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Choose the best substance addiction treatment for you or loved one

So you’ve reached your personal “bottom” with whatever drug or drink you’ve become unhealthily dependent on, and it’s time to find help. Congratulations! But with so many choices, it’s hard to know which is the right step for you to take and at what point in the process. This article highlights the most common treatment options available, and the relative advantages of each.

  • Narcotics Anonymous Meetings: Technically not a “treatment” option at all, Narcotics Anonymous and Alcoholics Anonymous meetings are self (rather than professionally) run. Also known as “Twelve Step” meetings because they are based on a philosophy known as Twelve Step Recovery, NA and AA meetings are an excellent choice at any point in your recovery, from the day you decide you need help but are still using/drinking all the way through your 50th clean and sober anniversary.. NA and AA are the single biggest addiction recovery support networks available in the world. They offer free support groups somewhere in your area day and night.

Because Twelve Step Recovery is a system of spiritual principles, members are motivated by the motto that to ‘get recovery you have to give it away’; this means people with a year or more “clean time” are more than happy to help you the newcomer as part of their own ongoing program. Getting a sponsor who speaks to you one-on-one on a daily basis, works with you on the “steps” and is available for help when you experience urges is the best way to “work” the AA and NA program. If you have major issues with drinking and drugging, you might even consider going to both kinds of meetings.

  • Detox: If you are physically addicted to painkillers, benzos or alcohol, you are going to need a safe place to come off of them. While “outpatient detox” (where a doctor prescribes you medicines to help ease withdrawal on an outpatient basis) might seem like a more convenient option, the temptation to use or drink when the withdrawal symptoms become intense is usually quite high. Plus, withdrawal from benzos such as Xanax and daily alcohol alcohol consumption can be medically dangerous and should not be conducted outpatient. While detox units are usually located in a hospital or rehab setting, there are some freestanding detoxes, as well. The one I refer my own patients to is intimate, comfortable, and in a nice setting so it feels less like being in the hospital.
  • Inpatient or Residential Treatment: The difference between inpatient and residential treatment is one of where you live while you are in treatment. Inpatient facilities require that you live on their main campus, which you likely won’t be leaving during your stay except to go to Twelve Step meetings with a supervised group. The setting is sometimes similar to a hospital but it can also be very nice and even upscale. Residential treatment consists of attending your program during the day, and returning to supervised living quarters off-premises. This can feel a little more like ‘real life’, as there is a little more privacy (although you will always share your living space with roommates unless it is a very upscale program), and you may be taken to buy groceries for cooking at home,
  • Rehab treatment consists mostly of groups on various topics throughout the day and evening, such as daily living skills, addiction education, cognitive-behavioral strategies, Twelve Step philosophy, and yoga and meditation for emotional centeredness. There is also a family component where on particular weekends families come for education and support groups.
  • Residential treatment was instituted because insurance companies usually pay for more days of treatment when each day costs less. Treatment costs for inpatient can be astronomical, as the guidelines are closer to those for sub-acute hospital facilities. Unless you have the money to pay “out of pocket” for rehab, the times when insurance paid for all “28 days” are long gone. Rehabs are generally very savvy about maximizing insurance reimbursement and usually can get you 10 days to 2 weeks of insurance approval, but the remainder of your stay becomes your responsibility. Residential treatment programs can usually get you 28 days covered by insurance (depending on the insurance) or even longer.

The quality of both rehab and residential programs varies tremendously, and the most important thing is to get recommendations from professionals you trust, people you know with at least a few years of clean and sober time, and online reviews. I would strongly suggest NOT calling what appear to be addiction hotline numbers, either from the internet or Yellow Pages. These hotlines are simply set up to funnel new patients to particular rehabs and you are not getting as much of a choice as you should. Your primary physician is less likely to be familiar with great places than people you meet in Twelve Step Recovery or friends/family members in recovery.

  • Outpatient Treatment: Outpatient programs usually consist of group therapy primarily with a few individual sessions throughout your treatment. Group has the benefit of being able to share with and get support from people who are going through the same things you are. The downside is that depending on the program, you can end up feeling you’re not getting a lot of individual attention. Insurance companies will often try to push you to go to outpatient after detox even when you are physically addicted to a drug like painkillers, but this is short-sighted. The amount of time in detox is 5-7 days, so going directly to outpatient as a follow-up leaves people too vulnerable to relapse. They are often still having some withdrawal symptoms, and have not had the opportunity to build new skills before facing the freedoms and risks associated with going home. Almost without exception, there is a family component of these programs that is especially critical if you live at home. Your family (spouse, parents, sibs, extended family, and even close friends) will receive vital education about addiction, what to do and not to do in order to support you. They will often be encouraged to attend their own Twelve Step meetings (Naranon is the counterpart of NA and Alanon the counterpart of AA) for their own recovery from the issues that addiction can cause within a family.

A much better alternative is detox first, then inpatient or rehab, followed by outpatient treatment at least 3 days/nights a week (they are primarily evening program because people are working during the day) and Twelve Step meetings along with it. Meetings are usually required by outpatient programs anyway; this mandate can push you to try them out and get comfortable before going later when it’s your choice.

  • Individual Therapy/Counseling: It is a great idea to see a licensed or certified individual therapist or counselor specializing in addiction after discharge from inpatient/residential or while stepping down in outpatient care (three or four days a week will soon decrease to one or two nights plus meetings). Therapists qualified to treat addiction are: psychologists, licensed clinical social workers, and certified alcohol and drug counselors. Make sure regardless of credentials that the therapists you are considering all have at least 5 years of specific addiction treatment experience. Your own therapist will get to know you and help you work on your own personal “triggers” for using drugs. You must become an expert on these vulnerability factors, and develop well-honed skills to use when the urge strikes you--which they invariably will at some point.

A spectrum of good treatment options is available to you now that you have decided to break free from the bondage of your addiction. Twelve Step meetings are free and widely available 24/7, and can provide support and guidance at any point in your recovery, whether day #1 or year # 32. NA and AA meetings are offered at detox and rehab centers, so you can begin going even while inpatient. Strongly consider inpatient detox if your drug is painkillers, heroin, benzodiazepines or alcohol, followed by inpatient rehab to help protect you in the first vulnerable month of cravings. Residential treatment is a slightly modified version of inpatient, and involves living in off-campus housing to maximize your insurance coverage. Intensive outpatient is a good choice if you are early in your pattern of abuse, and not using daily. It is also used as a follow-up after discharge from rehab and residential.

Finally, even while attending intensive outpatient 2-3 days/nights per week, it is highly advisable to find your own individual therapist specializing in addiction to see weekly. You can discuss private issues with your therapist which you may not feel comfortable discussing in group therapy or support group meetings and have the opportunity to develop coping strategies for your own personal triggers for using drugs and/or alcohol. Whatever you do, make sure you get recommendations from experienced people about any treatment facility you are considering and don’t fall for the 1-800 addiction help numbers which are usually a thinly disguised sales pitch for one particular treatment center.

Photo Credits: recovery by Flickr: Dawn Ashley

Dr. Sam Von ReichePsychologist and Certified Professional Coach

Dr. Sam Von Reiche is a licensed psychologist and success coach in northern New Jersey with over twenty-five years of experience in the treatment of addiction. Her CBT Plus model incorporates cognitive-behavioral and holistic strategies for rela...

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