It can be difficult to acknowledge that you or someone you love has a problem with drugs or alcohol. Many people struggle with addiction, but there are effective treatment options available to help. With the right support, treatment, and tools, you can begin to recover from an addiction to drugs or alcohol and achieve lasting sobriety.
Substance abuse affects millions of Americans. In 2018, around 20 million people, aged 12 and older, had some form of a substance use disorder (SUD). In addition to addiction, many people struggle with mental illness. In 2018, 47.6 million adults aged 18 and older suffered from mental illness.1
While some people struggle with SUDs, some struggle with mental health issues, and some struggle with both (also known as concurrent mental health issues), there are numerous rehab programs available that offer treatment for any or all of these challenges.2
This guide is meant to answer some of the questions you might have about the different types of treatment that are available that will address your unique situation and recovery needs.
What’s the Right Treatment Facility for Me?
The needs of each person vary when it comes to managing SUDs and mental health conditions, so it is important to look for a treatment program that is not one-size-fits-all. There are numerous treatment programs around the country, and there are many points to examine when it comes to selecting the right program for you. Various factors that should be taken into consideration when selecting a treatment program include:
- Insurance coverage accepted.
- Levels of care available.
If you’ve developed significant dependence on alcohol or certain drugs (e.g., benzodiazepines and other sedatives), it may be necessary for you to go through medical detox so that your withdrawal symptoms can be managed as safely and comfortably as possible. Medical detox provides a level of comfort during withdrawal and also helps to decrease the risk of certain withdrawal complications.3
Although opioid withdrawal may not present the same withdrawal risks as those associated with alcohol and sedatives, medical detox is also often used during early treatment for opioid use disorders (OUDs) to help manage what can often be significantly unpleasant withdrawal.3
Some programs provide detox only, so there is a chance you might have to relocate to another facility to pursue more comprehensive substance rehab. However, there are also programs that provide both detox and ongoing treatment in the same facility.
Additional factors to consider when choosing a treatment program may include whether the facilities provide the following:
- Gender-specific programs
- LGBTQ-friendly programs
- Veteran and first responder programs
- Religious or spiritual programs
Although you want to enter substance abuse treatment as soon as possible, it is important to take some time to choose the treatment center that is right for you.
What Happens During Detox?
With professional detoxification, the goal is to manage your withdrawal in a safe, supervised way that minimizes your discomfort and decreases your risks of any medical complications. Though precise detoxification protocols and durations may vary, detox processes commonly consist of 3 important components: evaluation, stabilization, and the facilitation of additional substance abuse treatment.3
Medication is an important element of many detox protocols; detox medications may include different types of benzodiazepines or other anticonvulsant medications to prevent or manage seizures during alcohol withdrawal. People being treated for OUDs may be stabilized and maintained on medications such as buprenorphine or methadone to manage unpleasant withdrawal and strong cravings for opioids during recovery.3
Regardless of whether detox takes place in a detox-only facility or in a program that also has ongoing treatment, it is important to understand that detox and withdrawal management is only the beginning of treatment. Clearing alcohol or drugs from your body does not address the issues that lead you to addiction in the first place. Inclusive rehabilitation efforts should integrate counseling and behavioral therapy beyond the detox period to better prevent relapse and promote sustained recovery.3
Different Types of Addiction Treatment
There are various types of addiction treatment. While many people go to a 24/7 inpatient program, others do not reside at their treatment location and instead participate in outpatient programs. More intensive levels of outpatient care include both intensive outpatient (IOP) and partial hospitalization (PHP) programs.
Inpatient Addiction Treatment
For some patients, inpatient treatment may be the most appropriate level of care, such as for those with significant benzodiazepine or alcohol dependence. Withdrawal risks are a concern with certain substances such as these, and an inpatient treatment setting facilitates 24/7 supervision and medical intervention should withdrawal complications arise.3
Those with other medical or mental health conditions may also benefit from inpatient care to provide adequate management of these concurrent issues. Inpatient rehab may also be recommended for people with a history of previous treatment attempts or an inability to get to an outpatient treatment program.3 While inpatient treatment can last anywhere from several days to weeks, it can also last for several months in order to provide the needed treatment.
Many inpatient treatment programs encourage 12-step group participation and incorporate Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) meetings to facilitate recovery. Other programs may have similar mutual support group sessions but not necessarily those built on the 12-step mode (e.g., SMART Recovery).
There may also be specialty programs to complement more standard therapeutic interventions, including equine therapy, yoga, and other holistic therapies. Regardless of the amenities or treatment approach, many programs use a combination of behavioral therapies to help people make positive adjustments to their thoughts and behaviors surrounding drug use, increase their coping skills, decrease relapses, and ultimately promote a new life in recovery.4
Outpatient Addiction Treatment
Though outpatient programs sometimes function as “step-down” treatment after a person leaves a more intensive inpatient or residential program, some people utilize outpatient treatment settings as their first entry point for substance abuse rehabilitation.4 Outpatient treatment may be most appropriate for people who have a solid support system at home.
Many outpatient programs offer a similar range of recovery programming as inpatient treatment. However, the person goes home at night and can sometimes keep working and attending school. Outpatient program lengths may last for weeks to months but can be adjusted based on a person’s recovery progress and other individual needs.
Partial Hospitalization Program
Partial hospitalization programs (PHPs) are outpatient treatment programs that typically operate 5-7 days per week for 4-6 hours per day. The programming and range of clinical services available are often very similar to inpatient treatment, but the person goes home at night. Like outpatient programs, they may be used as a step down from inpatient treatment. Some people do go to a PHP as their initial point of rehabilitation services, but this depends on numerous factors regarding their substance use and treatment needs.5
Intensive Outpatient Program
An intensive outpatient program (IOP) is relatively less time-intensive than a PHP. A person may expect to participate with groups and other programming 2-3 hours a day, 2-3 days a week. IOPs can also be a step-down from a PHP or inpatient treatment but, like a PHP, it can also be the first step in treatment.6 In outlining the various levels of care, the American Society for Addiction Medicine defines intensive outpatient care as at least 9 hours a week of structured programming for adults, though adjustments can be made for additional hours based on patient needs.7
Aftercare and Alternative Treatment Options
Whether a person goes to inpatient treatment, an IOP, or a PHP, aftercare is crucial in helping you maintain your recovery. Aftercare can help reinforce the skills learned in rehab to help prevent you from relapsing. Examples of aftercare include AA, NA, SMART Recovery, and other support groups, though a comprehensive aftercare plan may also include various outlets of continued behavioral therapy, emotional and spiritual wellness, as well as physical and mental health care. The various elements of any aftercare plan should ideally provide a spectrum of additional treatment, sober activities, and social supports as part of the continuum of recovery and relapse prevention efforts.8
Regardless of what type of treatment you go to, it is important to get treatment for an SUD. Detox may be your first step on your recovery journey, but remember it is only the beginning of treatment. Depending on your personal situation and the many factors that influence your recovery needs, you may be in outpatient or inpatient treatment for some period of time after completing detox. Aftercare on a longer-term basis is the ideal way to follow up on any type of substance use treatment to ensure that you do not relapse.
- Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication No. PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
- National Institute on Drug Abuse. (2018). Comorbidity: Substance use disorders and other mental illnesses.
- Center for Substance Abuse Treatment. (2006). Detoxification and substance abuse treatment. Treatment improvement protocol (TIP) series, no. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment.
- National Institute on Drug Abuse. (2019). Treatment approaches for drug addiction DrugFacts.
- Center for Substance Abuse Treatment. (2006). Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. (Treatment Improvement Protocol (TIP) Series, No. 47.) Chapter 1. Introduction. Rockville, MD: Substance Abuse and Mental Health Services Administration.
- Center for Substance Abuse Treatment. (2006). Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. (Treatment Improvement Protocol (TIP) Series, No. 47.) Chapter 3. Intensive Outpatient Treatment and the Continuum of Care. Rockville, MD: Substance Abuse and Mental Health Services Administration.
- Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
- Patton, D. and McDowell, T. (n.d.). Substance abuse aftercare treatment. Arizona State University, Center for Applied Behavioral Health Policy.