For Immediate Treatment Help Call 1-800-610-4673

Levels of Care


Inpatient Treatment

The treatment of addiction is sometimes called a science, but it is also an art.  There is no “one size fits all” when it comes to addressing a chronic condition.  In light of that fact, the American Society of Addiction Medicine created The ASAM Criteria, outlining a numerically ordered, description of levels of addiction treatment, also called the CONTINUUM.

The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related and Co-Occurring Conditions, as its full title suggests, offers guidelines for care based on several important factors, used in assessment for appropriate care for addiction or substance abuse (and, when appropriate, co-occurring conditions–more on that later).

The levels of care guide facilities with describing care services available, help practitioners and families with placement in an appropriate facility to assist with recovery, and assist insurance companies with billing codes for level of treatment.  Levels of care are called a continuum because those receiving treatment can move fluidly up and down the treatment levels, as appropriate and as conditions improve or worsen.

More importantly, though, levels of care improve outcome: treating addiction with the appropriate level of intensity for that individual makes recovery more likely and more sustainable.

Here’s what you need to know.

Assessing a Complex Condition

In order for an assessment of an appropriate level of care to be determined, two things are required: a thorough understanding of treatment levels and an honest assessment of the individual.

As simple as that sounds, many complexities may get entangled in that process.  For example, insurance companies or court orders from judges may choose a lower level of care (such as outpatient treatment) for financial reasons, because it is a first attempt at treatment, or seemingly more accessible.  Those factors may have nothing to do with the two criteria named above.  The problem, then, is that treatment can look like it “doesn’t work,” when, in fact, it was never the appropriate treatment program for that particular individual’s condition.

So first, a more thorough definition of addiction:

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.  Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations.  This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”

Given that addiction affects the biology, psychology, social function and even the spiritual state of the individual involved by its very definition, it’s easy to see why a oone-size-fits-allapproach would have little chance of success–it would need to address those complex and individual factors in a way that cuts to the root of the problem for that person.

Fortunately, the assessment guidelines by the ASAM look at several criteria to determine the condition of these aspects of an individual’s life, factors such as:

  • What the individual has been using, and for how long,
  • Health history and level of physical change/diminished health as a result of substance abuse,
  • Emotional and behavioral state, including readiness/willingness to change,
  • Previous experience with attempts to change, and history of relapse,
  • Current living conditions, employment, state of familial relationships, etc, which may impact the success of treatment.

 

As you can see from this list, differences in appropriate care naturally emerge as you have an understanding of the individual being assessed.  For example, someone with a job, a great deal of familial support, and a genuine interest in changing would not need the same level of care as an individual with a diminished physical condition from substance abuse, insecure living conditions, a history of relapse, or no desire to change.

Changes in Condition

Looking at an assessment, such as determining appropriate care, can begin to seem like something that would be decided by an outsider–family members, a physician, a court order, etc might all want to dictate how change should go.  In some cases, intervention is indeed necessary, and the physical or emotional condition of the addict is not in good enough shape to determine to make a change on their own.

However, the guidelines for level of care were written with the addict in mind–as much as possible, the individual with a substance use disorder should have a say in how treatment goes.

The National Institutes of Health maintains a library of medicine, The National Center for Biotechnology Information (NCBI), which makes research into health sciences broadly available for the public.  For those old enough to remember going to a library and getting out little boxes of microfiche or rolls of film with medical research journals on it, the internet has changed all of that.  Now, many publications and the raw research behind them are available for anyone with a desire to read them.

Thanks to this database, anyone can understand the two primary settings for addiction treatment: inpatient and outpatient care.  The levels of care guidelines are subdivisions within these two primary possibilities.

Additionally, the NCBI has published what has become known as “Least Restrictive Care”–a patient’s basic, human and civil rights and right of choice for care, which state:

  1. Patients should be treated in those settings that least interfere with their civil rights and freedom to participate in society.
  2. Patients should be able to disagree with clinician recommendation for care. While this includes the right to refuse any care at all, it also includes the right to obtain care in a setting of their choice (as long as considerations of dangerousness and mental competency are satisfied). It implies a patient’s right to seek a higher or different level of care than that which the clinician has planned.
  3. Patients should be informed participants in defining their care plan. Such planning should be done in collaboration with their healthcare providers.”

The guidelines do go on to acknowledge the complexity of situations and state laws, which vary.  If an individual is a serious threat to himself or others, of course, a higher level of intervention and care would be warranted.  Yet, all substance abuse has an inherent element of self-harm.

All of this means that great care must be taken to provide appropriate care, while maintaining an addict’s self-determined involvement and civil rights.

Ideally, even more intense levels of intervention and care, will work toward improving the addict’s ability to freely and cooperatively improve his or her condition.  All treatment facilities have this data, and therefore choosing the right treatment program for a friend or loved one should be done with an eye toward long-term improved decision-making power.

The Levels Themselves

All of the above data pertains to a better assessment of the addict, as an individual, but what about the other criteria for effective assessment–an understanding of the levels themselves?

But first, a note about recovery rates.  If you or a loved one have struggled with substance abuse, it’s easy to feel hopeless, as if addiction is unmanageable.  People give up, turn to substitute addictions, or otherwise come to believe that the situation is irreparable.  In actuality, treatment for addiction has comparable success rates to other chronic conditions, such as Type I Diabetes and hypertension.

The comparison to other chronic diseases is more useful than just those success rates, though.  Take diabetes, for example.  No one questions the diabetic about not eating cake and cookies, but when someone with a substance use disorder chooses to abstain even from alcohol, friends and family don’t always understand.  Or when someone with a substance use disorder has a long-term treatment program, with follow-up for many years, insurance companies want to stop paying for it.

But a chronic disease doesn’t evaporate.  One can manage a condition and even completely change–just as addiction changes the mind, body and spirit, freedom from addiction can make lasting changes–but the appropriate long-term management for a chronic condition is an individual decision and process.

Overall, addiction treatment has a success rate of 40-60% across all treatment options. Obtaining the best outcome, then, has a great deal to do with choosing the appropriate level of care.

There are five overall levels–0 to 4, with decimals to delineate the sub-levels along what is intended to be a continuous line of care.  The freedom to move up and down that line, as a condition changes, is built into the decimal system.

Level 0.5 – Early Intervention for Adults and Adolescents

The smallest level of care might not even be recognizable as treatment, because it is instead an educational level, a preventative treatment.

When adults or adolescents identified as at-risk for substance use disorders receive preventative education,  they are getting Level 0.5 care.  This level can vary greatly, but may include:

  • Information about the potential for addiction of a prescription drug, such as a painkiller after an operation.
  • Drug education in at-risk communities or facilities, such as schools or even detention facilities.
  • Assessment of unconfirmed substance use disorder, the assessment process itself not yet being a placed level of care above 0.5.

 

Level 1.0 – Outpatient Services

For those tackling a substance abuse problem, or in the maintenance stages of a substance use disorder, receiving less than 9 hours per week of care (6 hours/week for adolescents), the care level is considered Level 1.0.

Outpatient services are often the first request of insurance companies or court orders, due to the lower cost of these reduced services.  Those undergoing outpatient services can still maintain full-time employment or school, live at home and otherwise continue day-to-day living.

However, outpatient services may not be the appropriate level of care.  When detoxification is needed or the stress of everyday life triggers substance abuse, removal from the scene to a live-in, inpatient facility, or a change of environment, may be a necessary part of recovery.

Even after a higher level of care on the CONTINUUM, most people in recovery will at least receive outpatient treatment to maintain stability.

Level 2 – Intensive Outpatient or Partial Hospitalization Services

Level two is broken into two numerals, 2.1 and 2.5, and is the lowest level of care recommended for anyone with a co-occurring condition and addiction (also called a dual diagnosis).

 

Co-occurring disorders refer to a complex list of conditions that may be present, in conjunction with, in advance of, or in result of addiction.  That list includes:

  • Depression
  • Anxiety
  • Schizophrenia
  • Paranoia
  • Personality disorders, such as bipolar disorder

For those individuals with a dual diagnosis, people whose treatment should include a detoxification component, or adults or adolescents with an extensive history of alcohol or drug abuse, Level 2 care should be considered the minimum level of care.

Level 2.1 is called Intensive Outpatient Services.  It includes 9 or more hours of treatment per week for adults, and 6 or more hours per week for adolescents.  The individual attends treatment services during the day, but can still go to school or work in the evenings and/or weekends, while undergoing active care.

Level 2.5 is called Partial Hospitalization Services for adults and adolescents.  It typically includes 20 or more hours of services per week, but for those stable enough to not require 24-hour care (such as able to be housed in a nearby facility).

Level 3 – Inpatient Care

Level three has four further subcategories, but they all involve residential or hospitalization care.  At least for the initial stages of care, in many cases, detoxification in a supervised setting may be the safest approach to treatment.

Withdrawal can be dangerous, or even deadly (in the case of benzodiazepines (benzos), opiates or alcohol).  Alcohol withdrawal syndrome may include hallucinations, fever and seizures, known as delirium tremens (DT).   Drug withdrawal can induce vomiting, which potentially leads to serious dehydration.

 

The length of time of substance abuse, and the complete list of substances involved, are a crucial component of assessment to determine appropriate level of care, within all levels, including the sublevels of Level 3.

  • Level 3.1 – Clinically Managed Low-Intensity Residential Services includes 24-hour structure and support, with at least 5 hours of clinical treatment services per week.
  • Level 3.3 – Clinically Managed Population-Specific High-Intensity Services is the designation for 24-hour specialized care, for those individuals with cognitive impairments or in danger (of self-harm or in a dangerous living environment). This level of care provides the structure and assistance needed under those circumstances, for adults only.
  • Level 3.5 – Clinically Managed Medium-Intensity Residential Services (for adolescents) and Clinically Managed High-Intensity Residential Services (for adults) is a transitional level, of more intense care, to stabilize care until outpatient services would be appropriate. As discussed in Level 1.0, a more intense level of care may be required for initial treatment stages (such as detoxification), until an individual in recovery can safely participate in outpatient-only care.
  • Level 3.7 – Medically Monitored High-Intensity Inpatient Services (for adolescents) and Medically Monitored Intensive Inpatient Services Withdrawal Management (for adults) – this designation level includes 24-hour medical supervision, such as round-the-clock nursing staff, and those who require medication, or have medical conditions such as dementia. Level 3.7 would not normally be a first line of approach, but only after demonstrated inability to complete withdrawal through other levels of care.

Level 4 – Clinically Managed Intensive Inpatient Services

The highest level of intensity of treatment is for those who require 24-hour medical care, with daily physician supervision, due to severe and unstable medical conditions, is Level 4.  The goal of Level 4 care, like other higher designations, is to provide the intense care needed for patients to safely participate in a lower level of care, with greater personal mobility and freedom, after an initial period of restrictive and medically-monitored treatment.

Inpatient Care

Any inpatient treatment is at least Level 2, but residential facilities provide Level 3 care, and may include a focus on life skills such as communication skills or job training.  Level 3 care includes daily structure and treatment, such as detoxification services, but may also include activities such as hikes, sports, art therapy or music therapy, to name a few.

The goal of inpatient care is to assist with the initial detoxification process, but in an environment that is also safe for personal assessment and growth.  Through individual or group therapy sessions, life-skills building activities and seminars, and the guided attainment of personal goals, an individual receiving inpatient care become better prepared to return to daily life and handle its stressors without substance abuse.

Start with an Assessment

To determine the appropriate level of care for yourself or a loved one, speak with one of our highly trained staff.  We start with a thorough assessment which will assist with both placement and appropriate treatment objectives to start the road to recovery.  In those cases where previous treatment was left incomplete, we can help you determine the appropriate level of care for a more successful treatment process.

Get started with an assessment today.



View items…


Drug and Alcohol Detox

Detoxification is a process in which people addicted to drugs or alcohol are medically cleansed of the toxins created by those substances. Detoxification, or detox for short, is almost always the first step in the rehabilitation process for addicts and alcoholics. Before addicted individuals can be admitted to treatment, they must first complete the detox process. There are many different forms of detoxification depending on the substance of dependence and the severity of the addiction.


There are also some drugs of abuse that do not necessarily create a particularly significant physiological dependence and therefore do not specifically require medical detoxification, such as methamphetamines, cocaine, and marijuana. The abuse of these drugs can result in a serious psychological dependence which often requires intense therapy and residential treatment, but not necessarily medically assisted detox. Nevertheless, detox protocols do exist for these substances. Other drugs such as heroin, alcohol, and prescription medications like opiates, barbiturates, and benzodiazepines create not only a psychological but also a serious physical dependence, requiring medical detoxification in most if not all cases of long-term use.

The Detox Process

There are mainly three steps involved in drug and alcohol detoxification:

  • Evaluation – The patient is first tested and evaluated for detox. Mental health issues and psychological evaluation will also be conducted to help evaluate the patient’s underlying issues.
  • Medical Stabilization – This can be done with or without medication, but in most cases, medication is necessary to help stabilize the patient and treat withdrawal symptoms.
  • Guiding patient to treatment – The final step is the recovery process itself, usually involving continuing on in a drug rehabilitation program.

Alcohol Detoxification

Alcohol is one of the most dangerous drugs of abuse, not only because of its availability and social acceptance but also because of its damaging effects and dangerous detox.  Many alcoholics who try to stop drinking on their own experience uncomfortable and even dangerous withdrawal symptoms, and in the worst cases, these symptoms can be fatal.  Alcohol withdrawal symptoms are dependent on the severity of the alcoholism and length of time the alcohol abuse has be going on.  During alcohol detoxification, the patient is medically monitored during the withdrawal of the alcohol from their system.  During this process, alcoholics may experience anywhere from mild to severe withdrawal symptoms such as sweating, headaches, anxiety, increased heart rate, insomnia, agitation, and delirium tremens (DT’s) leading to seizures and sometimes even death .  At a medical detoxification program, medical staff will use various medications to ease the most severe symptoms of alcohol withdrawal.  Most often drugs in the class of benzodiazepines such as Librium and Diazepam are used to assist with anxiety and act as anticonvulsants to prevent seizures from alcohol withdrawal.  Despite the medical assistance, alcohol detoxification always runs risks and for very severe cases of alcoholism where the patient has experienced cirrhosis of the liver or other organic diseases caused by drinking, the detox process can last several weeks to months for medical care. Most cases of alcohol detoxification, however, take anywhere from 3 to 10 days.

Opiate Detoxification

Heroin and opiate-based painkillers like Vicodin, Percoset, Darvon, Morphine, Fentanyl, OxyContin, and Methadone not only cause a psychological addiction, but also a physical addiction that makes the detoxification process especially difficult. With stimulant drugs, the addiction is mostly psychological and the physical symptoms are kept to a relatively low grade of discomfort.

Detofication of opiates from the body is a process that often involves other drugs being administered to make the process more tolerable. Some of the symptoms of opiate withdrawal are nausea, vomiting, diarrhea, high fever, cold sweats, shaking, muscles spasms, insomia, extreme fatigue, and muscle aches. Because the pain and discomfort is so severe in many cases of opiate withdrawal, addicts are often given benzodiazepines like Klonopin or Valium to “take the edge off” and help an individual to relax and hopefully sleep through the detoxification process.  Alternatively, other opiates are used to gradually taper the addict, most often buprenorphine (Subutex® or Suboxone®) or methadone.  These drugs have very long half-lives, so when the effects of them wear off, the user experiences less severe withdrawal symptoms than from their drug of choice.  

Detoxification of opiates from the body, like with stimulants, can range in length and severity, depending on the individual and his or her drug and health history. In general, a traditional opiate detox takes anywhere from 3-10 days, and thereafter a period of time when the recovered user may experience mild depression, lethargy, and fatigue, and other protracted withdrawal symptoms, known by the acronym PAWS (Post Acute Withdrawal Syndrome).

Another form of opiate detoxification is rapid opiate detox, in which doctors anesthetize the patient, administer a combination of opiate antagonist medications (usually narcan and/or naltrexone) that send the patient into immediate acute withdrawal for several hours while under anesthesia until the opiates are out of the system. Patients are usually monitored in the hospital overnight and then sent home within 1 day of the procedure.

Benzodiazepine Detoxification

Benzodiazepines are drugs classified as mild tranquilizers, which act as Central Nervous System (CNS) depressants, slowing brain function and relaxing muscles.  Although benzodiazepines have beneficial uses, such as their uses as muscle relaxants and sleep aids, the prolonged use of these drugs can lead to extreme physical dependence, which makes the detox process very dangerous.  Generally, when people addicted to benzodiazepines such as Xanax, Ativan, Valium and Klonopin undergo the withdrawal process, they can experience sleep disturbances and insomnia, irritability, headaches, fatigue, sweating, anxiety, and most importantly, seizures.  The withdrawal process generally creates the very symptoms that benzodiazepines are indicated to treat.  The way medical staff ensure safety during the withdrawal process for individuals addicted to benzodiazepines is to administer limited amounts of phenobarbital, as it is less addictive and less powerful than the benzodiazepines it is used to treat, but works well as a mild sedative and anti-epileptic (anti-seizure) medication.  Until the toxins from benzodiazepine abuse have been completely removed from the body, it is important for the addict to remain under medical care.  The cessation of benzodiazepine use can cause dangerous and sometimes deadly seizures until the drug is out of the body.  For some of the drugs in this class with longer half-lives, the toxins can remain in the body for as long as 4-6 weeks depending on the severity and length of the abuse.

Detoxification from Cocaine, Methamphetamines, and Other Stimulants

Detoxification from stimulants like cocaine, crack crack cocaine and meth, like with any other substance, can be psychologically grueling. Detoxifying the body of these kinds of drugs can cause significant psychological withdrawal symptoms including anxiety, irritability, insomnia, severe cravings, and fatigue. Detoxification from methamphetamine specifically can cause psychotic reactions, severe depression, and confusion.

The most common detox medications used to treat stimulant withdrawal are antidepressants and mood stabilizers. The detox process can last anywhere from 3 to 10 days, but in most cases tends towards the shorter end of this scale.

The Importance of Detox for Drug and Alcohol Recovery

The process of detoxification is only the beginning of drug or alcohol rehabilitation, but it is one of the most important parts of this process.  Detox is imperative because the psychological, social and behavioral rehabilitation process cannot begin if there is still a physical dependence on drugs and alcohol.  This physical dependence is one of the main motivations for alcoholics and drug addicts to continue using, as it is responsible for the painful and sometimes dangerous physical withdrawal symptoms that occur upon cessation.

Detoxification seems imposing because of the horrible stigma it has for being painful and uncomfortable, but rest assured that it is necessary for the recovery process to begin, and pales in comparison to the pain and dangers associated with continuing addictive behaviors.  The medical staff required for the detox process is dedicated to ensuring the safety and comfort of this procedure, and are assisted by a myriad of medicines available to aid.

Treatment-Centers.net

As it is with finding the appropriate treatment center, it is important to find the right detox facility to assist with withdrawal from addictive substances.  Some treatment centers do not offer detox, while others do, but this service can be found at most hospitals.  

If you are having trouble determining the best detox facility for an individual’s needs, give us a call.  We offer comprehensive, no-cost assessment and referral services to drug and alcohol detoxification programs and addiction treatment centers. If you are in need of help, please explore our site, fill our our confidential online drug and alcohol assessment, and by all means, CALL US – we’re here to help.



View items…


Residential Treatment

A residential treatment center (RTC), also called a rehab or recovery center, is a live-in health care facility providing therapy for substance abuse, mental illness, or other behavioral problems.

Residential treatment centers are often the best line of defense against a life of addiction and other compulsive behaviors. Although there are many levels of care for addiction treatment including one-on-one therapy, outpatient, and day treatment, residential treatment has proven to be the most effective form of rehabilitation for behavioral health disorders.  In the addiction recovery field, there are literally thousands of residential treatment centers geared towards all kinds of addictions and compulsions to help millions of people get their lives back on track.


Why are Residential Treatment Centers More Effective?

Residential treatment is considered the most effective level of care for addiction and co-occurring disorders for a variety of reasons. First and foremost is the length of stay, usually ranging from 30 days up to a year or more in long-term residential settings.  Longer lengths of stay are directly correlated with better treatment outcomes (i.e. longer lengths of sobriety following treatment).  Another reason is that the addict or alcoholic is in a safe, supportive environment with trained therapists and counselors, many of whom are in recovery themselves, giving them an advantage in relating with the individuals they treat. The difference between being in a safe and supervised environment versus going to outpatient treatment or therapy where the addict is free to resume their addictive behavior after the session has ended for the day can be the difference between life and death for addicts on the edge. It is not only the controlled environment that serves as a huge advantage in maintaining sobriety, but also the fact that residential treatment centers offer a host of activities to build self-confidence and life skills necessary for successful functioning in the real world after residential treatment has ended. Furthermore, residential treatment centers often employ far more intense forms of therapy than other levels of care. This intensity has been proven effective in diagnosing and treating the root causes of addictive behaviors.

Over the years, different kinds of residential treatment centers have emerged to cater to the changing needs of the addicted population. In addition to short-term residential and long-term residential treatment, there are treatment centers geared toward specific groups of people and people who do not respond well to the 12-step program or who would like to try something different. Some of the more popular residential treatment models that have emerged over the past 10 years include gender-specific treatment, gay/lesbian treatment, and adolescent treatment. Along with these more specific residential treatment models, there has been an emergence of alternative treatment methodologies like holistic treatment and faith-based treatment which offer alternatives to 12-step recovery.

Finding Residential Treatment

In the search for a residential treatment center, it is important to explore what each program has to offer to determine whether it will be most effective for the individual addict. Just because a residential treatment center is more specialized does not necessarily mean higher quality or better treatment outcomes. In the end, the rate of success comes down to the resolve of the addict or alcoholic entering treatment and how committed they are to their own sobriety. Please continue to browse our content pages to learn more about addiction and treatment. When it is time to find the right residential treatment for you or your loved one, please visit our publicly rated and reviewed treatment directory, with the largest database of addiction treatment, centers on the Internet, or call us \ and we will do all we can to help you find the most appropriate treatment center for your needs.



View items…


Outpatient Treatment

Drug abuse is a complex issue. It often requires specific types of treatment. One of the most well-known treatments for addiction is outpatient treatment.

Within outpatient treatment there are two subcategories. One is Intensive Outpatient Treatment, or IOP. The other is Partial Hospitalization Program or PHP. IOP recovery options are best for those who require treatment but are unable to enroll in a facility full-time because of employment, education or familial commitments. Those enrolling in IOP receive treatment 3 hours a day, three days a week on average.

PHP is more intensive than IOP. Those taking part in partial hospitalization programs are usually receiving treatment 6 hours a day, 5 days a week.

According to the National Center for Biotechnology Information, intensive outpatient services or IOP services should be flexible for each specific client group.

Outpatient Treatment, a Viable Solution in Desperate Times

According to the Substance Abuse and Mental Health Services Administration, more people become addicted to substances than actually get clean from substances every year. While an ideal scenario for some would be enrolling in an inpatient facility that is not an option for everyone.  Certain factors can prevent a lot of people (the majority actually) from being able to avail themselves of inpatient treatment.  Perhaps they cannot afford the cost of residential care.  They might not be able to take the time off of work and they may have families to support.  Their health insurance might not cover a stay at a residential facility.  Whatever the reason, residential treatment is not always feasible, necessitating a backup plan through outpatient rehab.

Outpatient treatment is very specific in the services it offers, though even the best authorities on the subject agree that outpatient treatment should never be used as a substitute for inpatient treatment unless absolutely necessary.  In fact, though the National Institute on Drug Abuse applauds outpatient recovery centers for their positive impact to society, they also say that outpatient rehab programs should be a necessity-only alternative to inpatient treatment.  According to the National Institute on Drug Abuse:

“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. It should be noted, however, that low-intensity programs may offer little more than drug education.”

Outpatient treatment centers offer a variety of services to their clients.  The mainstay of their programs is usually group counseling, but these programs very often offer one-on-one therapy services in tandem with group sessions.  Many outpatient facilities will carry further licensing to allow them to treat medical or psychological traumas and difficulties in addition to drug abuse and alcoholism.

Outpatient treatment centers usually offer their services on an open schedule, allowing for clients to hold jobs, manage families, attend school, etc. while also attending treatment.  Most outpatient centers require twenty to thirty visits over the course of one to three months to qualify for completion of the program.  Each visit lasts for one to three hours and visits are done usually one to four times a week, depending on the program.  There is a lot of variety in outpatient recovery routes, which allows prospective clients to pick the program that will serve their needs best.

Intensive Outpatient, A Gradient Above

People who struggle with addiction sometimes attempt an outpatient program but cannot stay away from their substance while in treatment.  This offers little in the form of safety or security for their clients, as the clients are still free to roam the town and score substances during the times when they are not attending treatment at the outpatient facility.  This of course is the main stumbling block of outpatient centers.  They simply cannot provide the safety, security, and forced abstinence from substances that an inpatient center can.  This leads directly to lower success rates than inpatient centers offer.

To try to find a comfortable middle ground, Intensive Outpatient Programs (IOP) were created in the early part of the 21st century to attempt to combine the positive traits of both outpatient and inpatient treatments.  An Intensive Outpatient Program (also IOT) offers a treatment approach with group sessions as its backbone.  The group sessions are well varied, very unique, multifaceted, and truly original, but the structure is essentially the same for each modality.  The National Center for Biotechnology Information, U.S. National Library of Medicine did their own research on addiction treatment as pertains to IOP and IOT programs, and they arrived at the conclusion that:

“Groups form the crux of most IOT programs. Several recent studies confirm that, for delivering relapse prevention training, a group approach is at least as effective as a one-on-one format (McKay et al. 1997; Schmitz et al. 1997). Group counseling allows programs to balance the cost of more expensive individual counseling services.”

Intensive outpatient rehabs, while still not as fully safe and secure as inpatient rehab centers are, offer a form of help and tools for recovery that some struggling addicts can use to vanquish addiction.

Partial Hospitalization Programs, Addressing Medical and Spiritual Addiction in Tandem

Partial hospitalization programs are a form of addiction treatment that was designed for struggling addicts who could not go to residential rehab but who still needed medical care.  This is an approach for recovering addicts who require a much higher level of care than the usual outpatient program or even an intensive outpatient program can provide them with.  The schedule at a partial hospitalization program, or PHP program, would include the client spending long hours at the treatment center during the day while receiving medical monitoring and treatment care, but not staying overnight at the center.

A PHP is more intensive and time-focused than outpatient or IOP treatments are.  These treatment programs will require their clients to meet every other day or five days a week Monday through Friday, for about four to eight hours a day, depending on the center.  The purpose of the more intensive approach is to provide medical monitoring and examination of each patient, closely analyzing them during each session to ensure a safe and stable recovery.

The steps to a PHP are very similar to those of fully residential center.  Intake staff conduct a thorough evaluation of the prospective patient.  A full physical and psychological analysis is done to ascertain what types of services will be needed.  Depending on each individual’s condition upon arrival, this will determine the amount, time frame, and types of services the client will receive while in the program.  Some recovering individuals come to partial hospitalization programs as follow up care after having completed inpatient treatment, and others are fresh off the street.  This variety of the patient-base requires PHPs to be able to offer unique services and customization in their programs.

The National Institute on Drug Abuse particularly recommends PHP for adolescents who cannot go to a residential program due to an age restriction, school restrictions, or financial restraints.  NIDA states that:

Adolescents with more severe substance use disorders but who can still be safely managed in their home living environment may be referred to a higher level of care called partial hospitalization or day treatment. Patients can attend a few hours each day.

While PHP may not be as intensive or structured as inpatient rehabilitation is, it does offer an admirable alternative, especially when medical assistance is required.

Day Treatment, A Cost Effective Rehabilitation Approach

Yet another outpatient approach to addiction treatment is that of day treatment.  Day Treatment is very similar to the Partial Hospitalization Program, the primary difference being that day treatment centers do not offer the same degree of medical services that PHPs do.

Another primary difference between Day Treatment and other approaches is the time spent in treatment.  While Day Treatment does not offer a wide range of medical services like PHP does, Day Treatment is the next best thing to residential care in terms of amount of time spent in treatment.  Clients who participate in a Day Treatment program typically spend their entire day in the program, at least five days a week, and only spend their overnights at home.  Day Treatment is the closest one can get to going to a residential treatment center without actually checking into an extensive overnight stay at a rehab facility.

Day Treatment is a good choice for a small percentage of the population of addicts.  It is a good choice for a small population because the people who do well in Day Treatment programs are people who have a lot of different factors and key issues to work on but conversely can be counted on to not abuse substances outside of the Day Treatment facility, in between sessions.  Day Treatment is an approach to addiction recovery that is useful yes, but not as widely used because so few addicts can abstain from substances and still work on their issues without being in a residential organization.

Sober Living, a Look at Post-Recovery Support

Though sober living centers do offer inpatient services more often than not, sober living institutes fall under the same category of outpatient programs because they are, “Ancillary, continuing care facilities. Sober living programs are only entered into after an individual has overcome addiction through inpatient or outpatient means.  The purpose of sober living is to provide a safe and supportive community for recovering individuals to transition into after completing treatment at a qualified rehab.

The reason why sober living facilities are in such abundance is because life after rehab is perhaps the hardest experience a recovering individual will experience.  In fact, some believe that life after rehab is even tougher than life before rehab, just in a different way.

When a person gets out of rehab, they are immediately thrown back into the real world, and all the demands and constraints of day to day living that they had left behind while in rehab come back in full force.  Stress comes back.  Obligations and responsibilities come back.  Old environments may loom back up once again, and negative, toxic people may come to call shortly after.  Old stresses and trigger mechanisms may emerge, and day to day life often feels like a battle to just stay sober.  Tools and therapy techniques plus knowledge gained from rehab will help, but it is often not enough and people frequently relapse.

According to the National Institute on Drug Abuse in a joined survey study with the Substance Abuse and Mental Health Services Administration, roughly half of all recovering individuals who seek some form of addiction recovery will relapse at some point in their lives, most of whom will relapse within one year of completing treatment.  Engaging in sober living is a decisive effort towards preventing that from occurring.

The National Center for Biotechnology Information, U.S. National Library of Medicine performed an extensive study and research project on the purported value of sober living.  They came out with conclusions that this approach far exceeded previously-thought levels of value.  Their summary was:

“Lack of a stable, alcohol and drug free living environment can be a serious obstacle to sustained abstinence. Destructive living environments can derail recovery for even highly motivated individuals. Sober living houses (SLHs) are alcohol and drug free living environments for individuals attempting to abstain from alcohol and drugs.”

While not a substitute for actual treatment, sober living centers offer an exemplary service to individuals fresh out of rehab who need support and further assistance in their monumental transition back into day to day living.

The Value of Outpatient Treatment

The value of outpatient addiction treatment is very clear to see.  Outpatient treatment provides an avenue for recovery that hundreds of thousands of struggling addicts avail themselves of every year.  Outpatient care creates safety and peace of mind for recovering individuals, giving them support and a place to learn the tools and gain the knowledge they need to walk away from drugs and alcohol for life.  To service a wider population of struggling addicts, outpatient therapies also come in different styles and approaches, designed to provide the exact care that individuals need.

  • Straight outpatient counseling and group support gives clients a way to find themselves and to find their mission in life, a recovery that is stable and unshakable.
  • Intensive outpatient delivers similar services as outpatient programs, only more extensive and involved.  More time is spent, more subjects are covered, and more avenues are taken to provide the kind of care needed to give recovering addicts control over their lives once again.
  • Partial hospitalization presents an invaluable service to clients who need medical and physical assistance but who are not able to enter into and through a residential recovery program or detox.  Partial hospitalization helps clients immensely to find their own path in life and to expand on that path to the best of their abilities after healing them physically
  • Day treatment provides clients with a recovery process that is as close to an inpatient stay at a residential center without actually involving overnight stays.  Day treatment centers are an excellent recourse for mothers of young children who have to be home at night, for individuals who have a physical disability that prevents them from staying at a residential center, or for individuals who simply cannot fund a stay at a residential program.
  • Sober living.  So important that it could be considered mandatory, sober living should follow any recovery program to ensure that recovered clients can stay clean for life.  Sober living centers give recovering individuals the tools they need to stay clean for life, no matter what kind of hardships they may end up facing.  Sober living centers create a very helpful environment that is based off of support and the shared goal of attaining a lifetime of sobriety.

Residential Care vs Outpatient Rehab

Residential addiction treatment is often the recommended solution for many reasons. But, it can be impossible for some to attend this type of treatment, making outpatient a viable option. Outpatient programs help thousands of addicts’ triumph over addiction every year.  For more information call our help line today.



View items…


Sober Living

Sober living is a housing option for addicts and alcoholics who have already completed an inpatient drug and alcohol rehab program, or who struggle with maintaining sobriety without a structured living environment.  A Sober Living Environment (SLE) is typically a group home providing a drug-free environment within which addicts and alcoholics live together and support one another with a common goal of staying sober from drugs and alcohol.  Sober living homes are widespread in the United States, are generally very reasonable in cost, and provide an invaluable transitional tool for addicts and alcoholics re-entering society following addiction treatment.


Sober living homes, also commonly referred to as halfway houses or three quarter way homes, are designed to be transitional living for recovering addicts and alcoholics coming out of rehab program, prior to complete reintegration to society.  Because of the very nature of drug and alcohol addiction, addicts lose touch with healthy behaviors and coping mechanisms to everyday situations and stresses.  The disease of addiction creates new, dangerous behavioral patterns that eventually become an everyday part of life and normal coping mechanisms for stress.

Drug and alcohol rehab programs begin the process of reprogramming the addicted individual to make the healthy lifestyle choices that enable sobriety and continued recovery.  This process is one that continues throughout the rest of an addict’s life, and it takes effort every day to continue along the path of recovery.  Most treatment programs last an average of 30 days, and that is rarely enough time to learn the skills necessary to re-enter society and cope with life’s stressors without the use of drugs and alcohol.  In general, 30 days is enough time to dry out and begin the process of recovery, but in most cases that process needs more nurturing before complete reintegration to society is a safe move. It is for this reason, sober living homes are so important and serve as such an invaluable tool in recovery after treatment.

Sober living homes vary in structure and management style, and it is important to get the facts on any facility before committing.  For the most part, sober living homes are apartment style or group home settings that house several recovering addicts and alcoholics trying to maintain their new sobriety after completing a treatment program.  Many sober living homes require recovering addicts to complete a minimum of 30 days in treatment before they can be accepted to reside at a facility.  There are several things about sober living homes that make them especially helpful for addicts and alcoholics in early recovery:

  • Sober living homes are exclusively for recovering addicts and alcoholics all of whom have similar goals of maintaining sobriety.  This will provide each resident with the support of like-minded people making recovery more of a group effort than an individual.  Sober living homes often also have one or more staff members residing with the residents to provide extra support.
  • In sober living homes, residents are generally required to submit to random drug testing and rooms are commonly checked for drugs, paraphernalia, and alcohol. These procedures are in line with residential treatment centers to make extra efforts to ensure substance abuse relapse does not occur among the residents, maintaining the safety of everyone in the home.
  • Residents of sober living homes are required to obtain a job and/or return to school for continued education.  This requirement ensures that all residents have constructive activities with which they can occupy their time.  By working and/or attending classes to further education, recovering addicts and alcoholics can begin on the right path immediately to improve their lives and remain substance free.
  • Most sober living homes have an evening curfew every weeknight(generally no later than 9 pm).  Shortly after the curfew, there is a roll call to ensure that every resident is home and substance-free for the day.
  • Most sober living homes require residents to attend several NA or AA meetings every week to continue the recovery process.  Often residents will carpool to these meetings, providing each other with support and assistance.
  • Depending on the home and each resident, the privilege of returning home for the weekend is extended to many residents on Friday evening, through Sunday morning. This allows eligible residents to return home to loved ones overnight Friday and all day Saturday.  This privilege is not extended to all residents and a decision is made based on many different factors including the resident’s relapse history, the home situation and possible hazardous people and substances.

Not all sober living homes employ these practices, so it is important to know all the rules and expectation prior to committing. Most sober living homes charge a very cheap amount of money for rent in comparison to other residential apartments or accommodations in the area, making it more than affordable for most recovering addicts to continue their recovery in a sober living facility. With the combination of support from other recovering addicts, curfews, and other supervisory restrictions, and the encouragement of employment and education, sober living homes have most all the tools necessary to guide recovering addicts and alcoholics along the path to sobriety. Residents have an opportunity to experience real life and still maintain the safety of a sober living environment. 

Through pressures and stress, each resident can return home to a supportive group of people who understand the difficulty of maintaining sobriety.  The transition from a treatment facility to the real world can be jarring as recovering addicts leave a safe environment and go out to the same dangers that surrounded them prior to treatment while trying to hold onto their newly learned coping mechanisms and habits.  Sober living homes provide a more seamless transition to the real world without any limits on the amount of time spent there. Recovering addicts can stay at a sober living home for years until they feel comfortable getting out on their own.  As with any part of the recovery process, from detox facilities and drug rehab programs to sober living homes and aftercare, it is imperative to do the research and know the facts before making a commitment. Please feel free to explore our links and search the treatment directory for more details on various treatment options.  We encourage all visitors to register with us and post questions and comments.  Please call us for guidance finding a sober living home.



View items…