The settings in drug and alcohol treatment centers vary both in environmental and philosophical approaches. Each type of setting has its own unique qualities. The differences are described below.
Therapeutic communities in the United States are primarily referred to in the field of addictive behavior as a mental health approach. They began in the early 1960s and were inspired by the early work of AA member Charles E. Dederich. He used many aspects of 12-step work with emphasis on behavioral changes to be practiced in residential settings. Therapeutic communities rely upon the patient community (and not necessarily the staff) to implement change through mutual support, peer pressure and positive role models. Today’s therapeutic communities are quite varied in style, content and preferred lengths of stay and operate throughout the world in both residential, school-based and outpatient programs.
Free-Standing Residential Treatment Center
A free-standing residential treatment center is a stand-alone program that specializes in the treatment of drug addiction, alcoholism and patients with a dual diagnosis. Patients stay within the addiction treatment facility full-time while under the care of a team of addiction professionals. While these rehabilitation programs may have other levels of care such as residential treatment, partial hospitalization or outpatient, the main focus lies in in providing 24-hour inpatient care. Some free-standing addiction treatment programs are capable of providing drug and alcohol detox, but not all programs offer this service in-house, nor do they provide on-site medical staff or certified addiction physicians, psychiatrists or nurses. Recovery Connection works with treatment centers that have in-house detox units to make your transition to residential care a smooth one. Call us at 800-993-3869 and find out if you qualify for treatment today.
Hospital Based Rehabilitation Unit
Hospital-based addiction treatment programs are exactly like they sound. These drug and alcohol treatment centers are units located inside hospitals. They are best suited for people who struggle with drug addiction or alcoholism and who have also developed chronic or acute medical or psychiatric problems. Lengths of stay in these types of addiction treatment programs are short and not as comprehensive as those in the dedicated treatment centers. The focus in a general hospital is always on stabilizing the patient and not on long-term addiction treatment and education. Addicts may be referred from hospital-based units to free-standing treatment centers to participate in complete addiction treatment programs. The average length of stay in a hospital-based unit is approximately 5 to 7 days. Some insurance carriers may not cover treatment in a hospital setting.
Long Term Residential Treatment or Extended Care
The average length of stay in a long-term addiction treatment center is approximately 90 days but some addiction treatment centers can provide care for up to a year or more. Today, it is not uncommon for people to access long-term addiction treatment when needed. These long-term treatment programs are designed for people who have previously completed residential addiction treatment and for a variety of reasons required additional long-term residential treatment. Some criteria for long-term care are:
Continued drug seeking behavior after completion of a thirty day addiction treatment program
Relapse after a short term stay in a treatment center for addiction
Require additional time in a structured setting to resolve outstanding clinical issues
Types of Addiction Treatment
Certain populations are particularly prone to the development of substance abuse and addiction or would benefit from specialized addiction treatment. Women, the gay community, particular religions, teens and those at the extremes of age all may require intensely individualized substance abuse programs. These can be provided in the various types of treatment settings listed below. Clinicians who work with specialty programs should have training in the issues pertaining specifically to that population. The issues for each demographic can have a profound impact upon the patient’s ability to confront underlying problems and establish a solid foundation for recovery. Also, those trained in different specialty programs will have sensitivity to those issues that the average clinician may not have.
Community Based Substance Abuse Addiction Treatment
Individuals who enter these specific addiction treatment programs are surrounded by others who have faced similar issues. This camaraderie provides a level of comfort that usually proves beneficial for more positive outcomes. Therapists are trained in the unique problems confronting each demographic. Typically patients in this type of program will attend 12-step meetings and work for pay or volunteer. These programs should not be confused with halfway houses, which are used as a transitional phase between treatment and returning home. Community-based substance abuse treatment programs include day or evening groups, individual counseling and are defined by the length of time spent in the program, which can be anywhere from 6 months to 2 years.
There are a few programs that claim to treat addiction with a spiritual foundation. Quality religious addiction programs will always be medically based, providing drug detox and drug rehabilitation based upon best practices in combination with spiritual teachings. However, there may be some religious rehab programs that do not understand the medical model behind addiction. In this case it is never good to rely solely on spirituality but on the combination of spirituality and behavioral intervention.
Camps and Farms
These programs are highly controlled addiction treatment programs that are used to treat repeat substance abusers. They were designed to break the cycle of addiction and criminal behavior. Beyond the structure, the quality camp or farm programs provide therapy and addiction treatment using best practices. There are also a range of teen drug rehab programs that use the camp or the farm structure to bring order back into the lives of these troubled teens. Some of the camps combine outdoor challenges to build self-esteem, trust, sharing and insight.
Treatment Modalities in Addiction Treatment
Medically Based Treatment
There are different types of addiction treatment programs, but not all of them are based upon a medical model. When a treatment program states that it uses a medical model that means that they believe that addiction is a treatable disease. Doctors and nurses will be part of your treatment team along with clinical therapists. Treating addiction at such a facility is based on therapies and medications that have been tested in studies and reviewed for effectiveness.
Psychotherapy is the treatment of mental health and emotional and psychiatric disorders. Psychotherapy is based in verbal communications and interventions with the therapist and relies on a trusting relationship between the patient and therapist. Sessions take place in a structured environment for a specific amount of time. Therapy is an opportunity for someone to share present problems with an objective listener. Learning new skills to deal with daily stressors helps you handle the present with greater confidence.
Therapy groups typically include 6 to 8 individuals. Sometimes these individuals are dealing with the same issues, and sometimes people are placed in a group to learn to listen and identify with others in a safe environment. There are a range of issues that can be negotiated within a group context that might take longer in individual counseling.
In individual therapy, a patient meets privately with a mental health counselor or psychologist to discuss personal problems. Individual counseling typically happens once per week until the individual feels some improvement. Some issues, such as addiction and psychiatric illness, may require a longer period of time in ongoing therapy.
The concept of a disease affecting a whole family governs family therapy. Any disruption to the healthy social structure of the family unit is evident in the roles that individuals take. Addiction disrupts everyone’s life. To treat the addict successfully, the family unit and the dysfunction within the family unit must also be addressed.
Occupational therapy allows patients to improve their ability to perform everyday tasks in both their living and working environments. Occupational therapy can teach a patient how to use a computer, increase his or her physical endurance, work on short-term memory and approach abstract thinking, perceptual skills and coordination.
There are many ways of delivering information to addicts and alcoholics in treatment. In an attempt to use all the senses and ways that people learn, lectures are an integral part of the substance abuse treatment process. Lectures provide supplemental information to those lessons processed in group and individual therapies. Some examples of drug rehab lectures include: Relapse prevention, healthy relationships, anger management, medication management, managing depression and anxiety and conflict resolution.
The 12-step programs based on Alcoholic Anonymous are a philosophical and spiritual approach to living without taking a drink or a drug, one day at a time. The success of the 12-step programs is based on a basic reality that a person can change, that life needs to be lived in the here and no, that a power greater than self can help the addict stay away from drugs and alcohol. Finally when one addict helps another, both individuals are helped to stay clean and sober. Service gets an addict or alcoholic out of self-centered thinking.
Types of Specialized Addiction Therapies
Experiential therapy is a combination of Gestalt therapy, cognitive behavioral, family and other models that involve making the unconscious issues conscious and moving the client toward resolution. There are a number of techniques that can be used including art therapy, role playing, yoga, etc. The client can then live in the present, reflect upon behavior and express feelings more freely.
The technique of bringing one’s mind into the present has been practiced for thousands of years. There are two types of meditation, both of which produce a calming, relaxed environment for the mind and the body.
Concentration meditation brings the mind’s focus to a single sound, sensation of breath or an object.
Mindfulness meditation brings the focus to the sounds and sensations of the present reality as an observer. The body remains quiet and the mind remains focused. Learning to quiet the mind and body is beneficial to one’s health and to the healing process.
Dialectical Behavior Therapy
Dialectical behavior therapy is most effective for people who have engaged in self-harm or those who have serious thoughts of hurting themselves. It is based on a theory that sees the interconnectedness between biological, social and emotional issues. DBT skills change problem behaviors, find solutions and encourage healthy thinking.
Cognitive Behavioral Therapy
Several of the therapies listed here can be classified as CBT. These include rational behavior therapy, dialectical behavioral therapy and rational emotive behavioral therapy. The basis for
CBT is that thoughts produce feelings, which then produce actions. If we improve our thinking, we feel better and take healthier actions.
Rational Emotive Behavioral Therapy
REBT is a form of cognitive behavioral therapy that places the focus on the present. It accepts that the past is with us in our present thoughts about ourselves or the values we hold.
REBT focuses on the harmful beliefs and allows patients to alter how the past influences thoughts, feelings and actions today.
Hypnotherapy uses exercises that place the patient into a sleep-like state. It is a myth that one loses the ability to have free will and independent thinking. The patient is moved into a focused stated, which then enables him or her to deal with emotions and awareness. This therapeutic approach enables one to reframe problems and let go of negative thoughts. It also teaches patients self-regulating skills.
Creative Arts Therapies
The creative arts therapies use art, dance, music and theater to address patients’ emotional and physical problems. These specific creative approaches are combined with traditional therapeutic approaches to address the feelings, emotions and thoughts that accompany the issues. The ability to express an experience or an emotion or thought in and of itself can be healing. The product of this expression can be used to mark progress in recovery as well.
A licensed, trained music therapist uses music to address physical, emotional, cognitive and social needs of a patient. Exercises can include creating music, singing, movement and listening to different types of music. Music therapy can be useful for those who have difficulty expressing in words his or her feelings. Music can be the form used to give voice to these thoughts and feelings.