Levels of Care Available
Usually, care for a drug or alcohhol dependence problem begins with a
short, more intensive professional intervention, and then continues
indefinitely with a less intensive professional intervention.
Participation in peer self-help support groups is helpful (if not
necessary) throughout this process.
While detoxification and preliminary psychiatric medication provision
is sometimes done in a hospital setting, little actual therapy gets
done in an inpatient setting. Patients are almost always discharged as
soon as possible, and sent out to participate in one or more forms of
psychosocial therapy, peer-support groups and the like.
Substance Abuse Rehabilitation Programs
Rehabilitation ("Rehab") programs are the second most intensive sort of
drug and alcohol dependence care, next to hospitalization. The typical
'Minnesota- model' rehab program lasts for several weeks to one month,
and plays out in the context of an inpatient environment (the patient
lives at the rehab clinic for the period of treatment). Patients
detoxify for the first few days of their rehab experience. Thereafter,
they spend their days participating in a combination of individual and
group psychotherapy, twelve step meeting participation, and
recreational and occupational therapy. Rehab is most useful at the
beginning of a treatment cycle as an intensive and immersive way to
interrupt the drug or alcohol dependent patient's substance abusing
lifestyle. Good rehab programs will help a patient plan for aftercare
in the form of intensive outpatient programs, continuing psychotherapy
and twelve step attendance.
Partial Hospitalization/Intensive Outpatient Programs)
Partial Hospitalization Programs (PHP) and Intensive Outpatient
Programs (IOP) are programs where patients come to a hospital or
outpatient clinic setting for several hours (IOP) or a full day (PHP)
and participate in a range of psychosocial interventions that commonly
include psychotherapy in supportive, coping-skills/relapse prevention,
and social skills/interpersonal/growth group formats, consultation with
a psychiatrist for medication management, and twice-weekly drug
screening. Social work consultations and case management (where a
social worker will act as an advocate for patients, hooking them up
with social services in the community) may also be present,
particularly in a partial hospital settings.
IOP programs are a good transitional step for patients leaving rehab,
helping them to make a more managed transition to assuming
responsibility for their own sobriety than simply dropping them into
once weekly psychotherapy would allow. Despite the fact that PHP and
IOP programs are extremely helpful to recovering addicts, particularly
in the early stages of recovery, they are increasingly rare (as health
insurance companies don't like to pay for this level of care if they
don't have to).
Residential Centers And Halfway Houses
Some recovering persons require special extended support to help them
maintain their sobriety (e.g., they are homeless, they are severely
impaired and cannot manage their own living situations, they live with
actively drug abusing people and to return to that environment would
almost certainly assure relapse). Social workers can help recovering
persons to get placement in a variety of sober housing facilities where
they can live communally in relative safety, and in an environment that
encourages sobriety and twelve step meeting attendance. Usually,
recovering people loses this housing if they relapse, providing further
incentive for their maintaining sobriety.