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Seeking help for addiction without going to treatment
WHO TO SEE: An Addictionologist
DO YOUR RESEARCH BEFORE SEEKING HELP FROM: A Psychiatrist
Psychiatrists tend to treat addiction as they treat mental illness, with medications and their brand of therapy. They tend to see the symptoms of addiction (depression, anxiety, trouble sleeping, impulsivity problems, etc) and treat those symptoms with medications (which are quite often addictive drugs). This reinforces the addicted person’s belief that “a pill will fix me” or “I have another disorder that causes me to use and I have to medicate that disorder”, when oftentimes these symptoms are a result of the impact addictive substances have had on their brain.
Your medical doctor is also likely to steer you in the wrong direction. It is my experience that most doctors, psychiatrists, nurses, psychotherapists, and other medical and mental health professionals lack any real knowledge of addiction. Society in general lacks knowledge of addiction, and that, unfortunately, is going to take a lot of time and public education/exposure to change.
WHO TO SEE INSTEAD: An Addictionologist
Addictionologists are medical doctors that specialize in treating addiction. You can find addictionologists at your nearest substance abuse treatment center, outpatient clinic, partial treatment, hospital detox setting, and sometimes in private practice. If you are unsure where to find one, go to The American Society of Addiction Medicine member directory on ASAM website. Here you can search by city to find your nearest addictionologist.
Of course, you may also seek help from any mental health professional or medical professional, but I would suggest that you research their knowledge and experience with addiction. Ultimately, it will probably take calling or going to a treatment center that specializes in treating addiction to find the right person. It may be risky to try searching on your own.
There is more than one way to recovery
No one program is right for everyone, so it is important to find the treatment program that meets your needs specifically. A large majority of treatment programs are 12-step focused due to the availability of 12-step meetings all over the world and the support network that is instantly found there. There are also many faith-based treatment programs – some focus on a Christian version of the 12-steps and encourage involvement in Celebrate Recovery – a Christian version of the 12-step program – while others do not include anything at all about the 12-step process in their program and instead focus only on Christian principles.
Faith-based vs. 12-step focused treatment
If the person seeking treatment has strong religious beliefs or has a desire to seriously strengthen their faith, then a faith-based treatment program may be a good fit. Many of the faith-based programs are lower in cost and longer in duration, which is also appealing to many without insurance who are seeking long-term treatment. However, proceed with caution and do your research. It would be important to ask about staff credentials (do they employ Master’s level therapists?). Some faith-based programs see addiction as a moral issue (it is not) and, by focusing on morality, may be shaming or punitive in nature. Also, faith-based programs have a tendency to lack follow-up or continuing care after a person has left treatment. Celebrate Recovery meetings are available in most larger-sized cities, but even then the availability of these meetings may be fairly limited. Also, faith-based programs vary greatly. Some are simply work programs in which an individual is placed in a structured work setting defined by the facility and is required to attend religious activities when not at work. Others are very structured treatment programs similar to the structure of 12-step based treatment programs but with religious teachings incorporated throughout.
After completing treatment, 12-step meetings are available anywhere, including other countries and on cruise ships, and the fellowship that is found within these programs simply cannot compare with that found in church or any other recovery-based activities. Therefore, if a person has been exposed to 12-step recovery while in treatment, they are likely to be more open to attending 12-step meetings upon discharge. Relating with other people who have the same disease is extremely important for the recovering person to continue for the rest of their life. The very difficult work of learning how to live a recovery lifestyle can be carefully attended to through sponsorship and guided 12-step work.
Note: In the long run, there is absolutely no reason why a person cannot have both a strong religious/spiritual faith and be actively involved in a 12-step program. In fact, many people find that, through working the 12-steps, they develop a much stronger faith than they ever had before. But remember, the 12-step program is a spiritual program, not a religious one. This means that God will be a part of the program, but you don’t have to be of any particular faith/religion to participate. In fact, religion should not be a part of any 12-step meeting unless a person is speaking only about their own experience of God through religion (so as not to offend others in attendance who are of different faiths). Remember, religion has a moral code or prescribed behavior to follow (Christianity, Judaism, Islam are religions) whereas spirituality has to do with the nature of a person’s spirit and is broader in definition. It is stated in the 12-step Traditions that the only requirement for attendance is a “desire to stop” (stop drinking, using, engaging in the addictive behavior, etc). This is so that everyone with a desire to stop feels welcome. The 12-step program is not “anti-religion” – it is simply open to all people of all faiths (or even those with no faith).
Success rates of treatment programs
I am of the belief that if a person wants recovery, they can find it anywhere they go. It is not the treatment program that is going to keep a person clean or sober, it is the person that must put into action what they learned in the treatment program. With that being said, there are some programs that are better than others. Unfortunately, there are no published standards for “effective addiction treatment” – so anyone can claim to have an effective program. Many programs are now having to measure their rates of retention (the number of individuals that enroll and actually complete the program) in order to keep their funding and continue to get referrals. It wouldn’t hurt to contact the treatment centers you are researching and ask about their retention rates.
Length of stay makes a big difference
Much of the latest research on the effectiveness of inpatient treatment has indicated that a period of 90-days of inpatient treatment gives the patient their best chance of success in recovery. A majority of insurance policies only cover an average of 14-28 days at the most (sometimes less than that), so be prepared to pay out-of-pocket if a 90-day stay is your goal. If you don’t have insurance, or your insurance does not cover inpatient treatment, there are probably state-funded or low-cost options in your area or in surrounding areas. Navigating the system may be difficult at first, so getting connected with a treatment professional in your area would be a good idea.
TYPES OF TREATMENT
Detox programs usually exist within a hospital or clinic setting. Some inpatient facilities offer medical detox first, followed by inpatient rehabilitation. Detox usually lasts for a period of 3-7 days, although it can take longer depending on the medical issues for the person being detoxed. Sometimes detox can be completed on an outpatient basis, with a doctor providing prescription medications and instructions for the medications to be tapered down over a period of several days at home. It is possible to complete detox on an outpatient basis, but there are more medical risks involved and the risk of relapse is high, as most people struggle with physical withdrawal symptoms and craving that using will easily relieve and the temptation and availability combined make it very tough to abstain.
Inpatient detox programs usually provide a safe environment for the patient to detox along with a structured schedule which may include psychotherapy and education groups. Counselors, social workers, and/or case managers may be available to assist with planning and setting up the next phase of the patient’s recovery, such as inpatient or outpatient treatment, partial treatment, or halfway-house placement as well as helping connect the patient with the local resources (mental health centers, 12-step meetings) in their area.
There are a number of different types of inpatient treatment programs available nation-wide. See the Samhsa treatment facility locator for local options in your area searchable by zip code. 12-step based inpatient treatment programs are helpful because the patient will likely learn about addiction as a brain disease along with coping skills that are a built-in benefit to working the 12-step program. Plus, 12-step meetings are located in every state and almost every country in the world, so wherever a person travels, they have instant access to a room full of people who have knowledge and experience with their same disease. This will prove to be invaluable.
When a patient arrives for inpatient treatment, they should be prepared to stay busy. Call ahead or look on the treatment center’s website for a list of items that are allowed versus items that are prohibited. Most inpatient treatment programs have a very structured schedule in order to keep patients busy and focused on their recovery, as well as to help them develop new habits. Here is an example of what a person might experience during a typical day in inpatient treatment:
6am – Wake up, shower/get ready
7am – Breakfast
8am – Chores (patients are expected to keep their area clean and stocked with supplies)
9am – Meditation Group (daily reflection/meditation is an important component of recovery)
10am – Group Therapy (2 hours)
12-noon – Lunch
1pm – Addiction Lecture (educational lectures on addiction/recovery topics)
2pm – Addiction Lecture #2 (a different topic)
3pm – Exercise/Time to work on assignments
4pm – Individual therapy with your counselor
5pm – Dinner
6pm – Wrap-up meeting with fellow patients
7pm – Travel to an outside 12-step meeting
9pm – T.V. time/free time (work on assignments), phone time (10 minutes per patient)
11pm – Lights out
Most reputable inpatient treatment programs will include some family component, as family education about addiction is also a key factor to a successful recovery. While it treatment, the counselor may contact the family for family sessions by phone or in person. The counselor may also make recommendations for long-term inpatient treatment, outpatient treatment, continuing care treatment, and/or aftercare treatment following the completion of the inpatient treatment program. Success in recovery will depend on the patients level of willingness to do whatever it takes to recover. Following recommendations are an indication of their level of willingness.
Immersion Programs/Therapeutic Communities
Addiction treatment through immersion in the practice of the 12-steps of recovery is a fairly innovative option that is becoming more common. These inpatient treatment programs are designed for motivated individuals who have completed detox and do not require medical supervision (although some programs may offer detox first). Initially, the patient is introduced to the fellowship of the 12-steps, offered education about addiction, and then begins step work and individual therapy. As they continue through the treatment, they complete stages of treatment with increased levels of personal and social responsibilities. The family may also participate in a family program on site. Throughout the treatment, the patient attends outside 12-step meetings, obtains a sponsor, and focuses on their step work. The primary focus of immersion programs is to help the patient recognize, understand, and apply the principles of the 12-step program and integrate these principles into their lives. Upon completion of the inpatient program, the patient can transition home with the hope that they will fully engage in a recovery lifestyle. Immersion programs tend to last 8-12 weeks or longer.
Therapeutic Community programs are like immersion programs, however the staff members live amongst the patients as well. There is more of an emphasis on the importance of the community as a primary agent of change. Individuals in the program also assume partial responsibility for the recovery of their peers. Patients can remain in therapeutic community programs for 12 months or longer.
Outpatient treatment usually consists of three hours of group therapy per day, 3-5 days per week, for about 6 weeks. Outpatient treatment is more suitable for highly motivated individuals who are employed, have a good social support system established, and can maintain abstinence for long periods of time. Patients attending outpatient treatment programs generally reside at home and attend the program during the evenings or days (many offer a day-time option vs. and evening option).
Although many patients would choose to enter outpatient treatment rather than inpatient treatment, outpatient treatment is not appropriate for everyone. Patients who lack adequate motivation, lack adequate support at home or work within an environment in which co-workers use, or have tried repeated attempts at outpatient treatment and have failed may need to consider inpatient treatment instead.
Partial Hospitalization or Day Treatment Programs
Partial hospitalization means that patients spend part of their day in a hospital/clinic treatment setting and then return home. Partial hospitalization programs are similar to outpatient treatment programs with the exception of longer hours (most last an average of 4-7 hours per day) and more therapy. There may also be access to a psychiatrist or addictionologist on site. Patients attend group sessions for 2-3 hours and meet with counselors or a psychiatrist/addictionologist individually. Patients usually live at home or in a structured setting (such as a halfway house) and attend these programs during the day.
Many treatment centers offer Aftercare programs following the completion of treatment. An aftercare group will likely meet once per week for 1-2 hours. Aftercare is a group therapy session facilitated by a psychotherapist or other mental health professional/addiction specialist. The group is for patients who have discharged from a higher-level program. Most aftercare programs are free and ongoing. Some may limit participation time to 2 years post-treatment.
Halfway House, Sober House, 3/4 House
Halfway houses, sober houses, or 3/4 houses are houses that offer residence to recovering individuals who are in need of a supportive living environment. These terms are often used interchangeably, however, there is a wide array of differences when it comes to the quality of these programs. Reputable halfway houses will drug screen randomly, maintain a structured schedule with curfews, require 12-step participation along with obtaining a sponsor, randomly screen for drug/alcohol use, and assign house-keeping duties to residents. Most require a 90-day commitment to stay and are likely to allow a person to stay for 1 year or longer.
Methadone, Suboxone, etc (coming soon)
For information on other treatments such as replacement therapies like Methadone and Suboxone, see the “Medications” section coming soon.