What Is Substance Abuse Treatment?

by National Institute of Health

(Page 2 of 6)

Who Provides Treatment?

Many different kinds of professionals provide treatment for substance use disorders. In most treatment programs, the main caregivers are specially trained individuals certified or licensed as substance abuse treatment counselors. About half these counselors are people who are in recovery themselves. Many programs have staff from several different ethnic or cultural groups.

Most treatment programs assign patients to a treatment team of professionals. Depending on the type of treatment, teams can be made up of social workers, counselors, doctors, nurses, psychologists, psychiatrists, or other professionals.

What Will Happen First?

Everyone entering treatment receives a clinical assessment. A complete assessment of an individual is needed to help treatment professionals offer the type of treatment that best suits him or her. The assessment also helps program counselors work with the person to design an effective treatment plan. Although clinical assessment continues throughout a person's treatment, it starts at or just before a person's admission to a treatment program. The counselor will begin by gathering information about the person, asking many questions such as those about

• Kinds, amount, and length of time of substance or alcohol use
• Cultural issues around use of alcohol or drugs
• Effects of drug or alcohol use on the person's life
• Medical history
• Current medical problems or needs
• Current medications (including pain medication)
• Mental health issues or behavioral problems
• Family and social issues and needs
• Legal or financial problems
• Educational background and needs
• Current living situation and environment
• Employment history, stability, problems, and needs
• School performance, problems, and needs, if relevant
• Previous treatment experiences or attempts to quit drug or alcohol use.

The counselor may invite you, as a family member, to answer questions and express your own concerns as well. Be honest - this is not the time to cover up your loved one's behavior. The counselor needs to get a full picture of the problem to plan and help implement the most effective treatment. It is particularly important for the counselor to know whether your family member has any serious medical problems or whether you suspect that he or she may have an emotional problem. You may feel embarrassed answering some of these questions or have difficulty completing the interview, but remember: the counselor is there to help you and your loved one. The treatment team uses the information gathered to recommend the best type of treatment. No one type of treatment is right for everyone; to work, the treatment needs to meet your family member's individual needs.

After the assessment, a counselor or case manager is assigned to your family member. The counselor works with the person (and possibly his or her family) to develop a treatment plan. This plan lists problems, treatment goals, and ways to meet those goals.

Based on the assessment, the counselor may refer your family member to a physician to decide whether he or she needs medical supervision to stop alcohol or drug use safely.

Medically supervised withdrawal (often called detoxification or detox) uses medication to help people withdraw from alcohol or drugs. People who have been taking large amounts of opioids (e.g., heroin, OxyContin®, or codeine), barbiturates or sedatives ("downers"), pain medications, or alcohol either alone or together - may need medically monitored or managed withdrawal services. Sometimes, alcohol withdrawal can be so severe that people hallucinate, have convulsions, or develop other dangerous conditions. Medication can help prevent or treat such conditions. Anyone who has once had hallucinations or seizures from alcohol withdrawal or who has another serious illness or (in some cases) a mental disorder that could complicate detoxification may need medical supervision to detoxify safely. Medically supervised withdrawal can take place on a regular medical ward of a hospital, in a specialized inpatient detoxification unit, or on an outpatient basis with close medical supervision. Detoxification may take several days to a week or more. During that time, the person will receive medical care and may begin to receive education about his or her disease.

Q: My wife just started treatment. I called the program yesterday to ask the counselor some questions. The counselor said that she "could not confirm or deny" that my wife was even there! What's that about? A: Federal and State laws protect an individual's privacy in treatment. Before the counselor can talk to anyone (including you) about your wife's treatment, the program must first have her permission, in writing. Even if the counselor knows that you know your wife is there, she still can't even say that your wife is in the program until your wife signs a "release of information" or "disclosure authorization" form. You may want to talk to your wife and be sure she understands that you would like to be involved in the treatment program.

Not everyone needs inpatient medically supervised detox. People with mild withdrawal symptoms from alcohol or drugs and people using cocaine, marijuana, opioids, or methamphetamine do not generally need to be hospitalized for detoxification. However, they may need outpatient medical care, a lot of support, and someone to ensure their well-being.

Social detoxification can meet this need. Sometimes social detoxification centers are part of a residential treatment program; other times they are separate facilities. Social detoxification centers are not hospitals and seldom use medication, but the person does stay there from several days to 1 week. The social detoxification staff includes nurses and counselors. The staff watches each person's medical condition closely, and counselors are available to help him or her through the most difficult part of withdrawing from alcohol and drugs.

It is important to know that detoxification is not treatment; it is a first step that can prepare a person for treatment.

What Types of Treatment Programs Are Available?

Several types of treatment programs are available:

• Inpatient treatment
• Residential programs
• Partial hospitalization or day treatment
• Outpatient and intensive outpatient programs
• Methadone clinics (also called opioid treatment programs).

Inpatient treatment, provided in special units of hospitals or medical clinics, offers both detoxification and rehabilitation services. Several years ago, many hospital-based treatment programs existed. Today, because of changes in insurance coverage, inpatient treatment is no longer as common as it used to be. People who have a mental disorder or serious medical problems as well as a substance use disorder are the ones most likely to receive inpatient treatment. Adolescents may also need the structure of inpatient treatment to make sure a full assessment of their substance use and mental disorders can be done.

Residential programs provide a living environment with treatment services. Several models of residential treatment (such as the therapeutic community) exist, and treatment in these programs lasts from a month to a year or more. The programs differ in some ways, but they are similar in many ways.

Residential programs often have phases of treatment, with different expectations and activities during each phase. For example, in the first phase, an adult's contact with family, friends, and job may be restricted. An adolescent may be able to have contact with his or her parents but not with friends or with school. This restriction helps the person become part of the treatment community and adjust to the treatment setting. In a later phase, a person may be able to start working again, going "home" to the facility every evening. If your loved one is in a residential treatment program, it is important that you know and understand the program rules and expectations.

Often residential programs last long enough to offer general equivalency diploma (GED) preparation classes, training in job-seeking skills, and even career training. In residential programs for adolescents, the participants attend school as a part of the program. Some residential programs are designed to enable women who need treatment to bring their children with them. These programs offer child care and parenting classes.

Residential programs are best for people who do not have stable living or employment situations and/or have limited or no family support. Residential treatment may help people with very serious substance use disorders who have been unable to get and stay sober or drug free in other treatment.

Partial hospitalization or day treatment programs also may be provided in hospitals or free-standing clinics. In these programs, the person attends treatment for 4 to 8 hours per day but lives at home. These programs usually last for at least 3 months and work best for people who have a stable, supportive home environment.

Q: My brother is in a residential treatment program. He says he can leave the program at any time. Is this true? A: Yes. Everyone has the option of leaving. All alcohol and drug abuse treatment is voluntary, although there may be consequences for leaving if the person is in treatment, for example, as part of probation or parole. If your brother chooses to leave and treatment has not been completed, the treatment staff may ask him to sign papers stating that he is leaving treatment against medical advice. The staff also will try to find out why he wants to leave early and will try to address any concerns he has.

Outpatient and intensive outpatient programs provide treatment at a program site, but the person lives elsewhere (usually at home). Outpatient treatment is offered in a variety of places: health clinics, community mental health clinics, counselors' offices, hospital clinics, local health department offices, or residential programs with outpatient clinics. Many meet in the evenings and on weekends so participants can go to school or work. Outpatient treatment programs have different requirements for attendance. Some programs require daily attendance; others meet only one to three times per week.

Intensive outpatient treatment programs require a person to attend 9 to 20 hours of treatment activities per week. Outpatient programs last from about 2 months to 1 year.

People who do best in an outpatient program are willing to attend counseling sessions regularly, have supportive friends or family members, have a place to live, and have some form of transportation to get to treatment sessions (some programs will provide transportation if needed).

Opioid treatment programs (OTPs), sometimes known as methadone clinics, offer medication-assisted outpatient treatment for people who are dependent on opioid drugs (such as heroin, OxyContin, or vicodin). These programs use a medication, such as methadone or LAAM, to help a person not use illicit opi-oids. OTPs provide counseling and other services along with the medication.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.