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Inpatient Rehab Centers

Inpatient Rehab Centers

With illicit drug use climbing in the U.S. and the opioid crisis reaching epic proportions, the need for substance abuse treatment programs is magnified. While various recovery programs are offered, inpatient rehab centers are often the best option and a vital first step in a continuum of treatment along a long road of recovery.

Inpatient drug rehab offers an intensive, around the clock setting and supervision by trained professionals. Patients live with others who are battling similar addictions. A daily schedule may include individual and group therapy sessions, educational lectures and special focus groups. Stays may range from 21 days to six months but vary patient by patient. Assessments and evaluations are critical to ongoing success.

Expert

Randal Lea
View Bio

With illicit drug use climbing in the U.S. and the opioid crisis reaching epic proportions, the need for substance abuse treatment programs is magnified. While various recovery programs are offered, inpatient rehab centers are often the best option and a vital first step in a continuum of treatment along a long road of recovery.

Inpatient drug rehab offers an intensive, around the clock setting and supervision by trained professionals. Patients live with others who are battling similar addictions. A daily schedule may include individual and group therapy sessions, educational lectures and special focus groups. Stays may range from 21 days to six months but vary patient by patient. Assessments and evaluations are critical to ongoing success.

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Specialized inpatient rehab options

While inpatient drug rehabilitation facilities treat various addictions, a rising need is related to heroin/opioid addiction. However, not only is the specific addiction important, but the patient’s individual needs and background are also analyzed when determining the best treatment option. Various specialized inpatient rehab programs focused at certain populations are increasing in popularity, including the following:

    • Women
    • Pregnant women
    • Patients with a dual diagnosis
    • LGBT
    • Adolescents
    • Seniors
    • Professionals, specifically attorneys, first responders, health care workers, airline pilots, clergy, business owners and executives, and professional athletes and other entertainment celebrities

The benefits of inpatient drug rehabilitation

While it is best to consult with professionals regarding the best mode of rehab treatment, there are obvious benefits to both inpatient and outpatient care. A combination of the two is often a natural progression in recovery.

Inpatient rehab is intensive and all inclusive. Patients are monitored 24/7 and away from the environments that contributed to the substance abuse in the first place. Unlike outpatient rehab treatment centers where patients live on their own, all the needs of inpatients are taken care of including food, housing and the actual treatment.

Inside Inpatient Rehab Centers: What to Expect

Inpatient drug and alcohol treatment centers are staffed to support patients the moment they decide to seek help. Here is a general outline of what one might expect.

1. Intake or admissions

While most providers are mindful of not gathering too much information too quickly, patients can reasonably expect that a thorough life history and medical history will aid the process of planning treatment and recovery. Reputable providers will often conduct a screening to determine if the caller is eligible to receive services in the program through a match of age, gender, presenting problems, and financial factors. There may be some initial questions to make a level of care recommendation, and some “exclusionary” questions to see if the center should refer to a more appropriate program if needed, such as for certain medical conditions, mobility, or psychiatric support. At the time of intake, a prospective patient will generally meet with an assessor and perhaps a nurse for part of an evaluation for initial safety and treatment. If insurance is involved, there is often a need to present the clinical recommendations for consultation with the payor. Families can expect to help by supplementing information given by the prospective patient who may be more guarded in sharing details or unaware of the extent of his or her problem. Generally, the decision to admit or not into a residential or detoxification program must be ordered by a doctor who reviews the assessment and recommendations.

2. Evaluation

Evaluation in residential treatment is an ongoing process usually conducted by a team involving nursing, counseling, and other personnel. Beyond the initial intake history, most programs conduct an in-depth social history that reviews the entire health, psychological, family, vocational, and spiritual functions of the patient. Every person with addiction presents with their own history, yet common elements the treatment team addresses often include emotional aspects of grief and loss, trauma, shame, resentment, fear, depression, and anxiety. Much of treatment will revolve around education about the disease of addiction and gaining insight into one’s own patterns of use and consequences. Assessment will also examine “recovery capital,” or those assets and strengths in the individual and her support system to build upon.

Assessment continues through program transition, and a working list of needs at discharge may extend into continuing care appointments which may include counseling, vocational or education referrals, and when needed, case management for transportation, housing, or medical appointments.  Not everyone may require this professional support, yet outcomes nationally suggest people who maintain some type of aftercare involvement and who participate in self-help groups after treatment do significantly better than those who do not.

3. Detox

Addiction medicine has evolved the last 20 years or so into standard protocols for safe detoxification from alcohol and tranquilizers which have the highest risk in withdrawal potential. Physicians exercise their experience and judgment based on clinical information to determine which medications, dosages, and duration are best for each patient. Detoxification from opioids and heroin is usually very uncomfortable, but both risk and comfort can be managed.

Generally, the longer a drug acts in the body, the longer withdrawal symptoms linger. Trained medical professionals use withdrawal scales to monitor the severity of withdrawal symptoms. As the scores of these scales rise, medical professionals administer appropriate levels of comfort and safety medications.

4. Alcohol and Drug Addiction Treatment

Many drug rehabilitation centers focus on an abstinence-based, “Twelve Step” approach that incorporates individual and group therapies, educational lectures and special focus groups on issues affecting individual patients such as trauma and grief. Patients are often taught healthy lifestyle alternatives through diet and exercise.

5. Discharge

Many residential programs are built around a standard length of stay. This may be a 30 day program, more or less. Almost all programs have some variable length of stay which may allow a patient more time or less time if right for the patient.  

In general, the addiction field is moving away from “acute” (crisis-driven) stays of 30 days in favor of a lengthier, more comprehensive model which may have a shorter period of detox and residential care followed by more follow-up in the community through outpatient programming, family counseling, aftercare, and medication management if needed.

6. Aftercare

Although patients returning home may believe they have “addressed the problem,” and rightfully so by facing the problem head on, leaving treatment is only the beginning of the recovery journey. Relapse begins with the first pill, drink, drug or fix someone uses; and it takes more than just resolve or a lesson learned to keep that one episode of use away. The most successful continuing care programs over the years have involved up to five years of structured counseling, urine drug screening, and peer support.  

Q&A with a Rehab Expert

Randal Lea, MA, LADAC, QCS is Executive Director for Community Based Services, Cumberland Heights Foundation. A licensed addictions counselor with thirty years of clinical and administrative experience, Lea received a master’s degrees in Counseling from Trevecca Nazarene University and in Psychology from Pacifica Graduate Institute. Lea has been a frequent presenter on such topics as Assessment, Sexual Behavior in Children, Ethics, Dreamwork, and Trauma and is a certified practitioner of DreamTending and a Qualified Clinical Supervisor.

Previous to his current role as Executive Director of Community Based Services, Mr. Lea served eight years as Assistant Commissioner with the Tennessee Department of Children’s Services. In 2008, he was recognized by the Praed Foundation as a national “Systems Champion” for implementing a statewide children’s assessment for DCS. He also received the “Friend of Children Lifetime Achievement Award” in 2010 from Tennessee Voices for Children after seven years on their board and was recognized in both 2000 and in 2015 as “Professional of the Year” by the local chapter of NAADAC.

  • Q. How effective is inpatient care compared to other types of rehab?

    Addiction treatment is most effective when the level of care matches the needs of a patient as assessed by a qualified addiction specialist, doctor, psychologist, or counselor. Assessment considers factors like physical needs (detoxification), stressors and supports at home and in the workplace or school, and the degree of motivation for recovery a person has in terms of accepting the extent of involvement with drugs and alcohol. One key to success at any level is matching the right care to the presenting problems someone has. For example, people with stable employment, supportive family, and a track record of problem solving skills might be good outpatient candidates. Some persons may have enough support and awareness to begin recovery with mutual help groups and individual or family counseling. The best assessment comes from:

    • A licensed practitioner with addiction experience and credentials
    • Someone who uses standard diagnostic tools or tests and can explain the findings
    • Someone who includes information from family or others that may help give a complete picture of recent use patterns and other behaviors
  • Under what conditions would you advise one to seek inpatient care?

    First, those persons using alcohol, benzodiazepines or other sedatives should be evaluated medically since the abrupt cessation of these substances may result in physical withdrawal. Withdrawal can be a serious, potentially fatal medical condition at worst; at the very least it can undermine recovery efforts.  People exhibiting irritability, depression, and anxiety when not using or people who have significant problems at home work or school might also require a period of 24-hour care, often from a couple of weeks to a month or more. The American Society of Addiction Medicine has published guidelines for placement by level of care for over 25 years which health professionals use as an industry accepted guide.   

    Families, employers, and even courts or attorneys often contact treatment centers or interventionists because they have exhausted all reasonable efforts to change the dynamic for the identified person. In these cases, even people who have significant strengths in other life areas may be profoundly mystified by an inability to stay away from alcohol and drugs despite overwhelming history of consequences. Residential treatment is often helpful when a patient is just starting to connect the consequences with their own behaviors and choices instead of focusing on perceived wrongs, resentments, or losses.  Being removed from a preventable, impulsive return to use allows patients to practice recovery skills, challenge old beliefs, and gain new supports during a time when each day removed from substance use renews health and builds refusal skills.

  • What should one know before entering inpatient drug rehab?

    We still encounter many patients and families who resist seeking treatment because of stigma associated with use or with a belief they should be able to power through. Structured treatment can help people realize the disease aspect of addiction – that it has predictable symptoms at certain stages, runs a certain course, and that recovery has foreseeable stumbling blocks and milestones. Trust is an important feature in the relationship between a patient, family, and treatment team. Patients should align with a center and with people who have their confidence, as some of the concepts covered in treatment initially may seem unrelated to addiction or recovery.

  • How has substance abuse care changed in recent decades?

    Addiction treatment has become more professionalized, evidence based, and outcomes oriented. The most exciting research period in history gets wiser every day in the knowledge of what lights up the brain (reward centers) and how old brain wiring sets up return to use. The field has learned a great deal in the last generation about how to tie together the evidence of behavioral change, biochemistry, specific counseling methods into life-transforming practices that return people to wholeness. The body of evidence includes better strategies for engaging families and employers and for addressing co-occurring disorders (like depression, anxiety, and PTSD) concurrently or in partnership with addiction recovery.

    Not all change is positive change. At this moment, we are at the height of an opioid epidemic involving both high-powered prescription pain medications and old-fashioned heroin. The lethality of these drugs is staggering. Treatment is now evolving to include paramedics and police who are being trained to administer life-saving drugs to overdose victims. These affected persons are not bad people; they represent every culture and class within our country. Health care plans have recently covered addiction treatment as an essential benefit, and mental health / addiction issues have “parity” with physical health issues meaning they cannot be denied for trivial reasons. These conditions are presently under debate and may change access to care during the significant opioid crisis that faces our nation.