Knowledge of what happens in rehab comes from experience, and even then, no two programs are exactly the same. To help navigate the recovery process system, it is helpful to have a basic understanding of key features, such as different program types, what happens between admission and program completion, and how to pay for treatment.
In some instances, a person who has developed an addiction to drugs may decide to seek recovery services and ask loved ones for help, or directly contact a recovery center and make arrangements for admission. In other instances, family members take charge of the process of encouraging the individual to enter treatment as well as making all the plans for rehab admission.
But how do people who have little to no knowledge of the rehab process manage to get loved ones into treatment? There are different paths to treatment, but all are slicked with the same intention: to help the person who is abusing drugs to achieve and maintain abstinence.
Staging an Intervention
When drug abuse is negatively affecting a person’s day-to-day life, and the person is resistant to treatment, concerned persons may opt to stage a formal intervention. This approach may or may not involve hiring a qualified and experienced interventionist.
Whether a professional interventionist is hired or not, there is established guidance on how to conduct an effective intervention. First, participants must explain their concerns to the person who needs help, and the group must make clear that entry into rehab is possible right now (because it has been planned in advance). Second, each participant must be clear what the repercussions will be if the person does not enter the designated rehab program right away. This information signals to the person of concern that the status quo is changing, and there will no longer be any support for any drug-related activities (e.g., paying rent, providing housing, paying bills, etc.). It is critical for concerned persons to have a united goal to immediately get the affected person into treatment.
An effective intervention will help those who abuse drugs to gain clarity about their need for treatment. It is critical not to lose the momentum of the meeting. A professional interventionist can help with every aspect of the intervention meeting and rehab admission planning. The drug rehab center that a family has selected may provide assistance, or at least guidance, on how to help get the person in need into treatment.
Types of Rehab Programs
The type of a program individuals seeking recovery enter depends on a host of factors, including the severity of the substance addiction, personal obligations, and finances/insurance. There is not a one-size-fits-all approach to addiction treatment because each client has different needs and goals. The key is to understand the available options, and to select the most suitable and feasible program, a critical task for which a qualified counselor can provide assistance.
As the National Institute on Drug Abuse explains, the following are the most common programming types on offer at rehab centers:
Long-Term Residential Treatment
A long-term residential program offers the most intensive level of care. Clients reside onsite at the treatment facility (typically not a hospital) and have access to care services 24/7. The most common type of long-term residential program is known as a therapeutic community, and lengths of participation usually run between 6-12 months. Aside from providing treatments targeted to help clients achieve and maintain abstinence, the main goal of therapeutic communities is to help integrate clients into a healthy and supportive social network. In this way, when clients complete a long-term residential program, they can more seamlessly re-enter mainstream society.
Short-Term Residential Treatment
A short-term residential program also provides an intensive level of treatment services but usually for a shorter period of time than long-term residential programs. These programs often follow an approach that is modified from the 12-Step model (in part because they were initially developed to treat alcohol use disorders).
The 12-Step model complements longer treatment stays because each of the steps takes time to complete. There are different treatment models in the short-term residential model, but one of the oldest ones is based on a hospital stay that is 3-6 weeks, which is then followed by services at an outpatient treatment program. In this way, treatment is partially residential and partially outpatient in order to maximize the recovering person’s likelihood of maintaining abstinence.
A recovering person may enter an outpatient treatment program after completion of a residential treatment program or as the initial start to the recovery process. Outpatient programs vary in intensity and treatment curriculum. A low-intensity program may provide drug education and minimal additional services. A high-intensity program may look similar to a residential program, but clients return home each night.
Clients typically participate in outpatient services for at least three days a week, for a minimum of 4-6 hours. An outpatient treatment setting is generally most suitable to individuals who have an adequate support system and/or personal obligations to meet, such as childcare, work, or school commitments. One important key to making the most of an outpatient program is to ensure that outside influences do not compromise the recovery process.
Partial Hospitalization Program
A partial hospitalization program can be thought of as less intensive than a residential program but more intensive than an outpatient program. Clients reside at home but engage treatment services at least five days a week and typically for 4-6 hours each day.
Clients in a partial hospitalization program may have a moderate to severe history of addiction, but their condition or risk of relapse is such that a residential program does not appear warranted.
If a treatment program does not provide a sufficient level of care, a referral can always be made to a higher intensity program. Treatment programs should always be dynamic and modifiable. As recovery is an individualized process, finding the right program setting is an integral component of effective treatment.
Overview of Steps from Admission to Graduation
Depending on how one looks at it, recovery has different starting places. If looked at from the widest angle, it begins with the decision to achieve sobriety. The critical next step, then, is to find a suitable rehab center. Most all rehab centers are staffed with treatment consultants who provide free and confidential consultations. The goal of the consultation is to acquaint prospective clients with the services on offer and make helpful treatment recommendations.
Recovery starts with the detox process. When a person is admitted to rehab, the center will follow a structured treatment plan. In some instances, however, a person may begin treatment at a detox facility and then be referred to a local inpatient or outpatient program.
The detox phase of treatment is typically 3-14 days. Medical detox is generally recommended; it’s always required for detox from alcohol, opiates, and benzodiazepines. After medical detox is complete (or a person is stabilized on abstinence maintenance medication, such as methadone), recovering individuals will enter the abstinence maintenance phase of treatment, which takes the form of different primary services, supplemental services, and wellness-oriented offerings.
In outpatient programs, treatment is typically 30-90 days. Residential programs can span that same amount of time; however, there are always exceptions. Some people continue treatment in either program type for several months.
In terms of primary services, the cornerstone of recovery after detox is therapy. For this reason, most all rehab centers offer both individual and group recovery sessions. Typically, individual sessions occur weekly whereas group sessions are offered daily.
In terms of supplemental programming, comprehensive rehab programs will typically offer recovery groups (often 12-Step-based meetings), drug education, art and music therapy, and family therapy. Wellness-oriented offerings range greatly and often tie into a program’s level of funding. Examples of wellness services are massage, acupuncture, yoga, and equine therapy. When there is a gym onsite, a daily exercise period may be factored into the curriculum.
Now that a general outline of what to expect has been outlined, it is helpful to take a closer look at the most critical features of recovery programs, detox and therapy, as well as a main component of aftercare, 12-Step meetings.
Typically, the first phase of treatment for substance abuse is detox. Although detox is a natural process, it can be aided by medications and medical professionals.
Detox is best understood if one has a basic understanding of physical dependence and addiction. As the National Institute on Drug Abuse explains, there are important differences between physical dependence and addiction. At the outset, it is useful to know that a person can be physically dependent on a drug (consider a person who regularly takes a prescription opioid such as hydrocodone after an injury) without becoming addicted to it (in this example, the person fully observes the doctor’s instructions and does not abuse the opioid in any way). However, the reverse proposition is not true; a person who is addicted to a drug is generally physically dependent on it.
The two main hallmarks of physical dependence are tolerance (i.e., needing more of a regularly used drug to achieve the familiar and desired effect) and withdrawal. The main hallmark of addiction is a psychological attachment to the drug. Detox addresses the physical withdrawal process, whereas therapy (discussed later) addresses one’s psychological addiction to drugs.
During physical withdrawal, a person experiences side effects, such as nausea, fatigue, muscle pain, and cravings for the drug (which present a risk for relapse). These side effects can be managed and observed when a supervised medical detox is undertaken.
In terms of a treatment setting, detox can occur onsite at a rehab facility equipped with a detox center, a hospital, or a standalone facility dedicated to this service. Medical professionals do not recommend anyone who has been abusing drugs undergo at-home detox.
When detox occurs as part of a structured recovery program, it can occur with or without medications, depending on the specific drugs of abuse present in the individual’s system. Using medication in detox (and also in abstinence maintenance phase) is often referred to as medication-assisted treatment. At present, the use of medications in detox only occurs when a person is in withdrawal from opioids or alcohol. If a person is recovering from these drugs, a treatment professional on staff at the detox center or rehab facility will be able to explain whether medications are recommended and, if so, the specific relevant details.
Therapy is the main pillar supporting the architecture of drug treatment programs across the US. Therapy is an umbrella term that encompasses over 200 schools of thought and practice. An accredited rehab center will implement a combination of therapies that best complement its overall treatment approach and that are ideally research-based.
According to the National Institute on Drug Abuse, the following therapies are research-based (i.e., have proven effective in the treatment of substance abuse in the context of individual and group sessions):
- Cognitive Behavioral Therapy
- Contingency Management
- Motivational Enhancement Therapy
- The Matrix Model
- Community Reinforcement Approach
Therapy is dynamically woven into the recovery process. Certain approaches, such as Motivational Enhancement Therapy (MET) may be introduced early to help improve a recovering person’s readiness for change and acceptance of treatment. An approach oriented to motivate participation in the recovery process can complement, or be followed by, one that focuses on providing clients with the skills necessary to avoid relapse, such as Cognitive Behavioral Therapy.
In other words, different therapies can be most appropriate to the recovery process at different times. The key is for recovering persons to receive treatment tailored to their initial needs upon admission that also evolves with them as their needs change throughout the different phases of recovery.
At the outset, it is important to note that 12-Step groups are not considered therapy in the clinical sense of the term. Therapy refers to both individual and group sessions that are led by a fully trained and licensed mental health professional. Therapists follow a theoretical approach to treatment (as discussed above) in a rehab or other structured setting. Twelve-Step groups are fellowships; they are member-led, and no therapists or licensed professionals are necessary to the process.
Rehab programs provide 12-Step meetings for clients because they help fortify the recovery process and also provide an introduction to a service that individuals can engage over the life of their recovery. After graduation from a recovery program, attendance at 12-Step meetings is often considered to be an essential component of the aftercare process. Traditional 12-Step programs in the “Anonymous” family, such as Alcoholics Anonymous and Narcotics Anonymous, are faith-based. As some individuals in recovery object to faith-based mutual aid groups, there are alternatives, such as SMART Recovery.
Although recovering people in rehab may participate in a faith-based 12-Step program during their stay, afterwards, they can opt to find local non-faith-based groups (or the other way around, from non-faith-based mutual aid meetings to faith-based ones). When it comes to 12-Step meetings, the important takeaway is that they are often considered to play an instrumental role in the recovery process, and they are readily available inside and outside of rehab.
Paying for Rehab
As the Substance Abuse and Mental Health Services Administration reports, the most common reason people do not enter a structured rehab program is that they believe they cannot afford it. We should note that the survey that yielded these results predated the Affordable Care Act and hopefully a shift is occurring today in this mindset. Irrespective of one’s finances, with the appropriate information and planning, paying for rehab need not be a barrier to treatment. In the case of a state-run program, there may be no cost to clients.
In terms of the cost of private rehab services, rehab centers may not publish their costs on their official websites because no standard fee schedule may accurately reflect the true costs for an individual client. Service costs directly relate to the individual client’s required level of care and length of stay. However, rehab centers usually state on their websites methods to pay for their services. In addition, some rehab centers may offer payment plans or have a sliding scale fee plan. The most common sources to pay for rehab are:
- Private health insurance
- Federal military insurance
- Medicaid or Medicare
- A state-financed health insurance program
Since the ACA has been passed, it bears discussing how it impacts coverage for drug recovery treatment. All plans that are purchased on the Marketplace, created by the ACA, provide coverage for the treatment of substance use disorders (though insured individuals will need to learn the specifics of claims coverage from the insurance carrier).
Individuals who presently do not have coverage can access the Marketplace and get help from a trained “navigator” by visiting the government’s official website, www.healthcare.gov. Individuals who are below a certain income may qualify for Medicaid. A navigator can help to process an application for private health insurance or Medicaid.
Information for Families
Families often play an instrumental role in every phase of recovery, including guiding individuals to recovery, supporting them while they are in rehab, and assisting with the aftercare process. For this reason, it is necessary for family members and other concerned persons to have information on how to get help.
The National Institute on Drug Abuse has published a guide: “Seeking Drug Abuse Treatment, Know What to Ask.” The guide is designed, in part, to help concerned persons to select an appropriate treatment program. After a suitable rehab center is identified and the recovering person is admitted, family members may be left wondering where they fit into the process.
The role that family plays in the recovery process depends largely on the rehab center’s offerings. Family members can be integrated into the rehab program curriculum in different ways. Some programs may offer family therapy, educational programs, and/or family-based social activities.
Family Behavior Therapy (FBT) is one family treatment model that a rehab center may offer. FBT has been shown to be more effective than supportive counseling and includes many pragmatic components. In FBT sessions, the therapist, client, and family members can work on substance abuse concerns as well as other problems, such as family conflict, unemployment, or depression. Therapists and the family work together to develop behavioral strategies and improved communication skills that can be applied in the home setting.
Education programs for families may include information about the causes and effects of drug abuse. Families may learn how to identify ways they may be enabling the substance abuse process or have become codependent on the illness. Knowledge about addiction and how the family dynamic interacts with it can be instructive to everyone and create a family environment that is supportive of abstinence.
Family-based social activities, such as a “Family Day” onsite at the rehab center, are intended to help maintain and fortify the bonds between recovering persons and their families. While these programs can be especially helpful when the recovering person is in a residential program, outpatient programs may also offer social programming for families.