and Mental Health Services Administration.

10. National Rehabs Directory. (2019). What is the Cost of Drug Rehab?