The Continuum of Care in Recovery
When you are ready to make the call for help in getting clean and sober; whom do you call? Where do you turn for help? When should you call?
The road to recovery begins with your decision to seek help. From that point forward there are different levels of care for you. Which one is appropriate varies from person to person. Factors such as: how much and how often and how long have you been drinking and/or drugging, your age, your gender, any special needs such as handicap access, dietary considerations and mental condition all figure into the "where-do-I-go" equation. Here is a brief description of the various levels of care to help you research your options. (NOTE: The alcoholic/drug addict is referred to as the "client" in this article.)
Intervention- Maybe your first step should be to call an interventionist, a professional whose role is to help you get the right level of care. An interventionist may start with a telephone assessment to determine whether an on-site intervention is necessary. In addition to working directly with the client, the interventionist helps the family make decisions and cope with the stress of an intervention.
Most interventionists are trained and highly skilled professionals whose primary interest is in getting the client clean and sober. Where the client is eventually placed is paramount; however, this is only the beginning for most interventionists. Long-term recovery requires a plan beyond the initial treatment program. Studies prove that the longer one spends in treatment, the longer one remains clean and sober. So the interventionist will most likely stay with the client through the entire process, as well as provide after care monitoring.
Detox Center - Many clients require a detox prior to entering into a treatment program. There are two levels of detox care: acute (hospital setting) and subacute (non-hospital) which are available at some residential treatment centers. Acute detox centers may be freestanding or part of a hospital. While both have 24-hour supervision, an acute detox facility is equipped to handle most medical emergencies resulting from detox. There are different types of detox: Medical, holistic, drug specific and alcohol specific.
Medical detox centers use drug therapy to help the client safely detox from alcohol and/or drug use. A medical doctor who specializes in addictionology is always on duty, as are a clinical psychologist, nurses and substance abuse case managers. This level of care is appropriate for those whose drinking and drug use is daily with high amounts consumed and for long periods of time. For those individuals, self-detox is dangerous and could be lethal.
A holistic detox uses natural aides to help the body detox. These include: B-12 injections, amino acid, mineral and vitamin therapy, either orally or by injection. Other alternative treatments include: acupuncture, massage, energy healing (like Reiki). Meals usually consist of healthy detox friendly food and beverages.
Drug specific detox uses a pharmacological approach to specific drug addictions. Opiate addicts may receive Subutex or Suboxone that serve as opiate replacements for the withdrawal process. Heroin addicts face a painful detox so effective therapy often includes Suboxone or Riva, Depade or Vivitrol (Naltrexone) with Catepres (Clonidine) for hypertension/high blood pressure.
Alcohol detox often results in serious side effects. Seizures, delirium tremens (DT's) and heart attack result in many cases and if these are not medically treated, death may result. Clients may receive sedatives, like diazepam or carbamazepine, to reduce DT's. Catepres may be used to help control blood pressure. Clients with co-occurring disorders like depression, bi-polar disorder require medications that address those symptoms.
In-patient Residential Treatment Centers
This is what most people think of when the term "treatment" is used. At this level of care the client receives intense clinical services such as group therapy and individual therapy several times a week. Focused substance abuse education and introduction into a Twelve-Step based program like Alcoholics Anonymous and Narcotics Anonymous are included. In addition to behavioral health professionals, a medical doctor is on staff as well as a registered nurse to help with meds administration. Meals are commonly prepared by a chef and served in a common dining area. On-site recreation is available and may include equine therapy, art therapy, dance therapy, yoga and more. Toward completion of a residential program, the client and counselor consider the next step of treatment. If an interventionist made the initial referral, he or she is often involved in placement after residential care.
Options for placement include: extended care, sober living, halfway house and transitional living programs. Some clients may opt out of treatment following completion of a residential program. However, professional referrals are made for a reason - they decrease the relapse rate and increase the probability for long-term sobriety.
Extended Care Programs
This level of care is often provided in an outpatient clinic in conjunction with sober living facilities that offer high levels of supervision and structure. Extended care is usually a three to six month program that includes: Intensive Outpatient Therapy (IOP), individual therapy, group therapy, Relapse Prevention, substance abuse education, recreation therapy and intense Twelve-Step work. Since extended care programs are three to six months in length, the client has an opportunity to examine his or her life in-depth and make cognitive, emotive, behavioral, spiritual and social changes conducive to a life of sobriety. Some programs offer alumni groups that help the client stay connected to his or her support network. Following extended care, the counselor and/or interventionist may refer the client to a sober living facility as the next step.
Sober Living
Most sober living programs offer a modest level of services and programs for the client. They generally have an on site house manager; however, a few sober living facilities have staff on duty 24 hours a day, 365 days a year. Always ask if staff is on-duty (awake) 24/7. The emphasis at this level is learning to live in a structured family like setting free of alcohol and drugs. Life skills management may be offered, as the client must learn to become independent in order to achieve long-term sobriety. Most sober living programs require the client to be employed or attend school as well as attend a minimum number of Twelve-Step meetings, have a sponsor and work through the steps in detail with that sponsor.
Halfway House
Halfway houses and sober living houses are synonymous in some states, while quite different in others. Generally speaking, a halfway house has house rules, a house manager who lives on site, requires clients to be employed and attend Twelve Step meetings. Clients have more freedom and often are free to come and go at will. Few, if any, halfway houses have 24/7 staff supervision. (Again, someone is awake and on-duty 24 hours a day, every day.) Since some states do not regulate or license halfway houses, they may not have liability insurance. Remember to ask whether the house is a private residence, an apartment complex or some other structure. Also ask to see the rules, the insurance certificate and you may even want to call family members of current or former clients.
Summary
In order to achieve long-term sobriety one must consider the full continuum of care, which includes a bio/psycho/social model. I see many men in my program who relapse after completing a residential program, an extended care program, a sober living program or a halfway house program. Most of the time these men did not follow a continuum of care path and went home after the initial treatment program, or, went into a halfway house from a primary residential treatment program. Without the entire continuum of care, the alcoholic/drug addict is at high risk of relapse. It is worth repeating: studies confirm that the longer one receives care, the longer one stays sober.
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