A man addicted to heroin is surrounded by his family in an intervention. He’s told he simply must stop using the drug right now or he’ll face serious sentences imposed by the family. He may lose the right to see his children or he may not be allowed to enter the home again. In reading this scenario, it’s easy to empathize with the family performing the intervention. After all, they are trying to save the life of the addict, and they believe that a treatment center can provide real help that can allow the addict to recover. But the addict may face a whole series of questions about the center itself. How long do I have to stay there? Where will I sleep? What will they do to me? Will it hurt?
For addicted people, treatment centers can seem frightening, and they may be under the mistaken impression that there is only one type of center available. Many addicted people simply refuse to enter a treatment center for this reason. The fact is that there are many different types of addiction treatment centers. If addicts learn more about these centers and they’re allowed to provide some input on the center chosen, they might be more likely to embrace the help treatment can provide.
Families should remember, however, that one round of treatment in a treatment center is rarely enough to help the addicted person make needed changes. According to a study published in 2005 in the Journal of Substance Abuse Treatment, drug users take, on average, nine years to fully recover from addiction. People may need to use several different types of treatment in order to make changes that will stick over the long term.
Most addicted people and their families are familiar with inpatient addiction treatment centers. For many years, this has been the method most commonly used to help people look past their addiction and gain the help they need to move forward with their lives. Many programs last for about 30 days, and people who enroll in these inpatient programs must live in the facilities during the entire time. They’re not allowed to leave the facility to see family, take trips or go out to eat. Instead, they continue to receive withdrawal medications from doctors and nurses, and they participate in many talk sessions, either one-on-one with a counselor or in groups with many other recovering addicts. People who enter these programs are asked to disclose what substances they took and for how long, and they may not be allowed to use any form of drug or alcohol during their stay. Even the use of mouthwash or cold medications could be restricted. The addicted person may be asked to sign a list of rules, and he or she could be asked to leave immediately if those rules are broken.
These inpatient programs can vary widely, depending on how much the addicted person is willing to pay. The fundamentals of the programs do not change, but the buildings themselves may be strikingly different. For example, some low-cost inpatient programs have high numbers of patients who live close together, sharing rooms and communal living areas. In some of these programs, recovering addicts do chores or handle other physical tasks that keep the facilities clean and operational. Some deluxe inpatient facilities look almost like resorts, and they’re located on beautifully manicured grounds. Patients often have private rooms and they’re rarely asked to handle any chores. Some insurance companies only cover inpatient treatments in low-cost facilities, while other insurance companies will also pay for lavish care.
In therapeutic communities, medical staff members provide medications and conduct counseling sessions to help addicts succeed. When addicts are not participating in group or one-on-one counseling sessions, they’re asked to do chores around the house. They’re often not allowed to have guests or leave the home for any reason. These facilities may also have a strict set of rules regarding behavior, and the addicted person may be asked to leave if he or she breaks the rules over and over again.
Patients can stay in therapeutic communities for months at a time, and these long stays may help them truly change their lives in ways that will stick. The National Institute on Drug Abuse studied residents of a therapeutic community who stayed for 90 days or longer and found that, a year later, only 15 percent had returned to daily drug use. By comparison, 38 percent of addicts returned to daily use when they had completed a three-week inpatient treatment program.
Therapeutic communities may be covered by some insurance policies, but longer stays may not be covered. Price rates can vary quite a bit from facility to facility, so it pays to ask about the cost long before the addict begins to call it home.
Small children or demanding careers may keep some addicted people out of treatment programs. They may not have the ability to step out of their lives for weeks or months at a time and receive intense addiction counseling. These addicts may benefit from an outpatient program, and these programs can vary in intensity. Some programs require the addicted person to spend most, if not all, of the day in the facility. Other programs require the addict to participate for only a few hours per day.
Frequent drug and alcohol testing is a large component of these outpatient programs. Since the addicts are out of the supervision of the addiction counselors for large periods of time, it can be easy for addicts to fall back into bad habits. Testing can keep the addict honest and help counselors spot relapses. While the addict is at the center, he or she might also participate in one-on-one or group counseling sessions. The addict might also take classes regarding addiction and learn more about how the problem works on a chemical level.
Since the addict isn’t living in the center and may not receive any meals at the center, the costs may be significantly lower than inpatient treatment programs. For people living on a budget without insurance coverage, these programs may provide real relief they can actually afford. Some addicts choose outpatient programs when they’ve completed an inpatient program and faced a relapse. The help here is a sort of refresher course that can help the addict avoid another relapse in the future.
No matter whether the addict lives in the facility or not, all treatment centers provide some sort of therapy. The goal here is to change the way the addict thinks, and therefore to help the addict change behavior through the mind. There are two sorts of therapy types that are commonly given. One is based on cognitive treatments and one is based on 12-step program principles.
In cognitive therapies:
The addict may meet alone with a therapist.
Therapy focuses on fears and triggers. The addict is asked to think of situations that bring on cravings and then come up with coping strategies.
Hypnosis and regression therapies may be used to help the addict deal with painful memories.
The addict may be encouraged to focus on his or her strengths and ability to fight the disease.
In a 12-step program:
The addict meets with a large group of other addicts and is paired with one recovering addict who can provide guidance.
Surrender is emphasized. The addict is encouraged to believe that the addiction is too strong to fight alone and recovery can only happen with the help of a higher power.
The addict is encouraged to “work the program,” walking through a series of steps that can encourage the addict to leave behind the guilt and pain of past behaviors.
Once the addict is moving through the program, he or she is asked to mentor another new addict. Working as a role model can give the addict a sense of power and purpose.
In short, the two methods diverge when it comes to controlling addiction. In a cognitive model, the addicted person is encouraged to feel strong, powerful and able to beat back the disease. In the 12-step model, the addicted person is asked to cede control. According to an article published in 2002 in Psychiatric Services, there is no significant advantage in one system or another, when it comes to recovery rates. Some addicts may simply prefer one method over another and some may benefit from a combination of both sorts of treatments.
Some treatment centers provide medication therapies to help patients heal. People who are recovering from heroin addiction, for example, may benefit from medication therapies for many years. Some patients even need to stay on these medications for life. People recovering from alcohol addiction or an addiction to painkillers may also need medication therapies to help re-train their bodies to function without the drugs. While many treatment centers offer these therapies, not all of them do.
Some addiction treatment centers rely on holistic therapies to help patients heal. Instead of prescribing medications and administering those medications to deal with symptoms, these facilities might use biofeedback, acupuncture, reflexology or massage. Medical management focuses on alternative therapies rather than medications. Since the centers focus on total body health, addicts may be given additional training that can help them improve their overall health. They might be taught to perform yoga or Tai Chi, and they may be asked to go on long walks each day. They may also be asked to change the way they eat and be given vitamin supplements to correct imbalances that persist in the body. The hope is that, at the end of therapy, the addicted person will have a completely new set of tools to use to care for the body and keep it healthy. Once the body is clean, the person may not want to contaminate it with drugs. Addicted people who are drawn to the alternative lifestyle may truly enjoy this method of addiction recovery.
Dual Diagnosis Therapies
Many people who are addicted to drugs, alcohol and compulsive behaviors have mental health disorders waiting in the wings. In fact, according to the National Drug Intelligence Center, four million adults in the United States had both addiction problems and mental health problems in 2002. Some common mental health issues that can exist with addiction include:
Obsessive Compulsive Disorder
People with co-existing problems may emerge from detoxification programs with a bundle of mental health symptoms that have gotten worse during the withdrawal phases. Their mental health status may make their relapse all the more likely, unless they get the help they need to deal with both issues.
Treatment centers that focus on these co-existing problems might provide mental health counseling for the disorder, helping the patient to deal with symptoms and understand how addiction may play into the progression of the disease. Patients may also attend group counseling for the addiction, learning how others have managed both problems and gone on to lead healthier lives. People with addiction and mental health disorders may benefit from these approaches, as they’ll be given their mental health prescriptions in a controlled environment. They won’t be able to abuse the medications in these facilities. And for some, this may be the first time they’ve had their mental health status addressed in a controlled environment. This could be an immense help.
Choosing the Right Center
For many families, the decision begins with a call to the insurance company. Some insurance companies cover specific forms of treatment for set periods of time but they do not cover other forms of treatment. Some insurance companies even regulate which facilities people can use in their area.
For people who choose to cover the cost of treatment on their own, the options are quite vast, and it can take some detective work to find the right facility. In general, a good facility should provide:
A tailored program. No addict or addiction is exactly the same, and the treatment program shouldn’t be so rigid that it can’t be tweaked to meet the needs of the individual.
A multi-faceted approach. Addictions are more than mere chemical dependencies. They involve feelings, habits and moods. The addict is more than just a receptacle of addiction. The facility should provide an array of services that can help the addict feel better about multiple aspects of his or her life.
Frequent monitoring. During the early days of recovery, it’s easy for addicts to slip back into old habits. An effective program will screen the addict’s urine or blood frequently, to make sure the person remains clean.
Medical management. Some severe forms of addiction can lead to life-threatening withdrawal symptoms, and medical staff should be available to step in and provide assistance if this occurs.
As mentioned, the addict should also be allowed to weigh in on the treatment facility chosen. In most cases, the addict is not legally required to stay in the treatment facility, and he or she can simply walk right out the door when the mood strikes. Addicted people who are forced to live in places they don’t agree with might be more likely to leave than people who are asked to live in places they helped to choose. It’s another way to allow the addict to take a bit of control back in his or her life, and that small gift could pay off big benefits in the end, both for the addict and for the addict’s family.