12. Treatment Paths


#1

Here we’ll cover:

  1. Treatment considerations
  2. Treatment options: traditional an non-traditional
  3. Therapeutic approaches
  4. What to ask
  5. What to look out for

1. Treatment considerations

Treatment for addiction can be understood by three different measures: Setting, Intensity and Validity.

  1. Setting (inpatient / outpatient):

We know that a lot of people don’t have the option of putting commitments on hold and entering a residential addiction treatment center. If it’s possible, great. If not, focus your research on places providing outpatient services in your area.

  1. Intensity (daily, weekly, duration):

You’ll want to consider, with your loved one, how often addiction therapy or professional addiction treatment is needed and what length of treatment is best. This will depend a lot on the severity and momentum in your situation.

  1. Validity (evidence-based approach, success rates):

Be sure to ask direct questions about how much time they get with their addiction therapist, which behavioral change approaches they use, and ask for the research-based success rates. There’s a list of helpful questions you might ask in an upcoming section.

Determining what’s right for your loved one will depend on their situation.

2. Treatment options (traditional and non)

First, a quick reminder: there are many paths to change and none are one-size-fits-all.

The following is a summarized overview of the most common types of traditional addiction treatment, they’re listed separately but often used effectively in combination.

Outpatient Services

Provide both group and individual behavioral interventions and medications when appropriate. Services can be offered during the day, before or after work or school, in the evenings or on weekends. Typically, outpatient programs are considered appropriate as the initial level of care for individuals with a mild to moderate substance use disorder or as continuing care after completing more intensive treatment. Outpatient programs are also suitable for individuals with co-occurring mental health conditions. Connecting with an addiction specialist might help as an initial step to getting additional support and help finding a residential treatment.

Typical length: months to years.

Residential Treatment

Offers organized services in a 24-hour setting, but outside of a hospital. These programs typically provide support, structure, and various evidence-based clinical services. Such programs are appropriate for physically and emotionally stabilized individuals who may not have a living situation that supports recovery, may have a history of relapse, or have co-occurring physical and/ or mental illnesses.

Typical length: weeks to months.

Medically Monitored // Managed Inpatient Care

An intensive service delivered in an acute, inpatient (live in) hospital setting. These programs are typically necessary for people who require withdrawal management, primary medical and nursing care, and those with co-occurring mental and physical health conditions.Treatment is usually provided by an interdisciplinary team of healthcare professionals, available 24 hours a day, who can address serious mental and physical health needs.

Typical length: days to weeks.

A Less Traditionally Recognized Route

There are many paths to change, and some paths do not include traditional treatment. For some, the road is long and gradual, not stopping use all at once, but tapering off. The biggest determinant in this kind of change is that life outside of the addiction becomes more fulfilling and less stressful.

From personal experiences, we’ve found the following three factors are most supportive of this transition.

  1. Involvement in community: A community that engages people in an active way and

accepts them without conditions (because shame and guilt are toxic and do the opposite of creating conditions for healing!) support and offer deep, authentic connection. Reconnecting with family members can be one key way to rebuild a sense of connection

  1. Purpose: When someone feels deeply connected to a reason for existing on this planet, they immediately feel some sense of worth and are pulled forward by this reason for existence (and out of the addiction that’s supplanted that reason thus far).

  2. Improved physical wellbeing: Simply by improving physical health and wellbeing whether it be through small amounts of exercise, healthy eating and sleeping habits or meditation practices, can set the foundation for positive change against addiction.

There are a growing number of alternative therapies, we will stay informed and share, as more evidence-based options and information become available.

3. Therapeutic approaches

On the traditional treatment path, you’ll hear mention of different behavioral therapeutic approaches.

To familiarize you a bit, the following give an overview of some of the most widely used.

Behavioral Therapies can be facilitated in individual, group, and/or family sessions, and in all addiction treatment settings. They’re designed to help patients recognize the impact of their behaviors – whether in dealing with stress or interacting in relationships. Therapy addresses the addiction and a person’s ability to function in a healthy, safe, and productive way. The therapies are also intended to teach and motivate patients on how to change their addiction-related behaviors to control their substance use instead of having the substance use control them.

Cognitive-Behavioral Therapy

The basic theory behind Cognitive-Behavioral Therapy, often called CBT, is that substance use disorders develop, in part, because of behavior patterns and habits of thoughts that were created from a faulty foundation. CBT techniques aim to adjust those behaviors and improve coping skills by putting attention on identifying and modifying dysfunctional thinking.

Contingency Management

Behavior change involves learning new behaviors and changing old behaviors. Positive incentives for changes can help the process. Contingency management involves giving tangible rewards in order to support positive behavior change. In this therapy, patients get a voucher with monetary value that can be exchanged for food items, healthy recreational options, like movies, or other desirable goods or services when they exhibit desired behavior such as drug-free urine tests or participation in treatment activities.

Community Reinforcement Approach (CRA)

Similar to Contingency Management, Community Reinforcement Approach (CRA) Plus Vouchers is an intensive 24-week outpatient program that uses reinforcers to reward people who reduce their substance use. Participants attend one to two counseling sessions weekly, and are eligible to receive vouchers with monetary value if their urine tests are drug-free several times per week. Research has demonstrated that CRA Plus Vouchers promotes treatment engagement, facilitates abstinence, and improves psychosocial functioning compared to those who received an intervention of standard care only.

Motivational Enhancement Therapy (MET)

MET uses motivational interviewing techniques to guide people to resolve any uncertainties they have about stopping substance use. MET promotes empathy, develops patient awareness of the discrepancy between their goals and their unhealthy behavior, helps avoid argument and confrontation, addresses resistance, and supports their belief in their own ability to succeed.

Family Therapies

An obvious benefit to improve a person’s commitment to treatment and to promote changes is engaging supportive family members and a social support system. Family therapies engage partners and/or parents and children to support the individual in making behavioral changes that create positive outcomes.

4. What to ask (do)

Try the 5 questions that follow as a starting point for conversations you have with professionals in the treatment field. While we know you’re ready to make something happen fast, a strong suggestion is to not let eagerness get ahead of due diligence. Gather as much information as possible about different programs before making a decision so you know which has the potential to be most effective.

  • What kind of addiction treatment does the program or provider offer?

    • It is important to gauge if the facility provides all the currently available methods or relies on one approach. You may want to learn if the program or provider offers medication and if mental health issues are addressed together with addiction treatment.
  • Is the treatment program tailored to the individual?

    • Matching the right addiction therapy to the individual is important to its success. No single treatment will benefit everyone. It may also be helpful to determine whether treatment will be adapted to meet changing needs as they arise.
  • What is expected of the patient?

    • You will want to understand what will be asked of you in order to decide what treatment best suits your needs.
  • Is addiction treatment success measured?

    • By assessing whether and how the program or provider measures success, you may be able to better compare your options.
  • How does the program or provider handle relapse?

    • Relapse is common in the healing and recovery process and you will want to know how it is addressed. For more information on relapse: see Relapse Is Part of the Process.

5. What to look out for (do)

A note of caution: there are predatory treatment programs out there. The more aware, attentive, and armed with specific questions you are, the better prepared you’ll be to find a treatment option that matches your needs.

Here are a few tips:

  • Be wary of unsolicited referrals to out-of-state treatment facilities.

    • Anyone seeking to arrange for addiction treatment out of state may be getting paid by the treatment center.

    • In Massachusetts, it is illegal for recruiters to accept kickbacks for referring you to treatment.

    • Anyone paid a referral fee for recommending a particular treatment center does not have your best interests in mind.

  • Be wary of anyone offering to pay for your insurance coverage. They can stop paying your premiums at any time, which will result in the cancellation of your insurance.

  • If you accept an offer by someone to pay for travel to an out-of-state clinic, make sure you have a plan and the means to pay for a trip back home.

  • Be careful about giving your personal information – including your social security number or insurance number – to a recruiter, unless you can confirm that the person is employed by a medical provider or insurance company.

  • If someone is offering to arrange travel or cover insurance costs for treatment, call the treatment facility or your insurance company to confirm that the person is an employee.

For balance, an important reminder here:

There are a lot of reputable treatment facilities that are in business for the right reasons.

In your search stay focused on the light, with just enough awareness of these risks so you’re equipped, even in a vulnerable time, to handle dishonesty if it comes up.

Now, let’s talk about the cost.

Cost and a lack of desire to change are the number one obstacles to treatment.

Treatment options range from free to supremely expensive. We’re here to tell you that the $40k a month option is not the only way to get results.

Explore all the settings we’ve included in this section, from one-on-one therapy to outpatient services to residential treatment. Know what’s available, and resist the urge to rush a decision without being informed of the options and considering what matches best to the situation at hand and you’re loved one’s desires and motivations.

If the person you’re concerned about has health insurance, speak with the insurance company to find out if any of the options are covered.

What to do now:

Digest the information on treatment paths, perhaps with a specialist who may be able to guide you.

And remember with 22 million families struggling with addiction, it’s likely you know someone in your personal circle who can also be a sounding board.