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A Beginners Guide to Addiction Treatment & Rehab

Addiction is a major problem in the United States. The problem is illustrated quite well by the opioid epidemic sweeping the nation. The US Department of Health and Human Services estimates that in 2015, 12.5 million people abused prescription opioids, resulting in over 33,000 deaths. According to the 2015 National Survey on Drug Use and Health, 6.2% of adults and 2.5% of youth (individuals aged 12 to 17) suffer from alcohol use disorder, which is a medical condition where an individual’s alcohol consumption causes harm or distress.

Given these numbers, it’s easy to see why treating addiction is of such importance. One way to treat addiction and substance abuse is rehab. But what exactly is rehab and how does it work?

Addiction is a major problem in the United States. The problem is illustrated quite well by the opioid epidemic sweeping the nation. The US Department of Health and Human Services estimates that in 2015, 12.5 million people abused prescription opioids, resulting in over 33,000 deaths. According to the 2015 National Survey on Drug Use and Health, 6.2% of adults and 2.5% of youth (individuals aged 12 to 17) suffer from alcohol use disorder, which is a medical condition where an individual’s alcohol consumption causes harm or distress.

Given these numbers, it’s easy to see why treating addiction is of such importance. One way to treat addiction and substance abuse is rehab. But what exactly is rehab and how does it work?

How Rehab Centers Help

Rehab is a treatment program designed to help those with addictions to psychoactive substances, namely drugs and alcohol. Specifically, rehab aims to stop addiction by acknowledging a problem exists and dealing with that problem. Some of the goals of rehab include:

  • Detoxification. It’s common for those entering rehab to be high or at least have remnants of drugs or alcohol in their system.
  • Overcoming denial. No treatment for addiction will work if the individual doesn’t acknowledge they have a problem.
  • Understanding the nature of addiction. Individuals should learn that addiction is a disease of the brain.
  • Formal diagnosis. Rehab facilities commonly identify and treat co-occurring mental health issues.
  • Addiction management. Rehab centers provide techniques, tools and methods for making mental and behavioral changes to stay sober.
  • Identifying triggers. Rehabs help patients identify habits, personality traits, emotions or cues that promote or encourage addiction.
  • Recovery support. Rehab facilities help one build and maintain support networks and relationships.

What Substances Can Rehab Treat?

Rehab can help treat a variety of addictions, such as:

  • Alcohol
  • Cocaine
  • Heroin
  • Marijuana
  • Methamphetamine
  • Opiates
  • Opioids
  • Tobacco products

What to Expect in Rehab

There are several key elements to a successful and effective rehab program, regardless of the specific type of treatment chosen.

Detoxification

Not all who enter rehab will require detox and the ones that do may need varying degrees of medical care and supervision. With an addiction, the body becomes so used to the addictive substance that removing it from the system can cause extremely painful withdrawal symptoms. In many instances, the withdrawal symptoms can be dangerous.

The exact detox process will depend on the substance and the severity of the addiction. However, all detox processes will be supervised and implemented by medical professionals who can make the detox process as safe and comfortable as medically possible. The detox can last anywhere from a few days to a few
weeks and often occurs in a medical facility.

Addiction Therapy and Education

The exact length and nature of therapy varies. Most evidence-based therapies will have a medication and cognitive-behavioral component to them. More on this below.

Recovery Support

This generally entails finding ways to prevent relapse. The specific aftercare program is based on the individual’s progress and continuing needs. Examples of aftercare include counseling, support groups and sober housing.

Intake & Evaluation

At this time, the treatment providers assess the individual to determine the most effective treatment plan for that person. Depending on the program, an interview, medical exam and/or psychiatric exam will be conducted. One of the things treatment providers will look for will be the existence of concurring mental health or psychological problems. Family members and friends may also be interviewed to gain additional insight into the individual’s addiction.

Common Drug & Alcohol Abuse Treatment Approaches

There are two primary types of evidence-based therapies used in rehab: pharmacotherapies and behavioral therapies.

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Pharmacotherapies involve the administration of medications to help ease withdrawal symptoms, treat co-occurring mental health issues and reduce the possibility of relapse. Medications are commonly used to treat opioid, tobacco and alcohol addictions.

During detox of an opioid addicted individual, methadone and buprenorphine ease the withdrawal symptoms. Naltrexone is used to treat the addiction by diminishing the pleasurable effects of opioid use.

When treating a tobacco addiction, a nicotine replacement is provided, such as bupropion and varenicline. Common medications used to help treat alcoholism include naltrexone, acamprosate and disulfiram. These medications are often used in conjunction with other treatments, such as counseling and behavioral therapies, or are primarily used during the detox process.

Addiction Therapies Used in Rehab

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy is based on the concept of learning. In particular, a person learns methods of coping with cravings (self-control development), identifying behavior that may cause them to use an addictive substance and changing problem behaviors that exist alongside the addiction and contribute to it. The techniques and skills learned in rehab stay with them once their treatment is over.

Community Reinforcement Plus Vouchers

Generally used for outpatient treatments, this therapy approach uses positive reinforcement from the community such as family members, friends and coworkers. The primary goal is to prove that a lifestyle that doesn’t involve addictive substances is better and more enjoyable than a life of addiction. This is usually achieved when someone can abstain from addictive substances long enough to learn new activities and skills that help sustain abstinence from addictive substances.

The 12-Step Method

Also referred to as a 12-step program, this type of therapy is very popular for treating addiction. There are many variations of the 12-step method, but each will have the following three overarching principles:

  • A person must accept that they no longer have control over the addiction, and it has caused problems that they alone cannot fix.
  • To address the addiction, a person must surrender to a higher power by seeking the support of others with addiction.
  • A person must have active involvement in the 12-step program for it to be effective.
Motivational Enhancement Therapy

Motivational enhancement therapy is special because its primary objective is to motivate the individual to help themselves. The first step involves removing the reluctance to stop using the substance. Then, the individual is motivated to change addiction habits. This therapy often supports the participation of the individual’s close family member, such as a significant other.

The Matrix Model

The matrix model is usually used to treat addictions to stimulants. This involves coaching and teaching from a therapist who cultivates a positive relationship with the individual. This unique relationship is not authoritarian or confrontational, but teaches and encourages a person to figure out issues that contribute to addiction. The therapist gives direction and encouragement as the individual takes proactive steps on their own.

Motivational Incentives

This involves providing positive reinforcement to individuals who take steps to curb their addiction. Research has shown that this form of therapy is extremely effective in keeping someone from using addictive substances. Positive reinforcements can be simple, such as vouchers that can be exchanged for drug-free goods or activities and prizes with a small to moderate value.

How to Choose a Drug & Alcohol Treatment Facility

Due to the unique nature of addiction, there are a plethora of treatment options available. The best treatment option will depend on facts concerning the addiction, such as how long it’s been going on, the presence of co-occurring mental health problems, the financial resources available for rehab and the substances the individual is using. Each of the major treatment options are discussed in detail below.

In a 2012, a five-year study conducted by the National Center on Addiction and Substance Abuse at Columbia University found that only about 10% of individuals addicted to drugs or alcohol (excluding nicotine) received any form of addiction treatment. And most of those treated did not receive evidence-based treatments that utilize scientifically proven methods of fighting addiction.

Therefore, regardless of which treatment option is chosen, there are certain traits or characteristics to look out for when choosing an effective rehab option.

  • The treatment will last a long time. The exact amount of time will depend on the type of treatment chosen, but almost any effective treatment for addiction will last at least a few weeks.
  • Avoid intervention-based, episodic treatments if possible. The most effective treatment will involve long-term help to address the chronic disease that is addiction.
  • The treatment relies on evidence-based therapies.
  • The treatment will use multiple therapies to deal with the multiple causes of addiction.
  • If any other mental disorders exist, they will be treated at the same time.
  • A long-term follow up plan is in place to check in with the individual even after treatment is officially over.

Types of Addiction Treatment Centers

  • Residential Treatment
  • Outpatient Addiction Treatment
  • State-Funded Treatment Programs
  • More Factors to Consider When Choosing a Rehab Facility
  • Also known as inpatient treatment, residential treatment is a comprehensive treatment that surrounds the individual in a controlled setting 24 hours a day, seven days a week. Residential treatment can be long-term or short-term.

    Long-Term Residential Treatment

    Long-term residential treatment lasts at least two months, but can often last up to one year. This type of treatment is considered one of the most effective options available, although it’s also expensive.

    The most common long-term residential treatment program is based on the idea of a therapeutic community. In a therapeutic community, everyone, not just the professional staff, play a part in helping the individual fight addiction. Treatment will often begin with detoxification and handling the physiological aspects of the addiction, but will soon shift to the psychological side of the problem. Because treating addiction often involves changing behavior, it can take a long time to implement these positive changes and make them permanent.

    Additionally, the individual is surrounded by those who will reinforce these changes in behavior. They are shielded from triggers and influences that lead to addiction, making the treatment that much more effective. For example, the longer a person is separated from former acquaintances and settings relating to the addiction, the more foreign and less familiar they will seem. This improves the chances of avoiding a relapse.

    Short-Term Residential Treatment

    In short-term residential treatment, the individual will reside at the treatment facility and be monitored 24/7 until the rehab is over. However, it will last for a much shorter period of time, often a few weeks to a few months. As a result of the shorter time period for rehab, the approach is different from the long-term residential treatment option.

    Like the long-term residential treatment option, the individual will usually go through detoxification and engage in behavioral and pharmacotherapies to address both the physical and mental aspects of addiction. But with a shorter time in rehab, there is less opportunity for training, therapy and reinforcement of positive and constructive habits. Additionally, there is little opportunity for a person to “grow distant” from his or her former life.

    After the short-term residential treatment program is complete, the individual must be diligent in completing follow up (aftercare) or outpatient treatment programs. A strong support network is essential to avoid relapse.

  • In outpatient treatment, a person does not live at the treatment facility. The exact type of treatments will depend on the specific program, but is often less intense and of shorter duration than inpatient programs. There are a few other major differences as well.

    • Outpatient programs are ideal for those with extensive support networks. Because the treatment will cease when the individual leaves the outpatient session, it’s very important that they have family, friends or local support groups to help continue the treatment process. Without a source of support and accountability after an outpatient treatment session is over, the effectiveness of the treatment program will be diminished.
    • Outpatient programs are good for those who want treatment, but can’t afford to spend an extended period of time away from their job, home or current living situation. Even short-term residential inpatient treatment programs often last a month. This is a very long time to be away from family or work.
    • Outpatient treatment is usually significantly cheaper than inpatient treatment. However, even if it’s not as effective as inpatient treatment, it’s better than no treatment at all. A strong support network of support can drastically reduce the drawbacks of outpatient rehab.
  • These rehab programs take a variety of forms, such as inpatient, outpatient, support groups and counseling. However, because they are state funded, the quality of care usually is not on par with private or luxury treatment rehab facilities. There can be waiting lists to enroll and the ratio between professional staff and individuals is quite large. In addition, some of the newer therapy or medical treatment options may not yet be available in state funded treatment programs, thanks to financial or bureaucratic considerations.

  • Amenities

    The amenities provided during inpatient rehab are generally connected to the cost of the program. Luxury rehab treatment centers may provide plush accommodations, gourmet meals and recreational activities, such as spa treatments.

    On the other end of the spectrum are state funded treatment programs. Most state funded treatment programs don’t even have enough money to offer the most effective treatment possible, such as having more treatment specialists on staff. As such, the amenities will be adequate, but not luxurious.

    Visitation

    Visitation is encouraged for most individuals in rehab. Familial and social support is extremely important to help fight addiction, especially after the treatment is over. Family and friends may even participate in the treatment during their visits.

Additional Substance Abuse Treatment Options

Addictions Counseling

Individual and group counseling is often a part of inpatient and outpatient rehab programs. While the specific approach and techniques used in counseling will depend on the individual, the primary purpose of counseling is to create behavioral and psychological changes. Counseling usually includes teaching coping techniques. Additionally, counseling will often address other concurrent issues, such as mental health problems, financial troubles and relationship issues.

Addiction Support Groups

A strong community can make recovering from addiction easier. For many, advice and discipline is much better received from peers, such as those who are currently going through the same recovery process. Support group treatment is rarely used on its own, but is either a part of another program or acts as aftercare treatment when the primary treatment is completed.

Sober Housing

Also known as recovery housing or halfway housing, sober housing is a type of aftercare that offers a way for individuals to transition from rehab (typically inpatient) to the everyday world. In a sober house, an individual will have a tremendous amount of freedom compared to inpatient rehab. However, there are still rules and limits they will be expected to comply with, such as curfews, staying sober, finding employment, and attending support group meetings.

Q&A With Addictions Expert Christopher Gerhart

About Christopher Gerhart

Christopher Gerhart has been a licensed and certified substance abuse counselor for more than 20 years. He is presently the proud owner of a small but effective private outpatient practice.

  • Q. From a clinical perspective, is inpatient rehab more advantageous than outpatient? Why or why not?

    A. Yes and no. Inpatient rehabilitation can get someone out of a bad situation and help them learn and practice more effective patterns of living in their daily lives. For someone who is living in the drug house, or their home environment is so toxic that staying clean and sober is extremely difficult, residential treatment may be preferred. Also, logistics can be an issue. If someone lives so far away from services that they cannot effectively engage and participate in group and individual counseling sessions, then staying on campus may be a good idea.

    Outpatient gives someone the opportunity to practice newly learned skills in their environment, where they will be living after treatment is over and establishing relationships and connections in the community to support ongoing recovery. This can also give them the ability to fulfill some of their other roles in life such as parent, employee, coach, etc. all of which can be helpful in maintaining motivation and engagement in the recovery process.

  • Q. We often hear about someone relapsing into old habits. How common is it for an individual to go through rehab or treatment several times?

    A. Relapse is a reality; however, it is not required. People who relapse may harm themselves or others, sometimes fatally and forever. Motivation is such a big part of change that often gets overlooked. Some people say that a person can’t get clean until they are doing it for themselves. I think that this is a partial truth. I have seen many people get, and stay, clean and sober because of their spouse, kids, job, etc. Whatever the motivation is for that person, go with it.

  • Q. What are a few things patients can do after rehab is over to stay on the right track?

    A. Staying on a schedule really seems to help. In rehab, there are times and places for everything. Part of that is getting restructured into a more effective pattern of living. We would seldom, if ever, schedule a relapse episode, complete with barfing on our clothes, angering our friends, embarrassing our family, losing our job and going to jail. So, if it ain’t on the schedule, don’t do it!

    Becoming part of some group is also helpful. This could be an aftercare group, an AA or NA (CA, MA, Celebrate Recovery, SOS) meeting, the PTA, Rotary, Habitat of Humanity, or political/social action group. Being part of a group that is doing something good helps someone feel good about themselves, which often is something that has not happened in a long time.

  • Q. Many people fear rehab because they fear going through detox. Please talk about a few options that make detox easier to handle.

    A. The thing that helped me most with detox was the knowledge that I only had to feel that bad once, and never again. Embrace the suck.

    Medically supervised detox may be necessary for some people. An informed physician can prescribe medications that can help alleviate some of the symptoms; however, getting clean will still require some degree of personal discomfiture and a steadfast commitment to living rather than dying.

Q. From a clinical perspective, is inpatient rehab more advantageous than outpatient? Why or why not?

A. Yes and no. Inpatient rehabilitation can get someone out of a bad situation and help them learn and practice more effective patterns of living in their daily lives. For someone who is living in the drug house, or their home environment is so toxic that staying clean and sober is extremely difficult, residential treatment may be preferred. Also, logistics can be an issue. If someone lives so far away from services that they cannot effectively engage and participate in group and individual counseling sessions, then staying on campus may be a good idea.

Outpatient gives someone the opportunity to practice newly learned skills in their environment, where they will be living after treatment is over and establishing relationships and connections in the community to support ongoing recovery. This can also give them the ability to fulfill some of their other roles in life such as parent, employee, coach, etc. all of which can be helpful in maintaining motivation and engagement in the recovery process.

Q. We often hear about someone relapsing into old habits. How common is it for an individual to go through rehab or treatment several times?

A. Relapse is a reality; however, it is not required. People who relapse may harm themselves or others, sometimes fatally and forever. Motivation is such a big part of change that often gets overlooked. Some people say that a person can’t get clean until they are doing it for themselves. I think that this is a partial truth. I have seen many people get, and stay, clean and sober because of their spouse, kids, job, etc. Whatever the motivation is for that person, go with it.

Q. What are a few things patients can do after rehab is over to stay on the right track?

A. Staying on a schedule really seems to help. In rehab, there are times and places for everything. Part of that is getting restructured into a more effective pattern of living. We would seldom, if ever, schedule a relapse episode, complete with barfing on our clothes, angering our friends, embarrassing our family, losing our job and going to jail. So, if it ain’t on the schedule, don’t do it!

Becoming part of some group is also helpful. This could be an aftercare group, an AA or NA (CA, MA, Celebrate Recovery, SOS) meeting, the PTA, Rotary, Habitat of Humanity, or political/social action group. Being part of a group that is doing something good helps someone feel good about themselves, which often is something that has not happened in a long time.

Q. Many people fear rehab because they fear going through detox. Please talk about a few options that make detox easier to handle.

A. The thing that helped me most with detox was the knowledge that I only had to feel that bad once, and never again. Embrace the suck.

Medically supervised detox may be necessary for some people. An informed physician can prescribe medications that can help alleviate some of the symptoms; however, getting clean will still require some degree of personal discomfiture and a steadfast commitment to living rather than dying.

Recovery: Life After Rehab

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Once rehab is complete, treatment continues with aftercare. For some, aftercare includes outpatient treatment once inpatient treatment is complete. For others, it can be joining a support group and getting regularly tested to monitor progress. Individual therapy and 12-step programs can also serve as an aftercare treatment option.

Depending on the addiction, the individual may continue taking medications. For example, those suffering from an opioid addiction may continue taking methadone or buprenorphine as a part of maintenance therapy. Sober or halfway housing is another example of a type of aftercare program to help transition from inpatient therapy to living independently.

How Loved Ones Can Support Alcoholics & Addicts

Helping a loved one with addiction can be very hard. Below is a list of ways you can help and take care of yourself along the way.

  • Take part in the rehab. Several treatment options encourage family members or loved ones to participate in treatments, especially aftercare.
  • Don’t expect your loved one to start abstaining from addictive substances merely because you ask them to. And just because they can’t quit, that doesn’t mean they don’t love you; addiction is far more complicated than that.
  • Maintain your support of your loved one. It can be difficult to stand by your loved one when things get tough, but don’t abandon them.
  • Come to terms with the reality of the situation. You cannot force anyone to stop using addictive substances. The decision to quit is ultimately theirs, not yours.
  • Understand the difference between “helping” and “enabling.” You might think giving someone money to help pay rent or buy groceries is helping them, but it may actually be contributing to the addiction by allowing them to spend money on drugs or alcohol instead.
  • When taking care of someone suffering from an addiction, don’t forget to take care of yourself and maintain your health.
  • Maintain your conviction that your loved one needs help and must treat their addiction. Don’t let them convince you it’s not a big deal.
  • To help some people learn that they have a problem, you must allow them to face the harsh consequences of their addiction. This may require them allowing them to hit rock bottom.
  • Don’t be afraid to talk about what you’re going through. Having a friend you can talk to about how you’re feeling or your frustrations can be extremely helpful.