An in-depth explanation of the levels of care that are available to addicts seeking help.
Have you heard the story about the three frogs sitting on a log? Two decided to jump off. How many are left? Three. The two just decided to jump off. They didn’t do anything.
Deciding to get help for your addiction could very well be the most important decision you’ll ever make. Just like with the frogs, however, it’s simply that — a decision. Now you’ve got to take some action.
But what does that help look like? What should you do, where should you go — detox, treatment, inpatient, outpatient, sober living? There are a lot of care options out there, which is good. But decoding those options can be confusing.
That’s where this guide can help. It contains an in-depth explanation of the levels of care that are available to addicts seeking help. Let’s get started.
The first stop for many addicts is detox, the process by which you physically get the alcohol/drugs out of your system. If you’ve been drinking or using certain drugs for an extended period of time, you develop a physical dependence on them, which the National Institute on Drug Abuse defines as: “…the body adapts to the drug, requiring more of it to achieve a certain effect (tolerance) and eliciting drug-specific physical or mental symptoms if drug use is abruptly ceased (withdrawal).”
Once you become physically addicted to something, you will suffer mild to severe pain and discomfort if you abruptly stop taking it. With some substances — most notably, alcohol and benzodiazepines — detoxing on your own could be dangerous and even life-threatening.
During detox, you place yourself under the care of a physician who monitors you for signs of danger and prescribes medicine to help relieve withdrawal symptoms. The most common type of detox is the “short-term inpatient” variety, where you check into a medical facility staffed by doctors and nurses who care for you while you get physically stable. The typical stay is three to seven days. For a comprehensive look at the different detox methods available, read this post.
Detox is a vital part of recovery from addiction; nothing worthwhile can be accomplished until you are physically separated from your drug(s) of choice. But here’s an important caveat: Detox isn’t treatment.
Detox is about getting your body safely and comfortably off drugs (well, as comfortably as possible; some discomfort is inevitable). Once your body is physically clean, then treatment can begin. The unfortunate reality is that the majority of addicts who don’t receive some form of counseling and support services after detox will relapse. Addiction is simply too tough to beat on your own. Detox is but a start.
Intensive Outpatient Treatment (IOP)
In intensive outpatient treatment (better known as “IOP”), the addict continues to live at home while attending treatment classes and groups at an outpatient facility. Different service providers offer different programs, but one IOP may be 9 a.m. to noon four days a week, another may be evenings five days a week, and yet another could be all-day, three times a week.
IOP usually consists of:
- One-on-one and group therapy
- Drug education classes
- Classes to learn coping mechanisms and life skills
- Relapse prevention education
A few things to keep in mind regarding IOP:
- IOP is generally cheaper than inpatient treatment, as there’s no room and board to cover
- IOP enables addicts to continue working, going to school or otherwise fulfill personal responsibilities that they couldn’t do otherwise if they went inpatient somewhere
- But, you don’t get the structure and safety of an inpatient program, which is often an important component of success in early sobriety
Traditional Inpatient Treatment
This is what people usually mean when they talk about “going to rehab.” In this type of treatment, the addict enters an inpatient facility for what’s usually a 28-day program. Structured and intense, treatment consists of individual and group therapy and classes similar in nature to what’s offered in IOP. In addition to what’s listed above in the IOP section, the following is usually offered:
- Yoga, art and recreation therapies
- Family counseling sessions
- Exposure to 12-step meetings (many 12-step groups bring meetings into treatment facilities or, the facility may take clients on a van to “outside” meetings)
A few things to keep in mind regarding inpatient treatment:
- Being “away” is often a good thing for addicts in the tenuous stages of early sobriety; shielding yourself from drugs and temptation isn’t a long-term solution, but it is helpful in the beginning
- In some inpatient programs, you start in the detox side and move over to treatment when you get medically cleared to do so — these programs may not accept you if you don’t go through some type of detox first
- To complete this type of program, you need to take time off work or school and arrange for childcare if you have kids
Whether you go with IOP or inpatient, make sure you choose a facility that offers a 30- to 90-day aftercare program. Aftercare is just what it sounds like — a structured program that gives you additional support after you’ve completed treatment. These are group sessions held in the evenings two to three times a week.
A few things to keep in mind regarding aftercare:
- Some IOPs offer aftercare, but not all do
- All inpatient programs should offer aftercare — be wary of ones that don’t
- You generally attend with the same group of people you went through treatment with (although new ones cycle in and out), further strengthening the bonds of sober friendships that are so important in recovery
Also known as the “Florida Model” of addiction recovery, this model consists of several phases of treatment that gradually step down in structure and supervision.
The first phase of a long-term treatment program is usually 90 days to six months. It’s inpatient, but unlike the clinical, hospital-like setting of traditional inpatient treatment, these long-term facilities have a more resort-like, college campus feel to them.
A few things to keep in mind regarding long-term treatment:
- The components of treatment are usually the same as those offered in traditional inpatient treatment, but there’s a greater focus on sobriety as a new way of life — people are less focused on their discharge date so they can get back to their lives and more focused on building new, sober lives
- A longer program means greater protection from triggers and stressors and more time to work on the issues that contribute to addiction
- This model causes the greatest disruption to life as far as work, school and children are concerned
Sober Living/Halfway Houses
Most people in the recovery community use the terms “sober living facilities” and “halfway houses” interchangeably. This can be confusing to those who think of halfway houses strictly as places for people getting out of prison. Let’s clarify a few things: Halfway houses are sober living facilities that provide structure, supervision and rules for recovering addicts. These consist of such things as curfews, random urine tests and requirements that clients have jobs and attend 12-step meetings
People getting out of prison can check into a halfway house — in fact, many parole officers require it as a condition of parole — but halfway house aren’t only for this community. Many people who check in do so on their own volition and/or have never been to prison. This is the least restrictive level of care.
Clients may check into sober living after they’ve completed any of the above types of treatment — IOP, traditional inpatient or long-term treatment — because they would like additional support as they continue to lead a clean and sober life. But, treatment is not required before checking into sober living.
A note about 12-step programs & evidence based care
Twelve-step programs can be wonderful boons to people struggling with addiction. Millions of people worldwide have gotten and stayed sober through these fellowships since Alcoholics Anonymous was first founded in 1935.
While choosing an evidence-based program* that offers treatment consistent with what the scientific community knows about what works in addiction care is of utmost importance, the support and bonding offered in these programs can be most helpful. Don’t be afraid to reach out to these organizations to see how they can support and complement your care:
- Alcoholics Anonymous
- Crystal Meth Anonymous
- Cocaine Anonymous
- Heroin Anonymous
- Marijuana Anonymous
- Pills Anonymous
- Narcotics Anonymous
*A reputable facility will follow treatment standards that are backed by scientific evidence of what works. Ask if their treatment model follows the recommendations of any of the following organizations:
- The American Society of Addiction Medicine
- The National Institute of Drug Addiction
- The Substance Abuse and Mental Health Service Administration
- The National Institute of Mental Health
- The Joint Commission
- You deserve a healthy, sober life
Things probably look bleak right now. As you examine the options available to you, remember that millions of clean and sober addicts once stood where you now stand, wondering how on earth they were going to put their lives back together. It’s possible, and there are resources to help you. Don’t give up hope and take some action. Good luck.