Drug and Alcohol Abuse Programs

Table of Contents

You’ve just made one of the biggest decisions of your life—the decision to quit using drugs and alcohol. Rather than continuing the assault on your physical, mental, and social health, you are going to focus on getting better and leaving substance abuse in the past.

Whenever people talk about recovery, they often talk about going to “rehab” to treat their addiction, so for many it’s the obvious first step. The problem is that many people don’t really know much about what rehab is, what happens in rehab, and how to find a good program. Although the term is used frequently in everyday life, few people know much about the ins and outs of drug addiction rehab.

What Is Rehab?

Short for rehabilitation, “rehab” is a general term used for substance abuse treatment. There is no concrete definition for “rehab,” and treatment can look different for each person, but most often “rehab” refers to a period of inpatient or residential treatment where the individual lives at the center and participates in recovery-focused activities throughout the day to establish and maintain sobriety. Usually occurring at the beginning of a period of recovery, rehab offers an intensive but relatively brief period of treatment where the person focuses entirely on transitioning to a sober life.[1]

A person’s stay in rehab will vary based on numerous factors, including how far their addiction has progressed, whether they require medical detox, the presence of any co-occurring mental or physical health conditions, and what type of stay their insurance will cover. The most common rehab stays are 30, 60, or 90 days. Long-term residential treatment can last 6-12 months. 1

Although rehab usually refers to inpatient/residential treatment programs, it may be used when describing outpatient treatment as well. In outpatient treatment, the individual lives at home while attending some level of treatment at a doctor’s office, addiction treatment center, or mental health facility. 1 Some outpatient services are very intensive, with the patient visiting the center for treatment for many hours during the day.[2]

Rehabs will typically use multiple treatment approaches to help meet the client’s recovery goals, including 1

  • Counseling.
  • Behavioral therapy.
  • Medication.
  • Case management.
  • Client and family education.

Qualities of a Good Rehab

Choosing to go into treatment is a big decision and picking a rehab isn’t a decision to make lightly. Not all rehabs are equal, and not every program will necessarily be a good fit for you, so it pays to do some work to pick the program that is best for your unique situation.

Rehabs are as unique as the people they serve. Different rehab programs may vary by:

  • The treatments they provide.
  • Staff expertise.
  • Program locations or settings.
  • The range of amenities offered.
  • Staff-to-patient ratio.
  • Average treatment length.
  • Program costs.

In rehab, the types and combinations of services will differ, and the quality of those services may also differ. Unfortunately, not every treatment provider offers the high-level treatment options that you or your loved one deserves. Some rehabs give substandard treatments or no treatment at all. When lives are on the line, this is unacceptable.

Plenty of great rehab programs exist all over the country, and it is your task to find them. By investigating specific rehab offerings and asking a few questions, you may start to see the distinction between the good and the bad.

Good rehab programs provide treatments backed by science.

The best treatments are backed by evidence from independent research studies that demonstrates their effectiveness.[3] Many reputable treatment plans utilize behavioral therapy, medication management, or a combination of both. Behavioral therapies include counseling styles like: 3

  • Cognitive-behavioral therapy to help the person identify, avoid, and manage problematic thoughts and triggers that make them want to use substances.
  • Motivational incentives, such as cash rewards or vouchers, to reinforce sober activities, like attending therapy and passing drug tests.
  • Motivational interviewing to build and expand on the individual’s own internal drive to stay in recovery.
  • Group therapy to learn ways of confronting and addressing the addiction with the help of others in similar situations.

Medications utilized as part of treatment in rehab can help the person to end drug use, avoid relapse, and increase treatment compliance. 3 When you’re asking a rehab program about their treatment approach, ask about medications used during and after withdrawal and if they have staff qualified to prescribe and dispense these medications.

Good rehabs customize the treatment to the individual.

Lower-quality rehabs may be more likely to offer a “cookie-cutter” form of treatment where each person is labeled based on their diagnosis and receives a generic course of treatment. Great rehabs will thoroughly assess the entire person and provide a combination of treatment approaches.3

The best rehabs will consider the individual’s: 3

  • Treatment goals.
  • Physical health.
  • Mental health.
  • Addiction histories, especially previous rehab attempts and relapses.
  • Age.
  • Gender.
  • Culture.
  • Religion.

Effective programs will also make it easier for a person to access treatment and to live in recovery by: 3

  • Addressing mental and medical health needs.
  • Making childcare accessible.
  • Offering housing and transportation.
  • Providing financial, legal, and vocational services.

If providers only address the addiction, they may neglect several other important needs in a person’s life, which could ultimately increase the likelihood of relapse when rehab ends.

Good rehabs continue treatment for a sufficient period of time.

Quality rehabs will base the length of treatment on your addiction severity and recovery needs. Adjustments may be made as your progress is assessed throughout. 3

Certainly, detox-only programs will focus largely on addressing physical dependence and withdrawal and may be very short in duration (days to weeks); however, reputable detox centers will help you transition to further care once the acute withdrawal period has been successfully managed.

Longer periods of treatment are associated with better recovery outcomes. 1 According to the National Institute on Drug Abuse (NIDA), someone beginning a period of sobriety should plan to stay in treatment for at least 3 months, as shorter stays may be of limited benefit. 3

Good rehabs connect you to ongoing treatment.

What happens when rehab ends? Does the program simply end your stay by showing you the door, or do they have a number of step-down and aftercare options to continue your progress?

Effective addiction treatment programs view their role as only a portion of your overall care and longer-term recovery journey. They realize recovery from alcohol and other drugs is a lifelong process, which requires ongoing treatment and support. When your time at that facility is set to end, there will be planning meetings with your treatment team to determine the next step based on your needs and wants.2, 3

Outpatient therapy and support groups located in the community will be good options for continuing your care after rehab.3 It should be a red flag if the rehab neglects your aftercare planning or claims that no follow-up recovery efforts will be necessary.

Treatment: Stay at Home or Leave Town?

Now that you have decided to go to rehab, you need to consider the benefits and drawbacks of treatment close to home versus a program out of town.

Pros of choosing a rehab close to home include:

  • Easy access for you to visit or tour the rehab before you commit to treatment.
  • The ability to discuss the center with people who have already completed the program.
  • Keeping a strong connection with your loved ones through approved visits.
  • Building relationships with people that can be easily maintained after treatment.
  • Lower cost of transportation to and from treatment.
  • A smoother transition from rehab to aftercare services in your community.
  • Lower cost if your insurance only covers programs within your state.

Some potential downsides of going to rehab close to home include:

  • Being surrounded by the same people, places, and things that trigger cravings.
  • Feeling that you are not removed from your stressors and temptations.
  • Ease of leaving treatment early and returning return home.

Rehabs located far from home have advantages like:

  • Being completely removed from the people, places, and things that encourage use.
  • Increased privacy and confidentiality, like others in treatment will likely not have existing relationships with you or people you know.
  • The ability to get away from the responsibilities of your everyday life and exclusively focus on yourself and your recovery.
  • New scenery, which is often peaceful and tranquil, and offers a chance for quiet and introspection.
  • A chance to start fresh in a new setting.

Potential drawbacks of leaving town for rehab include:

  • Potentially high costs, especially those in exclusive locations, such as those near the beach.
  • The cost and logistics of physically getting to and from the treatment location before and after treatment.
  • Not having loved ones nearby to provide in-person support.
  • The inability to tour the treatment center or directly question people who have been through the program.

Just as there is no right form of treatment for every person, there is no ideal treatment location for everyone. 1 When making this decision, you have to honestly evaluate your situation and need to find the best option. During the process, be sure to consider your previous attempts at treatment. If previous options did not work well in the past, pursue alternatives. 2

 Why Are So Many Rehabs in Florida and California?

If you have decided an out-of-town rehab is in your best interests, you will be inundated with options in Florida and California. These two coastal states have exceptionally high numbers of rehabs and other addiction treatment centers.

According to the Substance Abuse and Mental Health Administration’s (SAMHSA) treatment locator map:[4]

  • California has about 1,100 treatment centers, with approximately 280 located within the boundaries of Los Angeles County.
  • Florida has more than 530 treatment centers, with high concentrations on both the Atlantic and Gulf Coasts.

Compare these high numbers with other places like South Dakota (only 50 treatment centers) and Wyoming (43 centers).4

Treatment availability is one reason to go to rehab in California or Florida, but the physical location is another. If you had the option of spending time in either a cold, rainy city or a sunny city near the beach, it’s likely you’d be tempted by the latter. A beautiful locale can be a big motivating factor for someone considering rehab.

Many Southern California and Florida treatments offer:

  • Consistently warm weather.
  • Oceanside locations.
  • Picturesque scenery.

Many treatment centers in California and Florida provide a luxury rehab experience that extends beyond the location. Luxury rehabs can deliver addiction treatment combined with all the amenities of an upscale hotel, including:

  • Private rooms.
  • Comfortable and spacious facilities.
  • Fine bedding and linens.
  • Gourmet meals.
  • Access to state-of-the-art technology.

Other reasons for the high concentration of rehabs in California and Florida may have to do with:[5],[6]

  • Relaxed laws making it easier to open and maintain treatment centers in these states.
  • Easier access to health insurance via the state’s healthcare marketplace.

For example, people in California can access a program called “Covered California” that provides health insurance to people very quickly – the same day in many cases.6

Many rehabs in these states strive to serve the needs of people struggling with addiction, but it is important to understand that not every program has the patient’s best interests at heart. Like any business type, some will be reputable and some will not. Some programs are only interested in profiting financially from your substance use. These programs may make false statements to tempt people in need into their programs and then provide little or no treatment.

Disreputable rehab centers may promise: 5

  • Transportation to and from treatment.
  • Rewards like gift cards for agreeing to treatment.
  • Drugs*

*In reality, some shady programs may encourage drug use to maintain your addiction so they can continue charging your insurance company.5 Unfortunately, this is a widespread problem; more than 75 people have been arrested for defrauding insurance companies for over $141 million since 2017.5

Some programs have recently come under fire for engaging in illegal activities, such as patient brokering. In a notable and horrific case out of Florida, one sober living home owner was convicted of prostituting clients and engaging in human trafficking.6 These unfortunate events do occur, but they do not represent all treatment providers, only a very small faction. There is a lot to be gained in treatment, so it’s important not to let the existence of corrupt centers distract you from your goal of attaining recovery. If you are nervous about finding a program that you can trust, we can assist you any time of day or night. Give us a call for immediate help. 

What Questions Should I Ask?

If you cannot see the rehab firsthand and talk to staff, some questions you can ask over the phone include the following:[7],[8]

  • Are you licensed by the state?
  • What is your accreditation?
  • Who is your clinical/medical director? What are their qualifications?
  • What are the credentials of the staff who have direct care with patients? What is their experience?
  • How long have the staff been employed at the center?
  • What is your program’s success rate?
  • What are the program costs?
  • How do patients spend their days? What is the schedule?
  • What do you expect of the patients during treatment?

If the person seems hesitant or is uncomfortable answering your questions, there might be cause for concern.

Finding Treatment Close to Home

Perhaps the best course of action in looking for rehab near you is starting with your primary care physician (PCP). Your PCP can assess your current symptoms and risks, recommend treatment options and locations, and observe your overall health. 8

There are other appropriate steps to find a local rehab if your PCP is not available. You can:

  • Consult with friends, family, or co-workers regarding their own experiences with local treatment centers.
  • Talk to a school counselor or mental health professional about potential options.
  • Complete an online search to find programs and read reviews.
  • Visit the rehab and ask to speak with a representative about treatment options.
  • Attend a local support group like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) to gather feedback about members’ rehab experiences and recommendations.
  • Call our hotline for immediate assistance.

Remember, knowing someone who subjectively appreciated or, conversely, disliked a program does not guarantee you’ll have the same experience. When getting recommendations, ask specific questions about what the person did or did not like about the program.

 Finding a Rehab that Takes Your Insurance 

In the past, clients had to pay cash up front for their addiction treatment. Now, due in part to the Affordable Care Act (ACA), insurance companies are required to pay for substance abuse treatment to the same extent that they pay for other medical treatment.[9] If you have insurance, there is a good chance at least some of your treatment will be covered.

The best way to find a rehab willing to take your coverage is to call your insurer directly. With the phone number located on the back of your card, you can speak to a knowledgeable representative who can look up and relay your covered options. Some plans will offer access to many programs across the country, but others might limit you to in-state options.

During your phone call, inquire about the length of stay allotted by your plan and limits on the total number of services covered.

Many rehab programs have extensive experience interacting with insurance companies, and may themselves help you determine whether your insurance will cover your stay at their facility.

Publicly Funded Treatment Programs

If you do not have insurance, you may be able to attend a publicly funded treatment program. These programs are funded by local, state, and federal tax dollars and offer services for free or at a significantly reduced cost.

Before you consider a publicly funded program, you should contact your county assistance office or the Social Security Administration to evaluate your ability to gain affordable health care.[10] If you do not qualify for government insurance, the publicly funded program will ask you questions about your current income and expenses to estimate your fee for the services.

Since these programs receive their financing from the public, the rehab experience will differ from more luxurious programs in their locations and amenities. However, quality care is not dependent on luxurious amenities, and you can recover in a publicly funded program and get your life back from addiction.

What If I Have a Dual Diagnosis?  

Some people go into rehab with knowledge of their dual diagnosis (simultaneous addiction and mental health issues). Other people will learn of their concurrent mental health and substance abuse disorders during the early stages of rehab. In either case, it is imperative that any addiction treatment program also be able to address your mental health needs. 1 Without treating both problems simultaneously, your providers are leaving you at risk.

You may think that your mental health is stable while you’re using, but it can be very difficult to accurately assess your mental state until after you have established some period of sobriety. Substance use often conceals or distorts mental illness.

Depression, anxiety, post-traumatic stress disorder (PTSD), bipolar, and schizophrenia commonly co-occur with substance abuse problems and require medication, therapy, or a combination to improve symptoms. 1 Be sure to discuss your preexisting mental health issues with staff and ask how the program manages these concerns.

Do they have psychiatrists or other practitioners able to prescribe medications? Do they have a team of mental health specialists including counselors, psychologists, and psychiatric social workers? You cannot ignore your mental health needs if you wish to attain lasting recovery.

What if I’m Pregnant?

For many women who have suffered from addiction, pregnancy is an extremely motivating force for them to seek recovery. Substance use can negatively impact the child in numerous ways. It may cause: 1

  • Sudden infant death syndrome (SIDS).
  • Breathing problems.
  • Seizures.
  • Low birth weight.

There are well-researched, evidenced-based treatments for pregnant women interested in ending their substance use, and some treatment programs will cater to pregnant women, using these appropriate treatment approaches. 1

Ask the rehab about their expertise with pregnant patients, prenatal care, and access to standard OB/GYN testing and appointments. Women with quickly approaching due dates may also inquire about newborn care and the ability to bond with their children during the remainder of their rehab treatment.

Frequently Asked Questions 

How Can I Help My Loved One Agree to Treatment?  

Seeing a loved one struggle with drugs and alcohol can be tremendously stressful. Since you want what’s best for this person, you will do everything in your power to get them connected to the help they need.

From the outset, you must be consistent in your approach. For the best outcomes, always approach the person from a place of love and support. Being overly negative or confrontational may lead to further strain in your relationship and may spark aggression or violence from your loved one.[11]

In a kind and nonjudgmental way, let your loved one know the ways that you’ve seen substances negatively impacting their life. Let them know you love them and care for them too much to see their life go in this direction and suggest professional treatment as a way to help them get back on track.11

Rather than simply telling them what to do, take the next steps together as a team. You can call addiction professionals, schedule appointments, and tour facilities together, although it may help to have some options already laid out so that you can quickly move to the next step.

As a trusted source of support, your role does not end when your loved one enters treatment. Instead, you will fill a valuable place on the treatment team during all stages of recovery. You may attend family sessions during treatment and then help them identify and avoid triggers for relapse when they return home. 11

Your support can encourage treatment and recovery, but ultimately you are not responsible for their life. Don’t put the weight of their addiction on yourself. You cannot magically convince the person to attend treatment and remain abstinent; you can only provide unconditional love and support. Ultimately, the decision to get help lies with them.

Do Adolescents Have Special Treatment Needs? 

Like other groups in addiction treatment, people in their teens and early twenties may benefit from services tailored to their unique situations:1

  • Mental health issues often fuel adolescent drug use, so providers must accurately assess these conditions.
  • Adolescents in group therapy (especially those who are very delinquent) may reinforce one another’s drug use, resulting in further harm. Counselors must carefully monitor and counteract this tendency.
  • Family therapy will be essential to strengthen relationships and motivate recovery.
  • Access to the full range of medication-assisted treatment may be limited in some programs, since drugs like buprenorphine are not specifically approved for use in children and adolescents.

Another concern for adolescents is education. If you are searching for rehabs, ask the staff about available educational components of their programs. Some rehabs will offer an academic curriculum provided by certified teachers, with the potential for earning credits toward a high school diploma.7

What Can I Do if I Don’t Have Insurance?

If you don’t have insurance, your focus should be exploring every possible option to gain coverage:

  • The ACA makes it easier than ever to have an insurance plan, and the Mental Health Parity and Addiction Equality Act compels your insurance to cover addiction services as it would any other medical condition.11
  • You may qualify to stay on your parents’ insurance as long as you are 26 years old or younger.
  • If you have a mental health condition or don’t make much money, you could qualify for coverage provided by the government. With Medicare or Medicaid, treatment might be obtained at low or no cost to you.

Do not give up your quest for rehab, even if all paths to insurance seem blocked. Individual rehabs may offer scholarships, grants, and flexible payment options to make your treatment a reality. Making many phone calls to various rehabs and your county assistance office may be frustrating but could result with you getting the treatment you need.

Does Rehab Really Work?

Professional addiction treatments help people stop using drugs, maintain recovery, and find success within their family, work, and community. 1 Substance abuse treatment should not be perceived as a one-time, definitive “cure” for addiction. For many, addiction follows a chronic course that may be marked by periods of relapse and recovery. 1

As such, treatment for addiction is often compared to treatment for other chronic conditions such as high blood pressure and diabetes. 1 Active participation during both treatment and aftercare can help improve symptoms. Conversely, a lack of engagement throughout treatment and inconsistent longer-term recovery efforts could negate recovery progress and, over time, increase the likelihood of relapse.

If you expect rehab to be a magic cure, you will be met with disappointment. Understand that you’ll have to do serious work in treatment and that this work won’t end once you leave the program. Recovery is hard work, and relapse is influenced by countless variables.

Recovery experiences are different for everyone and, in some instances, the success of any given rehab program may be difficult to succinctly measure. However, you can ask:8

  • How they define success.
  • If and how they measure success.
  • How many patients complete the entire program.
  • How they manage relapses.

Should I Look for a Rehab that has Medical Detox?

For people who have been consistently using alcohol and other drugs over time, medical detox is an important—often essential—stage of their treatment. During detox, your body will be safely cleared of all substances of abuse. Medical detox is a specific set of interventions used by a staff of doctors, nurses, and other professional staff members to ensure your health and comfort early in the recovery process.2

The first few hours and days of recovery can be tenuous because quitting alcohol and certain other substances can trigger distressing and dangerous withdrawal symptoms as the body readjusts to sobriety.2 By offering observation, a safe environment, and appropriate medications, professional detox can make the withdrawal process much less risky and less intense.

People abusing opioids, alcohol, and sedatives are at the greatest risk of ill effects during detox and are generally advised to seek out medical detox services.2 However, detox isn’t limited to these substances—anyone suffering from withdrawal can access detox for help in this first stage of recovery. 1

Depending on the specific site, a rehab may offer in-house detox services, or you can complete detox at a separate location prior to your time in rehab. Detox only addresses the physical impact of substances, so other forms of treatment are needed to address the psychological, social, and behavioral facets of addiction. 1

How Long Should I Attend Treatment?

Treatment for substance abuse will be widely vary among individuals, lasting from days to months. The most important factor to keep in mind is that staying in treatment longer helps you stay in recovery longer. 1

But no two people’s paths will look exactly the same. Some people need inpatient/residential care for an extended time, and others are able to sustain their recovery progress with outpatient treatment. The best treatment providers work with you to design and update your plan for care according to your current and changing needs.1

As mentioned, detox is often the first and shortest segment of addiction treatment, but it does little to create long-term change. If you are focused on having the shortest stint in treatment possible, consider at least attending 90 days if you can take the time and you can afford it.1  If your treatment team recommends methadone maintenance for an opioid addiction, one year is the minimum time needed for positive outcomes.1

Remember, you don’t have to spend all your time (or any) in an inpatient center, though you may want to if your home environment is triggering. An outpatient approach can be a great and less expensive way for you to access therapy and learn new skills that will help you stay sober.

Many people approach addiction treatment with the perspective that recovery requires lifelong effort. There is always an aftercare option to prolong your recovery; you can work with your treatment team to discover the best options for you. 

What Should I do After Rehab? 

The good news is that deciding what to do after rehab is not a choice you have to make alone. The best rehabs will reassess your recovery progress as you near the conclusion of your treatment to make an informed recommendation for the next step in your care. 1 Perhaps, another period of residential treatment will be best if returning to life seems overwhelming or risky.

Outpatient treatment options will be great for people who have made positive strides towards recovery during rehab. Some people will transition into an alternative housing program, such as a halfway house or sober living home, as they reenter society in a safe and controlled way.

Whatever recommendation you receive, investigate the pros and cons of each option. The same fraudulent practices that are running rampant in rehabs are also problems in sober living homes.5

No matter what treatment option you choose, your life should look dramatically different after rehab compared to before rehab. Especially early in recovery, you may be surrounded by the people, places, and things that trigger cravings for drugs.11 Interacting with them may make you likely to relapse. If you can avoid these triggers, you will be more likely to stay in recovery.

By staying active in treatment, interacting with healthy supports, and finding a sense of purpose, life after rehab could be the best part of your life.

References

[1] National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide.

[2] Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.

[3] National Institute on Drug Abuse. (2013). Seeking Drug Abuse Treatment: Know What to Ask.

[4] Substance Abuse and Mental Health Service Administration. (n.d.). Locator Map.

[5] WTAE.com (2018). Feds Investigating Pittsburgh Ties to Fraudulent Drug Rehab Centers in Florida.

[6] Daily Beast. (2017). Is the $35 Billion Rehab Industry Ready for a Disruption?

[7] Federal Trade Commission. (2008). Residential Treatment Programs for Teens.

[8] National Institute on Alcohol Abuse and Alcoholism. (2014). Treatment for Alcohol Problems: Finding and Getting Help.

[9] Healthcare.gov. (n.d). Mental Health & Substance Abuse Coverage

[10] PA.gov. (n.d.) Substance Abuse Services.

[11] National Institute on Drug Abuse. (2016). What to Do If Your Adult Friend or Loved One Has a Problem with Drugs.

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