Drug rehab FAQs

There are several levels of care available for patients at different stages of addiction. Most programs begin with detoxification, a process that cleanses the drugs from your system and prepares you for the deeper work of recovery. Your treatment can take place at a residential (also known as “inpatient”) facility, where you receive 24-hour monitoring, or at an outpatient center, where you receive recovery services during the day while living off site. Partial hospitalization is an intermediate level of care, which is less intensive than residential treatment, yet more structured than outpatient rehab.

The type of treatment that’s appropriate for you will depend on several important factors, including your history of drug use, your current level of drug intoxication, and your past experiences with treatment. The treatment team must also consider co-occurring health conditions — both physical and psychological — that could affect the outcomes of your treatment. Patients who show signs of mental illness as well as drug addiction require intensive, specialized treatment that addresses both conditions.

Matching the individual patient with the right level of care can be a complicated task. In general, patients with a more severe history of drug abuse and patients who are physically or psychologically fragile require a more intensive level of care, such as inpatient treatment or a partial hospitalization program. Those who are less advanced in their addiction and who are motivated enough to keep up with a more flexible program may be referred to outpatient treatment.

An intensive outpatient program can be just as appropriate as inpatient care in the right circumstances. A comparative study of patients in inpatient and outpatient treatment programs, published in Psychiatric Quarterly, found that inpatient treatment was typically more effective for patients with co-occurring psychiatric disorders and a lack of social support. Outpatient treatment was just as effective for patients who had a solid support network and no serious co-occurring disorders. This decision should be made only after careful assessment by an addiction treatment specialist.

Drug withdrawal symptoms can range from mildly uncomfortable to life-threatening, depending on the type of drug, the extent of the drug abuse, and the user’s physical and psychological health. As the body and brain withdraw from the effects of drugs, you may experience side effects such as:

• Headaches
• Nausea
• Irritability
• Fatigue
• Anxiety
• Loss of sleep
• Loss of appetite
• Sweating
• Watery eyes
• Runny nose
• Muscle spasms
• Bone pain
• Involuntary movements
• Seizures
• Hallucinations
• Confusion
• Fever

Drug withdrawal is usually accompanied by strong cravings for the drug of choice. These cravings can become so powerful that they overwhelm the user’s desire to quit. One of the primary goals of medical detoxification is to reduce withdrawal symptoms and cravings, so that the patient will be as comfortable as possible. Withdrawal can be made easier through medical monitoring, pharmaceutical therapy, fluid replacement, nutritional supplementation, and psychological support.

Drug withdrawal is only dangerous if you attempt to withdraw by yourself without any medical support. It’s impossible for the user to predict all of the side effects of withdrawing from drugs, especially if he or she uses multiple drugs and/or alcohol. Side effects like seizures, fever, hallucination, and agitation can be life-threatening. The National Council on Alcoholism and Drug Dependence cautions that drug withdrawal symptoms should be managed by medical professionals who specialize in addiction treatment. Professional detox programs also increase the patient’s chances of success in recovery by providing the emotional support that he or she needs to take the next important steps to healing.

During detox — the first stage in recovery — toxic chemicals are cleared from your system. The length of time required to complete this process can vary from one patient to another, depending on the extent of the user’s addiction. For lighter users, detox may last only a matter of days. The Treatment Episode Data Set report of 2006 indicated that the median length of stay in detoxification programs was four days, meaning that half of the users who were surveyed stayed longer, and half required more time to detox.

For heavy users, or those with complicated substance abuse histories, detox may take a week or more. Detoxification from certain prescription drugs, including sedatives or tranquilizers, may require a more extended drug tapering process to gradually ease the user off the medication and prevent serious side effects. Detox from narcotics like heroin, morphine, oxycodone, or hydrocodone often requires opioid replacement therapy with a drug like methadone or buprenorphine to ease withdrawal and curb cravings.

Co-occurring disorders (also known as a dual diagnosis) exist when an individual has a substance abuse problem combined with mental illness. In order to treat these patients successfully, a rehab center must provide treatment that addresses both the patient’s addiction and his or her psychiatric disorder. In a truly integrated rehab setting, mental health and substance abuse treatment services are provided at the same facility, by staff members who are cross-trained in both fields. Treatment plans are designed to accommodate the needs of patients who are struggling with both addiction and serious mental health conditions, such as depression, anxiety disorders, bipolar disorder, and schizophrenia.

Because the effects of drug abuse can often mask the symptoms of mental illness — and vice versa — identifying and treating co-occurring disorders can be challenging. To be effective, treatment must begin with a complete psychological assessment of the patient in order to determine the best course of recovery. In addition to substance abuse counseling, patients with co-occurring disorders usually require intensive psychotherapy, psychiatric medication management, and other services that are tailored to their mental health needs.

Estimates on the prevalence of co-occurring disorders vary, but in general, statistics show that a large percentage of adults who abuse drugs also meet the criteria for one or more psychiatric disorders. The Journal of Addictive Disorders states that over 70 percent of individuals who abuse drugs or alcohol also meet the criteria for mental illness. The U.S. Department of Health and Human Services estimates that about 7 million American adults have co-occurring substance abuse and mental health disorders. Individuals with co-occurring disorders are more likely to suffer from serious problems like chronic unemployment, poverty, homelessness, physical illness, and incarceration.

Inpatient treatment, also known as residential treatment, takes place in a structured, supervised environment, such as a hospital, mental health facility, or dedicated rehab center. Inpatients receive intensive substance abuse treatment services — and psychiatric care, if appropriate — while living full-time at the facility. Inpatients receive 24-hour monitoring by doctors, nurses, or therapists in the security of a drug-free atmosphere.

Inpatient care is often recommended for patients who have a history of heavy drug use, for those who have serious co-occurring health concerns, or for those who have relapsed after previous experiences with treatment.

Outpatient treatment is a more flexible, less structured path to recovery. In outpatient treatment, the patient can participate in counseling, education, medication management, and other recovery services during the day while living at home or in a transitional living center. Detoxification services are also provided in outpatient settings. Outpatient programs are offered in many locations: rehab facilities, hospitals, community health centers, and correctional facilities, and more.

Outpatient services are appropriate for individuals who have graduated from inpatient treatment and who are ready to make the transition back to the community. This level of care may also be the right choice for those in the early stages of drug abuse who are still functioning effectively and who are highly motivated to quit.

In medical residential treatment, patients receive pharmaceutical therapy and medication management from doctors, nurses, medical technicians, and other licensed personnel. Medications may be prescribed to ease the discomfort of withdrawal, to prevent drug cravings, and to help patients stay on track with their recovery goals. Patients with co-occurring disorders could also be evaluated and treated by medical professionals using pharmacotherapy as well as intensive counseling.

In non-medical residential or inpatient treatment, patients are monitored as they go through the withdrawal process and progress into rehab. However, the level of medical supervision is lower, and medication therapy is generally not provided as part of treatment. Non-medical drug treatment emphasizes behavioral modification, individual therapy, and group therapy instead of pharmaceutical interventions. Patients participating in non-medical treatment would typically be followed by physicians or therapists outside of the facility if psychiatric drugs or anti-addiction medications were recommended.

The cost of drug treatment varies considerably from one facility to another. Community health centers, non-profit or not-for-profit hospitals, and publicly funded rehab facilities provide recovery services at little or no cost. Forbes Magazine estimates that publicly funded drug treatment programs cost an average of approximately $1,500 at the low end, with the costlier specialized programs ranging up to $8,000 or more. Sliding scale payment plans and federal or state funding (such as Medicare) are accepted at these facilities. At the opposite end of the spectrum are private facilities that offer treatment at a much higher rate, ranging from $20,000 to $60,000 and higher. Some of these facilities accept health insurance as payment, while others accept only cash payment in full at the time of admission.

The services you receive will also affect the cost of treatment. Inpatient and residential programs typically cost more than outpatient services, due to the increased costs of staffing, housing, medical monitoring, and other expenses. Services like extra counseling, certain prescription medications, private accommodations, or optional therapies may come with an additional cost.

Regardless of your financial circumstances or your ability to pay, there is a level of drug treatment that fits your needs. Look for a facility that provides quality treatment from compassionate, highly credentialed professionals at a reasonable rate, with a variety of flexible payment options.

Not all drug treatment centers accept insurance, but many do. By the same token, not all health insurance plans will fully cover rehab services. Some plans cover only outpatient programs, which are usually less expensive than inpatient or residential care, while others will cover a wider range of options. Many insurance plans limit the amount of time that they will pay for treatment.

It’s important to discuss these questions with your insurance provider as well as the intake counselors at the center where you’re seeking admission. An intake counselor or case manager should be available to answer your questions and to find out whether your insurance company will authorize payment for the facility’s services.

According to the National Institute on Drug Abuse, research indicates that most people who complete substance abuse treatment will reach their recovery goals, as long as they continue to take part in activities that support a drug-free lifestyle (sober activities, counseling, 12-step meetings, etc.) Statistics from the Substance Abuse and Mental Health Services Administration show that in 2006, nearly half (47 percent) of individuals who were admitted to drug or alcohol rehab completed their program. But success in long-term recovery isn’t just about graduating from rehab or staying drug-free for a certain number of days. It’s about creating a new life that supports the health of the body, mind, and spirit.

Travel will be required if you choose to enroll in a treatment program outside of your community. For many individuals, traveling out of state gives them some distance from their usual drug abuse triggers and a new perspective on their lives. For others, leaving the community isn’t possible because of family relationships, job obligations, or legal issues. The decision about whether to travel to another state should be based on your individual situation and your personal requirements, as well as the specific services and the level of care that you need.

At one time, it was widely believed that only the addicted individual should make the decision to go to treatment. Today, however, substance abuse treatment specialists realize that intervention by family or friends is often necessary. If you’ve seen the signs of substance abuse in someone you care about, you may be hesitant to interfere, thinking that you’ll alienate your loved one or make the problem worse. In fact, stepping in to help someone you care about could literally save his or her life.

When you approach your loved one, try to be as calm and nonjudgmental as possible. Even if you have strong feelings and painful memories associated with your loved one’s drug abuse, it’s important to remember that addiction is now considered to be a chronic disease, similar to diabetes, heart disease, or cancer. In the early stages of drug addiction, an honest talk could be all it takes to persuade someone to go to rehab. However, most drug addicts develop a sense of denial about their problem as soon as they start using seriously. In most cases, by the time the problem becomes apparent, a one-on-one conversation isn’t enough to stop the damage.

The Mayo Clinic states that a formal intervention may be the most effective way to help someone who’s in denial about his problem, or who refuses to get treatment. An intervention is a planned meeting in which the friends, family, or coworkers of an addicted person meet with the individual in order to encourage him to get help.

Interventions can be conducted in different ways. The structure and content of the meeting should be tailored to the individual’s situation. Some addicts can benefit from a firm approach, while others need a more gentle, encouraging tone. In general, the goals of an intervention are:

• To make your loved one aware of how her addiction is harming her life and the lives of those around her
• To discuss a plan for recovery, including a specific drug treatment program
• To present consequences if your loved one refuses to go to treatment, such as a marital separation or changes in a custody agreement

To maximize the effectiveness of an intervention, it’s best to hire a professional intervention specialist to help you plan and stage the meeting. Intervention specialists can help you outline your approach, choose the individuals who will be present at the meeting, and develop a proposal for treatment, or a treatment contract. An intervention specialist can coach you in effective communication techniques and prepare you for the various reactions you might face when you talk to your loved one. Although it’s possible to confront your loved one alone or with a small group, you’ll have the best chance of getting the outcome you want if you work with a professional from the beginning.