Inpatient Alcohol and Drug Treatment – Why It Can Help
Inpatient treatment is one of the most common and effective methods of treating substance use disorder (SUD). Involving patients staying at their treatment facility for an extended period of time while they do the necessary work to recover from their drug or alcohol issues, the inpatient treatment process is the recommended, and often necessary, model for those with a prolonged and untreated history of SUD. It is also often the best option for patients battling co-occurring addictive and mental health disorders that, according to data from the Substance Abuse and Mental Health Services Administration (SAMHSA), affect nearly eight million Americans.
What Is Inpatient Alcohol and Drug Treatment?
Inpatient alcohol and drug rehab allows patients to reside at their treatment center for a predetermined period while undergoing a comprehensive and customized course of behavioral therapy for their SUD. The rehab and behavior modification process is separate from detoxification and withdrawal management (another critical component of the addiction treatment process); however, many inpatient facilities offer medically supervised detox on premises in addition to rehab as part of a comprehensive treatment experience. After completion of an inpatient program, patients may also have the option of “stepping down” to a lower-tier program, such as an outpatient or partial day program that offers offsite housing.
What Happens in Inpatient Treatment?
Inpatient alcohol and drug treatment is incredibly effective because it focuses on every area of a patient’s life that has suffered in the wake of their addiction, including their physical and emotional health, their relationships with their families, lifestyle issues, legal issues, and more. It is broken up into two phases: detox and rehab. While each inpatient treatment center will offer its own slightly different approach to care, most treatment programs will offer some combination of group therapy, individualized counseling, and supplemental behavioral therapies. The exact makeup of each patient’s program is contingent upon that patient’s care needs and the facility’s resources.
What Does Inpatient Alcohol and Drug Detox Look Like?
It’s important to realize that addiction is a chronic medical disease, just like diabetes, high blood pressure, and others, and requires acute and ongoing intervention and management from experienced and qualified doctors and nurses. Chronic alcohol and drug rehab creates serious and life-threatening tolerance that is often exemplified through debilitating physical and psychological withdrawal symptoms. The inpatient detox process allows patients to expel the toxins that have built up in their systems during their substance use in a compassionate, supportive, and medically supervised context. While detox programs generally last three to five days, exact progression will be dictated by ongoing care needs and any related health issues.
Multiple types of detox each yield their own withdrawal symptoms:
- Alcohol Detox Withdrawal Symptoms – tremors and shaking, gastrointestinal distress, extreme headache, fast heart rate, tremor, disorientation, headache, insomnia, seizures, and more
- Opiate and Opioid Detox Withdrawal Symptoms – extreme sensitivity to pain (hyperalgesia), nausea, vomiting, diarrhea, extreme changes in mood, excessive sweating, and more
- Stimulant Detox Withdrawal Symptoms – anxiety, chills, dehydration, dulled senses, slowed speech, loss of interest, slow heart rate, irritability, hallucinations, paranoia, inability to concentrate, and more
- Benzo Detox Withdrawal Symptoms – Sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremors, sweating, difficulty in concentration, and more
Inpatient medical detox offers expert, compassionate management of these symptoms as well as intervention from trained doctors and nurses in the event of an emergency. Those who endeavor to detox on their own commonly find the withdrawal period to be too much for them and wind up relapsing soon after.
Medication-Assisted Treatment in Inpatient Alcohol and Drug Treatment
Medication-assisted treatment (MAT) is another common element of inpatient alcohol and drug treatment. The process through which patients take certain FDA-approved medications to counteract withdrawal symptoms and cravings, MAT is commonly used to treat opioid and alcohol use disorder (AUD) through drugs like Suboxone® (buprenorphine), Vivitrol® (naltrexone), and methadone. The process is often initiated during the inpatient treatment process and continues after patients leave their program, under the ongoing supervision of their physician. These drugs are meant to make the extended withdrawal period more comfortable for patients who need help. Physicians oversee the gradual cessation of the medication until patients can live independently without them.
Common supplemental therapies offered during inpatient alcohol and drug rehab include but are not limited to:
- Cognitive Behavioral Therapy (CBT). A common tool to treat depression and anxiety, CBT helps patients address the root causes of their addiction by changing their thinking process through talk therapy. Data from over 260 studies compiled by Boston University indicates that CBT is highly effective in the treatment of cannabis abuse and other types of SUD.
- Dialectical Behavioral Therapy (DBT). DBT is commonly used to treat borderline personality disorder (BPD) as well as other types of mood disorder, a condition the American Academy of Psychiatry reports is a frequent and grave reality for many SUD sufferers. DBT is a modified version of CBT that helps patients identify and manage emotional factors in their lives that trigger substance use and other types of toxic behavior.
- Motivational Interviewing (MI). MI involves patients’ health professionals encouraging them to make positive behavioral changes in their lives, changes that patients are already considering. A more passive form of therapy, MI provides the validation that patients experiencing emotional ambivalence often need during the treatment and recovery process. Research from the Yale University Department of Psychiatry indicates that MI can be particularly effective in the treatment of alcoholism.
- Family involvement. Family involvement is the integration of family into patients’ treatment programs in the form of counseling sessions, education about the disease of addiction and the recovery process, and more. Family involvement is critical to the post-treatment recovery process, as the success with which patients transition back into their families very often determines vulnerability to relapse and long-term sobriety. The National Institute on Drug Abuse (NIDA) lists family involvement as an essential component of addiction treatment.
- Eye Movement Desensitization and Reprocessing (EMDR). EMDR is a comprehensive eight-stage therapy commonly used to treat trauma like military combat, rape, assault, sexual abuse, and more. The process is designed to reroute thought patterns regarding patients’ traumatic experiences through exploration of their impact on the brain’s natural resilience to cope and process them. The Palo Alto Mental Research Institute, among other organizations, has pointed to EMDR as an effective and important addition to the substance use treatment landscape.
- Role-playing therapy. Role-playing therapy helps patients identify improvable areas of behavior when interacting with their families and loved ones, while also addressing anxiety and defensiveness issues that can often lead to a problematic lack of assertiveness. Patients work with their therapists to identify dysfunctional interactive dynamics that exist in their lives and form a behavioral framework and coping skills to successfully maneuver without having to self-medicate.
- Life skills training. The reality is that prolonged and untreated substance use can have a serious and potentially lasting impact on patients’ cognitive ability and independence. At this point, it may become necessary to guide patients toward relearning basic life skills that may have suffered. Life skills training can include anything from meal preparation and maintaining one’s living space to financial management guidance and nutritional counseling. This therapy helps patients incrementally regain their independence and improve their quality of life.
Many inpatient alcohol and drug rehab facilities offer a far more comprehensive range of supplemental therapeutic modalities, including equine or pet-friendly therapy, art and music therapy, therapeutic journaling, adventure and wilderness therapy, and more. As research into addiction treatment unearths more and more promising evidence-based therapies, inpatient centers are increasingly employing more out-of-the-box treatment approaches, along with proven and established care practices.
Specialized Types of Inpatient Alcohol and Drug Rehab
Inpatient alcohol and drug rehab programs a diverse range of populations. As researchers are identifying the unique factors among many different groups that lead to SUD, inpatient care has become more and more intuitive.
In addition to options like 12 Step–driven rehab, secular and non-12 Step–based programs, and nonreligious and holistic programs, there are thousands of inpatient options that cater offer group-specific levels of care, including:
- Age and gender. Specific rehab programs for men, women, teens, seniors and adults
- Faith and spirituality. Christian, Muslim, and Jewish rehab programs to help patients draw strength from their faith
- Physical and psychological health. Programs that service the deaf and hard of hearing and the blind, as well as dual-diagnosis programs for co-occurring substance use and mental illness
- Ethnicity and culture. Specific programs for Native Americans, African Americans, Latinos, Spanish-speaking patients and others, as well as specific options for the LGBTQ population
- Income. Exclusive and luxury programs for higher-income patients (covered by private insurance only)
- Military service. Programs for veterans to treat the specialized conditions that veterans face, including chronic pain and PTSD
While most cases of court-ordered alcohol and drug rehab tend to be administered on an outpatient basis, inpatient rehab may be ordered for severe cases. It is the responsibility of the patient to pay for their court-ordered rehab programs.
How Long Does Inpatient Rehab Last?
While most inpatient treatment programs last an average of twenty-eight to thirty days, the duration of each patient’s program is largely contingent upon their progress and ongoing care needs. Some longer-term inpatient programs can last from ninety days to a year, during which patients gradually learn to live independently. These longer-term programs often include an eventual transition to sober housing to help patients prepare for a successful post-treatment transition into everyday life. Long-term inpatient treatment is often reserved for those who have suffered serious cognitive impairment or lifestyle damage, or those who have not been successfully in outpatient or regular inpatient programs. Trajectory of inpatient alcohol and drug rehab is usually directed by patients’ therapists and their case managers.
What Are Case Managers in Alcohol and Drug Rehab?
A case manager is essentially the point person throughout a patient’s treatment program. Prolonged and untreated alcohol and drug abuse can, and eventually will, impact every area of a user’s life. This means patients will need comprehensive, multilateral assistance that may extend beyond the clinical.
Some of the duties of a case manager include, but are not limited to:
- Coordinating all aspects of care in collaboration with the clinical team;
- Assessing progress and acting on clinical recommendations to move patients through their program, when appropriate;
- Facilitating the transfer of patient records and information vital to their care and progression through their program;
- Helping patients make informed decisions by acting as their advocate regarding their clinical status and treatment options; and
- Developing effective working relations and cooperating with the medical team throughout the entire case management process.
Case managers may also be able to help with areas like medication-assisted treatment (MAT) compliance and accessibility; coordination with local recovery organizations in patients’ areas; and referring patients to meetings and qualified therapists. They can even help with referral to life skills training support and job-placement services as patients prepare to leave their programs.
Advantages of Inpatient Alcohol and Drug Treatment
While intensive outpatient (IOP) treatment facilities may bring a greater level of flexibility than their inpatient counterparts—and according to data from Oregon Health and Science University can be just as effective in most cases—this flexibility can actually serve as a detriment in many cases. Patients in IOP treatment programs face a greater threat of disruption to the continuity of their care because they often immerse themselves right back in the toxic and dysfunctional circumstances that can trigger and sustain their substance use, whether it’s a negative family dynamic, repetitive trauma triggers, problems at work, or anything else. One of the primary advantages to inpatient alcohol and drug rehab is that it allows patients to remove themselves from these circumstances so they can properly contextualize them and identify their impact in a supportive setting.
Other advantages to inpatient alcohol and drug rehab include, but are not limited to:
- Regular and consistent medical and psychological support.
- Compassionate and experienced clinicians and staff.
- Ongoing supervision and accountability.
- Curtailed access to drugs or alcohol.
- Alumni programs for new friendships and emotional connections.
- Diet and lifestyle regulation and assistance.
- Consistent logistical support for a healthy post-treatment life.
- Expert-designed programs to help reconnect with family.
Inpatient treatment centers also provide a consistent and reliable network of support in the development of aftercare programs that are vital to post-treatment success.
Do I Need Inpatient Alcohol or Drug Treatment?
The National Institute on Drug Abuse (NIDA) reports that there are over 14,500 addiction treatment centers in the United States, with more being established each year; however, not all of these facilities offer inpatient services. Contrast this reality with SAMHSA’s research that fewer than ten percent of Americans who need addiction treatment actually receive it, and the need for more treatment facilities has never been more urgent.
While inpatient alcohol and drug rehab facilities are outnumbered by their outpatient counterparts and are generally more expensive, they are sometimes the most advisable and effective option for certain patients.
Candidates for inpatient alcohol and drug treatment include, but are not limited to:
- Patients who have relapsed after outpatient treatment;
- Patients with adequate employer-based health insurance;
- Patients with serious cognitive or lifestyle issues;
- Patients with co-occurring mental illness; and
- Patients with serious health issues who require hospitalization.
In each case of drug or alcohol abuse, it’s critical that treatment protocol matches patients’ ongoing care needs.
What Should I Look for in a Quality Inpatient Alcohol and Drug Treatment Facility?
While there are more and more inpatient alcohol and drug treatment centers being established to address the continuing rates of overdose in the United States, it’s important to realize that not all of these facilities will have the resources and expertise to effectively handle your specific care needs or those of your loved one.
When you’re searching for treatment, there are a few distinguishing factors to look for:
- Proper Accreditation – Be sure the facility you’re choosing is licensed by the mental health entity of the state in which they operate as well as organizations like the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) or the Commission on Accreditation of Rehabilitation Facilities (CARF).
- Credentialed and Qualified Staff – Most facilities will have their clinical rosters available for public display on their websites or elsewhere. It’s helpful to research the background of these professionals to determine their experience, education, and credentials.
- Access to Urgent Medical Care Resources – Be sure the facility you or your loved one chooses has a medical staff on premises or offers seamless access to local health care resources. Coordination with these services is essentially in the event of a medical issue during the withdrawal period and beyond.
- Clean and Comfortable Living Quarters – Patients’ comfort levels are an integral part of the addiction treatment process. It’s important that they feel safe, comfortable, and respected in their residences. Find out as much as you can about the accommodations at your prospective facility to find out if it’s right for you. You’re going to be staying at the facility for a prolonged period, so it’s best to ascertain that the environment will be conducive to your healing. A stressful or uncomfortable living situation can very often lead to relapse.
If you or a loved one are suffering from any kind of dual-diagnosis disorder, it’s important to determine whether or not the facility you’re considering can adequately provide simultaneous treatment for your addiction and co-occurring mental illness.
Paying for Inpatient Alcohol and Drug Treatment
While most state-funded, Medicare-, or Medicaid-funded treatment programs tend to be outpatient, employer-based health insurance and other means of assistance may be available to help you or your loved one pay for inpatient care. Some facilities offer scholarships for eligible patients in need of financial assistance. At the time of your initial inquiry, an admissions specialist should be able to provide a full insurance verification to identify what options are available to you. The staff expenditures, resources, and more in-depth care associated with inpatient treatment generally makes it more expensive than outpatient, partial day programs, or any other type of care.
Some insurance providers that cover inpatient treatment include:
- Health Net
- Mutual of Omaha
- United Behavioral Care
- United Concordia
- Health Beacon
- Blue Cross Blue Shield
- Health Alliance
- Humana Health
- Medical Mutual
- Molina Healthcare
- United Healthcare
- Value Options
- Harvard Pilgrim
- Coventry Health Care
Each insurance provider offers different tiers of coverage that can affect eligibility for assistance. Call your insurance company or your prospective treatment facility to find out about your rights and responsibilities. More and more programs are offering sliding-scale options, which allow patients to pay based on their income level.
After Inpatient Alcohol and Drug Treatment
The period following inpatient alcohol and drug rehab can take many routes depending upon patients’ progress and ongoing care needs. Some patients may be able to transition out of a formal treatment paradigm altogether; others may opt for a less in-depth “step-down” option like outpatient or IOP rehab. Regardless of which option they choose, patients should receive a comprehensive and realistic aftercare plan from their treatment provider and case manager outlining their resources and responsibilities in post-treatment recovery.
Aftercare plans should include referral information to recovery meetings and addiction-trained therapists in patients’ local communities, as well as behavioral coping tools that they developed in treatment to deal with the threat of relapse in high-pressure situations. Most inpatient alcohol and drug rehab facilities will also offer regular post-treatment follow-up calls and emails to assess patients’ ongoing progress, as well as alumni connection opportunities like social events and social networking platforms to help patients stay connected with the friends they’ve made in treatment. These alumni resources give patients the opportunity to continue to exchange support in the most vulnerable times.
A Proven and Effective Treatment Model
Inpatient alcohol and drug rehab is largely considered the gold standard of treatment because of its comprehensive and fully immersive nature. It provides patients a much-needed opportunity to work on the issues that lead to and sustain substance use while developing a behavioral framework to address the lifestyle fallout associated with their substance abuse. If you or someone you care about has spent years struggling with addiction, and it is systematically destroying your life, it might be time to consider inpatient treatment. The goal of the process is to help you address and leverage the lessons learned about your past, identify how they’re affecting you in the present, and use that knowledge to better your future.
To find an inpatient treatment center near you, search our extensive database of options from around the country.
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- pdfs.semanticscholar.org – Dialectical Behavior Therapy for Patients with Borderline Personality Disorder and Drug-Dependence
- ncbi.nlm.nih.gov – Behavioral Therapies for Drug Abuse
- www.drugabuse.gov – Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)
- ncbi.nlm.nih.gov – Eye movement desensitization and reprocessing: treating trauma and substance abuse
- ncbi.nlm.nih.gov – Substance Abuse Intensive Outpatient Programs: Assessing the Evidence
- samhsa.gov – Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings
- jointcommission.org – Joint Commission Home Page
- carf.org – Home Page
- treatment-centers.net – How to Find A Drug or Alcohol Rehab Center Near Me