Oftentimes, inpatient treatment is the most immersive level of care someone can receive. It can provide intensive, 24-hour care under the direction of a team of professionals
Effective treatment is essential to improve outcomes for people with substance abuse issues. These treatments should be individualized, readily available, and well-rounded to address the full needs of the individual, not only their addiction 1. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2014, more than 21 million people needed treatment for substance use issues, but only 2.5 million people actually received the help that they needed. This means that more than 88% of all people with substance use problems go without specialized treatment 2.
One potential barrier to those seeking treatment is the difficulty of knowing which program to choose from the many types available. With so many options, it can be challenging to know which type of care to choose. Different levels of treatment may be more appropriate for each individual and their unique situation. To seek effective treatment, it is helpful to know what options exist and which one(s) may be a proper fit.
Issues Dictating Level of Care
The selection of the most appropriate level of care is influenced significantly by the individual’s current situation (including the state they live in, their current employment status, their support system, their home environment, and other factors such as mental and medical health history).
Addiction Screening and Assessment
A thorough evaluation of someone struggling with drug addiction will focus on numerous factors like 3,4:
- Demographic information—Age, sex, ethnicity, culture, sexual orientation, and level of education.
- Physical health history—Medical or psychiatric issues, past surgeries, active prescribed medications, physical or cognitive disabilities, and allergies.
- Toxicology–Levels of substances currently in the patient’s body.
- Current and former substance abuse, including: substances used and for how long; periods of abstinence; methods of use; how often the substances were used; and the dose/purity of the substance.
- Physical assessment and vitals—How is the person is responding, feeling, and functioning in the present situation? Does the individual need additional medical care outside of standard addiction treatment?
- Current mental status—Is the person alert and aware of their surroundings?
- Current and former mental health symptoms and diagnoses—Is there a history of psychosis, violence, or suicidal thoughts/behaviors?
- Past treatment for substance abuse and mental health conditions—What forms of treatment have been employed previously? Where they helpful?
- Living situation—Who does the person live with, and what is the quality of their relationship(s)?
- Transportation and financial stability—Does the individual have the ability to attend treatment outside of the home?
- Dependent family—Are there people that depend on the individual for care?
- Criminal justice involvement—Does the person have current or former legal issues?
Once this information is gathered, professionals can better evaluate each unique situation and, from there, direct the individual towards a treatment that will be the best fit for the individual.
Inpatient Drug Addiction Treatment
Inpatient treatment is often recommended for individuals with:
- High amounts of stressors and triggers in their environment.
- Low availability of support.
- A history of chronic substance abuse.
- Poor treatment outcomes in the past.
Oftentimes, inpatient treatment is the most immersive level of care someone can receive. It can provide intensive, 24-hour care under the direction of a team of professionals 5,6,7.
A primary focus of inpatient drug treatment will be to stabilize the individual’s acute and immediate medical and psychiatric condition to ensure their safety and set them up to engage healthfully in ongoing addiction treatment. Inpatient treatment can take place in hospitals or specialty behavioral health centers 2.
Although detox can take place in a number of settings, it will often occur as the initial portion of an inpatient treatment program. Detoxification is a group of interventions employed to manage the symptoms of cumulative substance toxicity and the acute withdrawal from these substances in someone dependent on them. This process allows the body to rid itself of the influence of drugs in a controlled environment to improve comfort, minimize any risks, and improve future prognosis 3.
In some cases, detox takes place an inpatient setting. The most intense type is medically managed intensive inpatient detoxification. This form of detox usually takes place in a hospital’s inpatient center and provides 24-hour acute care. Another type that is somewhat less intense is called medically monitored inpatient detoxification. This level includes 24-hour medical supervision to complete detox. Certain other detox programs take place in a freestanding detox center apart from a hospital 3.
Inpatient Psychiatric Care
These inpatient settings will have a particular focus on the treatment of acute mental health symptoms that are directly or indirectly related to substance abuse. SAMHSA reports that 45% of people receiving treatment for substance abuse disorders also have a co-occurring mental health condition 2.
This setting is most appropriate for someone with serious mental health issues that cannot be well managed outside of an inpatient setting. Like other forms of inpatient treatment, this level of care will be take place in a more restrictive and highly-structured environment with medical attention 12. One may find a high staff to patient ratio that aids in directing individual and group therapies as well as connecting to services following discharge 12.
Though conceptually similar, the principle differences between residential treatment and inpatient treatment will be the structure, the medical intensity, and the setting.
Residential treatments are often set in home-, apartment-, or dormitory-like environments, whereas inpatient settings will more closely resemble a medical/hospital setting. The duration of stay will differ as well. Hospital based inpatient treatments are usually shorter, lasting days to weeks. Residential options are more extended treatment options, lasting from weeks to months and are more appropriate for people with less acute or dangerous symptoms 2,6,7.
In addition to providing a safe and drug-free environment in which to recovery, many residential programs provide ample individual and group therapy sessions, access to medical services, nutritional counseling, wellness activities, and thorough planning for aftercare programs.
It should be noted also that there is a level of detoxification that takes place in a residential setting called clinically managed residential detox. It will offer 24-hour “social detox” support but no medical care 3.
Therapeutic Communities (TCs)
Therapeutic communities (TCs) are variants of long-term residential treatment with typical lengths of stay between 6 and 12 months. This setting will provide care 24 hours daily in an environment with more freedoms than a hospital. Treatment remains highly structured and staff members may use confrontation techniques, (such as challenging thought distortions or bringing attention to instances of poor decision-making) with residents to reduce denial, create motivation, and produce change 6.
In TCs, residents and staff work together towards the goal of relearning problem-solving skills and new ways to interact with their environment. With this focus in mind, TCs offer individualized care that can be modified for various groups of people in recovery including adolescents and people with disabilities. Some TCs may include 6,7:
- Employment opportunities.
- Family therapy.
- Other supportive services.
Short-Term Residential Rehabilitation
Short-term residential rehabilitation programs were designed originally to manage alcohol addiction with lengths of stay between 3 and 6 weeks. These programs were based on an adapted, high intensity 12-step model (such as that used by Alcoholics Anonymous). Early in treatment, the focus will be on becoming substance-free and establishing a plan for continued treatment at the conclusion of this short-term program to minimize the risk of relapse 6.
Short-term residential treatment programs have expanded to a larger range of substance use issues beyond only alcohol 6.
Recovery housing is a short-term, less intense level of residential treatment that often follows an initial inpatient or other residential treatment period. Participation will depend on the individual’s ability to thrive with increased independence. This treatment level will serve as a transition from more structured services to the freedom of independent living. Treatment may focus on:
- Boosting occupational skills.
- Finding employment.
- Managing personal finances.
The social model is a type of residential treatment where no mental health or substance abuse professionals are on staff within the home. These residences are sometimes called sober living houses (SLHs) and are established as a drug-free, recovery-focused environment. They are not funded or licensed by any government bodies 8,9.
Without the guidance and treatment of a professional, the residents will find support through others residing in the community. The social model focuses on support, sharing, and positive role modeling of behaviors to avoid relapse and build healthy coping skills. Many times, the residents are expected to work in the community, pursue their education, or engage in volunteer activities as a condition of their residence. Since professional treatment is not available within the home, the individual must seek formalized options elsewhere 8,9.
Treatment through the Criminal Justice System
Contrary to popular thought, substance abuse treatment does not have to be voluntary to be helpful for the individual. People that have entered the criminal justice system through legal charges, probation, or incarceration have good chances of achieving success in ending substance use and entering a period of recovery. This can occur before, during, after, or instead of incarceration. In fact, people that begin treatment in prison and maintain a form of treatment upon their release tend to have better outcomes in the future, marked by less substance use and criminal behaviors 6.
For someone with a substance use disorder who has gone to prison, treatment for addiction should begin during incarceration, rather than afterward, for improved outcomes 10. Unfortunately, less that 20% of the incarcerated individuals that need treatment receive it, according to the National Institute on Drug Abuse. To improve this issue, a high degree of coordination is required between the treatment providers and criminal justice personnel 10.
While incarcerated, individuals may receive treatment styles in an individual or group therapy setting to achieve their treatment goals including:
Those addicted to opioids may be placed on maintenance medications (e.g., methadone) to facilitate the recovery process 10.
Residential Re-Entry Centers
Residential re-entry centers (RRCs), also called halfway houses, offer assistance to people that transition from incarceration to life outside of prison. People will live at the RRC as they acclimate to society and to their environment. RRCs will function in a way similar to a sober living house, but there will be more structure and accountability from professional staff hired to guide the process. Someone living in an RRC can expect 11:
- Their location and activity to be monitored.
- Unannounced drug tests.
- Opportunities to complete substance use and mental health treatment.
- Assistance with housing outside of the RRC.
- Assistance with employment through job training and interviewing skills.
- Provision of other supportive services such as financial management.
As mentioned, not every inpatient and residential treatment program will be appropriate for each person. Someone may begin with a more intense form of treatment before “graduating” or “stepping down” to a less intensive form of treatment. Eventually, an individual will work towards maintaining their recovery at the least restrictive environment that continues to accomplish their goal of a sober life.
- National Institute on Drug Abuse. (2016). Drug Facts: Treatment Approaches for Drug Addiction.
- Substance Abuse and Mental Health Services Administration. (2015). Behavioral Health Treatment and Services.
- Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
- Australian Government: The Department of Health. (2004). Models of Intervention and Care for Psychostimulant Users, 2nd edition: Assessment for Detoxification.
- Substance Abuse and Mental Health Services Administration. (2016). Treatments for Substance Use Disorders.
- National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
- National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide.
- Massachusetts Executive Office of Health and Human Services. (2016). Substance Abuse Services Descriptions.
- Polcin, D. L., Korcha, R., Bond, J., & Galloway, G. (2010). What Did We Learn from Our Study on Sober Living Houses and Where Do We Go from Here? Journal of Psychoactive Drugs, 42(4), 425–433.
- National Institute on Drug Abuse. (2014). Principles of Drug Abuse Treatment for Criminal Justice Populations: A Research-Based Guide.
- Federal Bureau of Prisons. (n.d.). Completing the Transition.
- Columbia University Medical Center. (2015). Columbia Inpatient Psychiatry Program.