Addiction is a devastating disease for everyone involved, extending from the individual affected through the family and immediate community. The sooner an effective treatment program can be found, the better the chances are at achieving and maintaining sobriety.
Ever since the beginning of the opioid crisis in the late nineties, opioid addiction has exploded to unimaginable pervasiveness. Likewise, addiction treatment centers and programs have become available in abundance, each more narrowly focusing on individual needs and preferences. While the plethora of treatment options is a significant benefit for those seeking individualized programs, it can be difficult to know how to begin to search for the right one. There is no singular approach or method of treatment that will work for every individual who is suffering from addiction, and searching through pages of results on search engines can quickly overwhelm and frustrate the most savvy researcher.
Instead of searching aimlessly, in hopes that the pretty pictures on a website are indicative of the quality and effectiveness of treatment provided, the fastest way to the best treatment program is to have a clear search plan. A search plan provides easy-to-follow parameters, enabling a quick elimination of programs that won’t work, thus narrowing the options for a clearer picture of exactly what each program is offering, and how effective the details of those programs may be for specific and individual circumstances.
An effective search plan involves four steps:
The last thing anyone wants to do is have their heart set on a particular treatment program only to find that it’s unaffordable or that insurance doesn’t sufficiently cover the cost. Most health insurance plans will cover at least one thirty- to forty-five-day stay in drug treatment per calendar year, which usually includes a medical detox.
It is important to first check any and all insurance coverage plans to have a clear understanding of:
Many services offered at drug treatment centers are wonderful supplements to the program but may come with a cost that insurance doesn’t cover. So, it is imperative to take the time to understand medical benefits before beginning to narrow down search criteria. All treatment centers will be able to assist with checking medical benefits, but it is always a good idea to have as much detail regarding coverage obtained directly from the health insurance provider.
Examine personal finances closely and determine what out-of-pocket expenses are affordable. It is not often that families have several thousand dollars of liquid assets available for the high price tag of drug treatment.
Drug treatment programs average around $15,000 for thirty to forty-five days, the range of costs being anywhere from $5,000 to over $100,000 for programs lasting for that period of time. Many treatment programs are structured to be long term, starting at ninety days and potentially continuing for a year or longer. Often, these programs are flexible in payment plans, but health insurance may not cover longer-term stays in a drug treatment program. This option should also be discussed with health insurance providers. In the event that health insurance cannot cover the entire cost of drug treatment, it is important to have a firm budget for out-of-pocket expenses. While considering out-of-pocket expenses, keep travel costs in mind if an out-of-state treatment program is an option.
An important detail to consider is that many private treatment programs offer a sliding-scale payment structure, in which the cost will be adjusted based on an individual’s ability to pay. If finances are of particular concern but state-funded programs are not desirable, this may be an excellent alternative.
Many drug treatment programs today feature extra amenities and activities, with beautiful locations and landscaping. Although location and available amenities should be a part of the decision-making process, before considering what would be nice, first consider what is needed.
Addiction is a serious disease, and drug treatment is not a vacation from life. It should provide a comfortable setting for each individual, but it is intended to provide the necessary tools, counseling, therapy, and support for recovery from addiction.
Dual diagnosis is a term for a mental health issue and substance abuse disorder affecting someone simultaneously. This can include any kind of mental health issue ranging from mild to very severe. More broadly, comorbidity is the occurrence of more than one illness or disorder in one person, which does not necessarily include substance abuse. However, individuals who are addicted to drugs are more than twice as likely to suffer from dual diagnosis. It is known that drug addiction can precipitate symptoms of mental health disorders, and self medicating mental health disorders can lead to drug addiction.1 Regardless of whichever disorder may have come first, dual diagnosis treatment is imperative for individuals who are known to suffer from addiction and one or more additional mental health disorders.
Without a formal medical diagnosis, it can be difficult to identify a dual diagnosis case in an addicted individual. Addiction itself is a mental health disorder, and some of the most common co-occurring mental illness are:
There are many other mental illnesses that co-occur with substance abuse and addiction, but the ability to identify dual diagnosis in people who have not been previously diagnosed is often marred by the effects of substance abuse. For this reason, virtually every addiction treatment center and program in the United States offers dual diagnosis treatment. Once in treatment, clinicians will be able to determine what if any co-occurring disorders may exist, and most often, will treat both disorders through a combination of behavioral therapies and medical treatments.
Not everyone suffering from drug addiction will need a dual diagnosis treatment plan. Although it is difficult to identify the occurrence of dual diagnosis, there is also no way to rule it out with addicted individuals. Therefore, it is important to be sure than any potential drug treatment program is experienced in and offers dual diagnosis treatment. Detox Needs All drug addiction treatment begins with detoxification, the process by which drugs and toxins from their byproducts are removed from the individual’s system. The all-important therapies and counseling cannot begin until detox has been completed. Depending on the abused drug, personal health, and severity of the addiction, detox needs may vary from light medical supervision to full hospitalization. The time it takes to complete detox varies by individual and the drug of abuse, but it is vital to understand how a treatment center performs detoxes and what medical staff they have available to supervise the process. Another important consideration with detox is the amount of time it will take, and how that may affect the time left for addiction treatment, therapies, and counseling offered through the program.
The most common form of detox is medical, in which a patient is administered medications for a variety of reasons throughout the detox process. Medical detox can take place in a treatment facility or in a hospital setting. Some treatment centers are licensed to perform medical detox within their own facility, while others use an outpatient detox process through a local hospital or medical facility specifically operating to perform them.
During a medical detox, the goals are to:
A variety of medications may be administered to accomplish these goals and see the person suffering from addiction through detox as painlessly as possible.
It is important to understand that there will be some level of discomfort during detoxification from any drug. Medical detox aims to keep the symptoms manageable, but there are some withdrawal symptoms that cannot be completely avoided, and these may linger for several weeks or months after detox has been completed.
These symptoms are associated with all drugs of abuse and include:
Medical detox can be used for any kind of drug, but there are some drugs which require a medical detox because of inherent health risks associated with symptoms of withdrawal. Specifically, severe alcohol and benzodiazepine addiction can result in dangerous withdrawal symptoms, which may be life-threatening and require hospitalization.
Gaining some popularity in the early 2000s, rapid opiate detox is advertised as a quick and painless method to detox from opiates like heroin and opioid painkillers. Rapid opiate detox, or ultra rapid detox, is not covered by most insurance companies, and the cost is more than $10,000. Ultra rapid detox is available through private companies offering the treatment but is unlikely to be offered by many drug treatment programs.The process takes place in a full hospital setting, where the patient is placed under general anesthesia and then is administered naltrexone, which is an opiate antagonist that immediately precipitates withdrawal and can expel all opiates from the system in a matter of minutes.
Understandably, ultra rapid detox presents itself as a panacea-like solution to the grueling discomfort of opiate withdrawal, in a procedure that takes only three days to complete.
Although it may sound like a miracle form of detox, it has come under a great deal of scrutiny, due to adverse effects and medical complications, including death in some cases. Ultra rapid detox has fallen out of favor for much of the recovery and medical community due to the high risk, and it has been reported as having little to no benefit over other methods of opiate detox.
Before making a decision on ultra rapid detox, it is imperative to speak with a physician about any and all health conditions and discuss all risks associated with this procedure.
Another form of detox from opioid addiction that has grown in popularity since the explosion of the opioid crisis in the United States is called medication-assisted treatment (MAT). Addiction to opioids like heroin, morphine, and other narcotic painkillers result in very uncomfortable and painful withdrawal symptoms. With continuing concern for relapse after detox, medication-assisted treatment uses long-acting opioids such as methadone or buprenorphine, both of which prevent withdrawal symptoms but do not provide the euphoric high of commonly abused opioids. This is considered to be opioid maintenance, but it is the fastest way for people suffering from opioid addiction to withdraw from use of the drugs while avoiding the withdrawal altogether. An opioid-addicted individual will be assessed and a comparable dosage of either methadone or buprenorphine will be prescribed. The two medications are different, so a medical assessment of the individual and the circumstances of addiction will determine which may be most effective. Both of these medications are heavily controlled to prevent abuse, but within a couple of days of beginning detox, an individual can be stabilized and ready for therapeutic treatment. Another benefit of medication- assisted treatment for opioid addiction is that the medications are very affordable, most health insurance plans will cover MAT, and a growing number of rehab programs offer the treatment.
This process is not without its risks and complications; as both medications are opioids, an addicted individual will still be dependent on them, experiencing withdrawal in the event of sudden cessation. Like any opioid, withdrawal from methadone and buprenorphine causes typical symptoms, but this medical maintenance treatment is required to work in conjunction with a drug treatment program, and participants can elect to taper down their dosages with the assistance of their physician and through continued adherence to their recovery plan.
Planning out the detox for an individual in need of treatment is an important step in creating a treatment plan, and determining what programs may work best is important as well—specifically in transition from detox to the therapeutic portion of treatment. Detox is the first step in drug treatment, and the success of that step lays the groundwork for the treatment to come. Inpatient or Residential Treatment?
Many people conflate the time lengths and forms of treatment offered in various programs and can easily be caught off guard by erroneous expectations.
Typically, an inpatient treatment program is licensed to perform medical procedures such as detoxification. These facilities are usually in a medical setting, or they have a dedicated medical center within, or on the premises. Inpatient drug treatment facilities may also provide addiction treatment in the form of counseling, group sessions, individual therapy, and they do so in a temporary-living type of setting. These programs are likely to be as brief as thirty days and no longer than sixty days.
A residential treatment program is just as the name implies. These facilities resemble residences, usually set outside of medical surroundings, and more likely to be situated in a more isolated area, providing ample space and opportunity for residents to call it home for several months. Many residential treatment programs are fully licensed to perform medical detox just as an inpatient program is. Although there are many different levels of care offered by residential treatment programs, the biggest difference is that these programs act as actual residences, typically beginning with sixty day stays.
Residential treatment programs also tend to be more thoroughly intensive, as the treatment offered has several benefits for each person in residence. Some of these benefits include: A comfortable setting.
People are always more responsive when they are comfortable. In a drug treatment program, no one wants to feel like they are in a “facility,” especially if they will be there for an extended period of time. Having the comfort of a home environment allows each individual the opportunity to spend time working on their recovery, building supportive relationships, and to do so without the sense of being in a controlled setting.
In residential treatment environment, everyone receives individualized attention, which focuses on the whole person—body, mind, and spirit. Often, there is little time to focus on the whole person in an inpatient program. Longer time in treatment allows the individuals, clinicians, and therapists to more closely examine any underlying issues that may have contributed to or exacerbated addiction, and to begin the process of healing individual aspects of the whole person.
The longer an individual remains in a treatment setting, the easier it becomes to learn and practice the skills required to maintain recovery once treatment is completed. Anyone can take a crash course on the bullet points of staying sober outside of treatment, but that doesn’t often dominate thoughts and behavior when someone in recovery is confronted with the relapse triggers, stress, and disappointments that are all a part of regular life. Residential treatment not only allows more time to learn the skills for staying sober but also coping skills, communication skills, healthy lifestyle guidance, and even resume building and interview skills.
Often, treatment programs do not explicitly differentiate between inpatient and residential, and many programs offer both. In these circumstances, there may be a separate fee for each, meaning an individual can enter the program as inpatient for a set period of time, then continue on to a level of residential care for an additional cost.
The levels of residential care can include:
It is important to determine what level of care will be necessary for the most effective addiction treatment. It should be noted that detox alone is not recommended, as an effective form of drug treatment. There is unequivocal research data which suggests that “good treatment outcomes are contingent on adequate treatment length“.
It remains important to check with health insurance providers, to determine what lengths of treatment can be fully covered, or even partially paid for.
This part of creating a search plan can get murky, because as searching begins, more and more amenities and supplemental therapies will pop up and seem like they are of the utmost importance to recovery. This is why searching for drug treatment is so daunting for so many people. If the needs for treatment can be checked off for hundreds of programs across the country, what makes one a better choice than the other?
This is where prioritizing preferences helps to keep it simple. There are five basic areas where preferences will need to be prioritized:
The order of prioritization varies depending on the individual in need of treatment, but these preferences are not about turning drug treatment into a vacation. Comfort is vitally important in a treatment setting, but most preferences tend to be about comfort, so it is important to distinguish what is closest to necessary from what would be nice to have in treatment
The population of a treatment center is the makeup of the people in attendance. In the everyday world, the population is made up of all kinds of people, from every type of background: men, women, LGBTQ individuals, teenagers, corporate executives, and members of the military, both active and retired. Most people go on with their daily lives in the mixed population that is the United States, and do so without thinking about it. But in addiction treatment there can be significant benefits to specific populations for some individuals in need of help.
One factor that can quickly derail anyone from active participation in treatment is a feeling of exclusion, rejection, judgment, not being able to relate to others, or vice versa. While these feelings may be entirely unintentional from the treatment population, everyone has a life of unique experiences, and some of them are riddled with severe trauma, which may be better handled around others with similar experiences. Additionally, there are several benefits to treatment programs that are designed around a specific population, their sensitivities, paths to healing, and general preferences.
Women tend to approach and navigate life in a unique way, and many who suffer addiction have experienced varying levels of significant heartbreak and trauma. Whether it’s a matter of childhood abuse by a close adult or abuse by a partner or spouse, some women who have experienced severe trauma at the hands of another person in their lives (who many times is male), may be better served at a women’s-only rehab.
Many rehabs with a female-specific population are designed in accordance with the way women tend to heal and specifically offer PTSD counseling. Whether or not women are officially diagnosed with PTSD, they have a statistically higher risk of significant substance abuse when they have been the victims of sexual or physical abuse.
Other women may be completely comfortable in a co-ed setting, but there can certainly be circumstances under which the vulnerability that occurs during treatment may be more effectively supported by other women, many of whom may have experienced similar trauma.
Like women, men have their own way of traversing life and dealing with challenges. Many men are products of unspoken societal expectations such as being strong at all times, that crying and showing vulnerability are unacceptable, as is asking for help. When drug treatment becomes the only way out of addiction, countless men meet the real challenge of life instead of protecting this false sense of pride. The truth that there is no shame in asking for help is something that men’s drug treatment aims to reinforce.
Similar to women, men may have also been victims of physical or sexual abuse, heightening a likelihood for substance abuse and addiction.
In a men’s rehab program, the population often shares similar experiences and can more openly express vulnerabilities and emotions without fear of judgement, or the pressure to appear strong in front of women. The program details are tailored to relate to many of the specific challenges men face, and offer activities and therapies designed for men. Through a men’s-only treatment program, participants can learn to break free of societal conditioning and embrace their true selves in lasting recovery.
The LGBTQ community is one of the most discriminated against in the United States, despite recent LGBTQ rights movements and victories. a great deal of acceptance and tolerance continue to grow, yet individuals in this community who are in need of drug treatment also have a unique set of circumstances and personal traumas.
Not every LGBTQ person will necessarily feel more comfortable in a treatment setting specific to the community, but for those who may, these programs offer one of the most important aspects to being a member of the LGBTQ community—and that is basic acknowledgement.
Many may find that co-ed, and mixed treatment centers may not discriminate against LGBTQ people but also do not actually acknowledge them for who they are and for their unique set of experiences and challenges. Just like anyone else, members of the LGBTQ community need to feel a sense of individualized attention that gives credence to the legitimacy of their specific needs.
Teenagers are in their own worlds of evolving personality in a unique time of life and development. It stands to reason that this population may not feel comfortable in an adult treatment setting. For this reason, teenagers under the age of eighteen (and twenty-one in some cases), are not admitted into adult treatment programs.
A plethora of treatment centers and programs are specifically designed for teenagers and young adults, typically up to age twenty-three. Many of these programs are specified as wilderness programs, where the energy and curiosity of this population can be of great benefit to identifying any existing behavioral or personality issues, which may contribute to addiction. Additionally, all teen drug rehab programs focus specifically on the needs and challenges of teenagers. Many incorporate school curriculum, with heavy focus on peer relationships and finding self-worth. Teen drug treatment programs also tend to be longer in duration in order to afford the time for acclimation to the program, education, therapy, and practicing new habits and skills essential to sustained recovery.
Active and retired military are among the most vulnerable populations to suffer from addiction. The high prevalence of PTSD among this population coupled with the pervasive availability of alcohol while on duty makes military members and veterans particularly susceptible to substance abuse. Although generally honored and revered in American society, military members often express a desire to go back to active-duty tours because of the camaraderie while serving with fellow members. Many military treatment programs offer PTSD therapies, which are specifically designed for combat-related trauma, and they place focus on the transition from military life to civilian life—a transition that many members find particularly difficult.
Many executives often feel that they do not have the time and cannot afford to compromise their business reputations by going to drug treatment. The reality is that more corporate executives attend treatment than the general population is aware of, and there is good reason. Aside from privacy regulations laid out by the nation’s strict HIPAA (Health Insurance Portability and Accountability Act), which explicitly prohibits any treatment provider from disclosing information about any individual in the program, past or present,4 corporate treatment centers take several extra steps to ensure privacy. Complete with executive vehicles, exclusive locations tucked far away from public roads, and use of personal assistants, corporate executives can maintain their full privacy while conducting business as usual and receiving addiction treatment care. For those whose high-powered careers are of the utmost importance, they have access to several treatment centers with the extra privacy and amenities to allow business to continue, without the need for any noticeable absence from the corporate world.
There are two basic approaches to addiction treatment: 12-step, and non-12-step. Within each approach there may be several more specific options. However, the approach of drug treatment is the method by which the program aims to get people suffering from addiction on the path to recovery. Recovery will be based on one of these two basic approaches, so it is important to be comfortable with and have some level of confidence in whichever approach is chosen.
The 12-step method has been the most common approach for addiction treatment for over fifty years. Although many people take issue with frequent occurrences of “God” and god being referred to as “Him” throughout the writings of the 12 steps to recovery, it is not an exclusively Christian-based approach. The third step opens the door to the belief in any higher power as understood by the individual.
The “Big Book,” written by Bill Wilson, one of the two founders of Alcoholics Anonymous, is a guidebook to living in recovery from addiction; it lays out 12 steps and 12 traditions, which are held closely by those who have found recovery through the 12-step approach.
Within the umbrella of 12-step treatment approaches, there are many options, including:
The 12-step approach remains the most popular approach for addiction treatment, and many programs offer it along with a non-12-step option to provide an alternative, if someone in treatment decides to switch the approach. While maintaining evidence-based treatment protocols like cognitive behavioral therapy, individual and group counseling, and medical treatment options for opioid addiction, 12-step programs are ideal for those seeking a traditional form of rehab, and for those who prefer to recover in accordance with their religion.
Growing in popularity is a non-12-step approach to treatment. While still utilizing all evidence-based methods of treatment, a non-12-step program simply takes another approach to recovery, which is typically based in self reliance and addressing underlying issues causing or contributing to addiction.
Often referred to as holistic, non-12-step programs address the whole person—mind, body, and spirit—just as many 12-step programs do. However, in a non-12-step or alternative treatment program, the focus is more on the individual than on the addiction. The basic premise of alternative treatment programs is that addiction is a symptom of the real problem(s) an individual is facing. Once they can address those issues or traumas and outgrow them, the addiction is no longer an issue. This premise does have some resistance by a few in the field who firmly believe that addiction is a mental health illness that cannot be cured, but only treated to the degree where an individual can adjust to live with the condition.
The plethora of options with a 12-step treatment program are not as widespread as non-12-step programs, but details about the preferences can be very quickly answered by any drug treatment program advertising as non-12-step. Additionally, just as 12-step programs have AA and NA for recovery and support, there are several nationwide support systems and meetings for those who take a non-12-step path.
These support groups include:
Supplemental therapies are extra forms of therapy offered in a drug treatment program that add to the comfort, healing, health, activity, and lifestyle of the individuals in attendance. Supplemental therapies are not essential parts of a treatment plan but are offered as extras, and may or may not come with an additional cost.
Some of the most common forms of supplemental therapies include:
These therapies are options at many drug treatment programs. Not all options will be available at all centers, but most will offer one or a few of these therapies. When discussing these options with individual treatment programs, be sure to ask if there is any additional fee for their implementation. If so, be sure to check health insurance benefits for coverage of the expense.
The location of a drug treatment program can make a world of difference for some people, especially given that treatment facilities exist in every kind of setting across the United States. Discernment over the location of drug treatment can be important because the surroundings of a facility can encourage recovery or may have an atmosphere to trigger relapse and abandonment of treatment.
Generally, treatment facilities are situated in quiet and serene locations. Whether along the coastline, on a mountainside, in the big, open country, or down an old country road outside a small town, treatment programs aim to keep surroundings peaceful and free from outside influence. However, this isn’t always possible, especially in densely populated metropolis areas. With an understanding that everyone cannot travel to a beautiful oasis for drug treatment, the various options for locations are intended to meet every need or preference, depending on the individual circumstances.
In some cases, it may be a good idea to keep treatment local or in an environment which is similar to the home environment, to ease transition back once treatment has been completed. In other cases, drug treatment may be the beginning of a new chapter in life, and a complete change of setting may be more ideal. Also, it’s not necessary to be a resident of another state in order to seek treatment there. The only exceptions are for state-funded programs, which are only for the benefit of state residents. When considering a treatment location requiring travel, factor in the costs for visits from family members and whether health insurance coverage will extend to out-of-state care.
It is important to remember that not all marketing is honest, and pictures displayed on the website of a drug treatment center may not always be accurate. Therefore, it is a good idea to map the location of the facility to find the street view, local surroundings, and get a clearer picture of the area surrounding the facility.
Having amenities in drug treatment doesn’t mean that someone is spoiled and using treatment as a luxury vacation. Amenities help to make the environment more comfortable and may provide more options for activity and health.
Separate from supplemental therapies, amenities are not additional therapy but are the extras to make someone’s stay more serene and inspire more peace and hope for the future.
Some of the most common amenities usually come with a cost, built into the overall cost of the program, including features like:
The amenities offered will vary by treatment program, but there is a direct relation between available amenities and the cost of the treatment. When speaking with various treatment programs, ask about available amenities and whether the cost is a part of the overall cost of the program. It’s also a good idea to inquire about any additional desired amenities that may be billed separately.
Now that all of the key elements of an ideal drug treatment program have been addressed in order to be most ideal and effective for an individual situation, the process of searching can be made much easier. Instead of searching aimlessly, without specifying where, what kind of treatment, or the length or level of care, a much more pointed query in a search engine will return very specific results. An example of the difference between a informed query, and a general search would be:
“long-term residential detox and drug treatment for cocaine addiction in Santa Monica, CA”, instead of “drug treatment for cocaine addiction”
Whether the results are actual treatment centers or only referral sites, a phone number will usually be listed to connect to someone who can directly answer questions about all of the considerations covered in this guide. The most important part of this process is to have a firm idea of exactly what is needed, what can be paid for, what is covered, and what is preferred. The person who answers the phone at a treatment program will certainly make every attempt possible to sell their services, as they should. A non branded referral website will be able to likewise capture every necessary and desired consideration, then run a search and return results containing as much search criteria as possible.
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Being armed with detailed information ensures a limited number of results, whether online or over the phone, so that searching won’t becomes an endless abyss of programs which may all look the same. Always speak to a representative at any treatment program in consideration and ask as many questions as possible until everything is crystal clear. If you are being rushed off of the phone, or the representative cannot answer your questions about the program, be wary.
As a reminder, check your search plan before each call and be clear on the following before dialing:
It is important to understand that the best option may not have every identified preference on a search plan, so it is necessary to prioritize which elements are absolutely necessary as opposed to those which are not. Priorities like the level and length of care and treatment approach are more important, whereas things like amenities and supplemental therapies typically are not as essential. The greater the level of comfort for someone seeking treatment for addiction is important, but do not lose sight of the primary goal of effective drug treatment. Drug treatment is a life-saving experience, and its structure should be conducive to the most effective way for each individual to find a workable path to recovery that can be sustained and lead to healthy and productive life thereafter.
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