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What Type of Addiction Services Do I Need?

By Sarah Benton, MS, LMHC, LPC

There is an endless and overwhelming amount of information on the Web about addiction treatment options.  Many people have no idea where to begin or what type of care that they or their loved one may need.  There is common terminology that is important for those seeking treatment and their loved ones to understand when reaching out for help.

Often, insurance companies will not cover treatment for individuals requesting a higher level of care, such as residential, without unsuccessful attempts of staying sober at a lower level of care.  It can also be helpful to obtain a substance abuse assessment by an outpatient addiction therapist in order to help determine a treatment plan that is appropriate.  However, if an individual is physically addicted to alcohol it is imperative that they receive medical attention before abstaining from alcohol.  This person could be seen and assessed at any local Emergency Room and many addiction programs require that an individual is medically cleared by an ER before they admit that person for further treatment.  ERs can sometimes be helpful in finding an available detox bed for the individual as well.  Additionally, contacting your Primary Care Physician for referral suggestions can be a great place to start.

The following levels of care are listed in order of the lowest to the highest level of care:

Outpatient services:  This is the lowest level of care and often the most desirable for those who want to seek out discreet addiction care.  Outpatient care may involve receiving treatment from a therapist, psychiatrist (prescribe medication), psychiatric nurse practitioner, or addiction counselor in private practice or who may be part of a clinic.  They may or may not be in network with insurance providers.  Some outpatient clinics may also provide therapy groups and alcohol/drug testing, which can lead to a more comprehensive treatment plan.  Additionally, it is recommended that individuals attend mutual help meetings in addition to receiving these types of services (i.e., A.A., SMART Recovery, Celebrate Recovery, Women for Sobriety). The outpatient level of care can be a starting point for many alcoholics or those questioning their drinking and if they find that they are still relapsing, then it is clear that they may need to utilize a higher level of care.  Insight Counseling in Ridgefield, CT is a reputable outpatient clinic (also provides teen and young adult IOP) that specializes in treating clients with addictive and mental health issues.

 Intensive outpatient program (IOP):  An IOP is a program that is also generally run out of a clinic or hospital and generally is about 3 hours per day, allowing for individuals to also attend part time work or school.  Some IOP programs are in the evening, allowing for those being treated to maintain full time work.  These programs typically involve group therapy, along with individual therapy, case management and medication management.   These programs can last for various lengths of time (weeks-months), as individuals are able to engage in work, volunteering or academics simultaneously.  They are both insurance based and self-pay.

Partial Hospitalization program (“day treatment”):  These programs are run out of clinics or hospitals and allow an individual to attend treatment throughout the day while living at home.  Individuals who are attending a partial program generally need to take time off from work or are not currently working in order to attend, as the hours can run from about 9:00am-3:00pm.  These programs involve mainly group therapy, along with individual therapy/case management and medication management (if needed).   Individuals attend partial programs for generally about 2 weeks depending on the program, their insurance and ability to self-pay.  The intention is to then step individuals down to an outpatient treatment plan upon discharge from the program.  If an individual is continuing to relapse during or after attending a partial program, than this may indicate that they need a higher level of care such as detox or rehab.  McLean Hospital in Belmont, MA, offers many of levels of care including partial hospitalization.

Intensive case management or community outreach programs:  These types of programs involve a variety of program structures.  However, many bring their services directly to the client and are able to meet them in various locations (i.e., at their apartment, coffee shop, college, etc.).  These programs also range in the level of intensity depending on the clinical needs of the individual and the fee is often determined by the number of weekly clinical contact hours.  The services may include care coordination, sober coaching, vocational counseling, family coaching, etc.

Sober living:  There are many sober living houses around the country, with a large concentration in California and Florida.  Sober living is the lowest level of residential care as they generally do not offer any clinical services in-house- but alcohol/drug testing is standard.  Individuals will often be connected with therapy and medication management outside of the house.  Many sober houses require that those residing there will be engaged in at least 20-25 hours of activities outside of the house per week.   Houses are usually gender specific.  Insurance does not pay for sober living, and there are a range of prices for this type of housing.  An example of a national chain of inexpensive sober houses is Oxford Houses and their website provides directories of the various houses around the country.

Transitional sober living programs:  Individuals are generally expected to stay in this type of program for several months, as this is intended as a bridge from treatment to the real world.  Many of these programs require that the individual has attended a rehab program at some point in the past. Some are connected to residential treatment programs, and offered as a step down option and others are independent programs.  These programs require that individuals will be living at the program, engaging in various forms of treatment such as individual, group therapy and medication management as needed. More comprehensive case management, structure and vocational coaching services are often provided in this level of care than traditional sober living. Additionally, it is expected that they will seek out vocational and/or academic pursuits that they can then continue once they leave the program.  Insurance does not generally pay for this form of treatment.  East Coast Recovery Services– The Strathmore House in Boston, MA is a new transitional sober living program option.

Residential treatment (“rehab”):  All residential treatment programs require that an individual live at the program during treatment, but it is not locked.  There are many types of programs and locations to choose from in terms of this type of care, as well as various price points.  These programs typically involve attending group therapy much of the day, individual therapy sessions, and medication management (if needed).  Some programs offer alternative forms of treatment such as equine therapy, wilderness excursions, acupuncture, yoga, massage, expressive therapy and many others.  Some programs do take insurance, but many are self-pay.  Many rehab programs are 28-30 days minimum in length, and it is crucial that comprehensive aftercare is established in order that the individual continue to receive some form of care upon discharge—rehab is not sufficient to “fix” alcoholism.

Detoxification (“detox”) and Inpatient treatment:  This is the highest level of care and individuals are placed in a locked unit generally in a hospital setting.  Most alcoholics are placed in this type of care in order to be medically monitored while they are detoxifying from alcohol.  They will meet with a therapist/case manager, psychiatrist and may attend minimal groups.  However, this level of care is not intended to be “treatment” for alcoholism, it is the beginning of the process in that it leads to physical sobriety, but true recovery is a longer journey.  Some detox programs are part of a residential rehab program.  Some alcoholics will end up in an inpatient treatment program as a result of suicide attempts while under the influence of alcohol/substances or other safety issues.  Individuals are held in these types of programs until they are physically and psychologically stabilized.  Insurance generally pays for this level of care for alcohol detox and the length of stay is based on the medical necessity and insurance coverage.

January 23, 2016 17,652 Comments

“Fools Rules” for Justifying Drinking

By Sarah Benton, MS, LMHC, LPC

One of the symptoms of an alcohol problem or Alcohol-Use Disorder is when individuals start to make “rules” around their drinking. These rules may offer a false sense of security that their drinking is under control. The origin of many of these “rules” is from the societal stereotypes about alcoholism and the belief that if one does not exhibit the behaviors or image of the “typical alcoholic” then he or she “must not have a problem.” Sadly this stereotype has been a powerful influence on the minimization of alcohol problems in our society.

It is important to define what the “Fool’s Rules” are, so that individuals can be honest with themselves about their relationship to alcohol.

 1. I always drink socially and don’t drink alone.

2. I don’t drink in the morning.
3. I’m drinking by choice, not because I have to.
4. I only binge on the weekends, I don’t drink during the week.
5. I can sometimes control the quantity I drink.
6. I can take breaks from drinking (i.e., 1 week, month(s), etc.)
7. I drink the same amount as my friends.
8. I’m a connoisseur of fine wines, champagne and craft beers.
9. I’m only hurting myself, not my loved ones.
10. I do well at work or academically therefore, I don’t have a problem.
11. I have never blacked out or passed out.
12. I never miss obligations due to my drinking or hangovers.
13. I never drink and drive (but I have to use Uber, cabs, sober friends to get home safely.)
14. I drink for fun and not to “self-medicate.”

Some of these rules are also myths that many believe and use as a way to assure themselves and others that they do not have a problem.  The bad news is that they may create a false sense of security, because those with Alcohol-Use Disorders may not be daily drinkers; they may only drink socially; they may be able to take breaks from drinking; they may only drink expensive liquor and may be successful personally and professionally.

Over time, the belief in these rules can be the justification that individuals use when defending their drinking habits to others.  Individuals “hang on” to the fact that they have some parameters which lead them to believe that their drinking is under control, but often “if you have to control something then it is out of control.”

Additionally, rules may be set and then broken once in a while or regularly, leading to new or adjusted rules.  This is referred to as “drawing lines in the sand” that are crossed and then recreated.  This behavior is a clear sign that an individual has some type of drinking problem and should have an assessment with an addiction specialist.  Creating rules for drinking and breaking and/or changing them can be an important process in determining if we have an alcohol problem.  The NIAAA website is a resource that can support individuals in assessing their drinking patterns, create low-risk drinking goals and assess if they are consistently adhering to them.

For an entertaining and informative discussion about “Fools Rules” and more, please visit my podcast with Liz Jorgensen “Straight Talk from the Sober Chicks” at Insight Counseling available on I-tunes.

January 23, 2016 17,662 Comments

Not Just One Way to Get Sober!

By Sarah Benton, MS, LMHC, LPC

There are many views and opinions about what is needed for alcoholics to maintain long-term sobriety/recovery.  There are therapeutic coping skills, the medical model, evidence-based research, 12-Step model, SMART Recovery, Celebrate Recovery, alternative treatments, wilderness therapies, spiritual/religious practices and more… The good news is that there are many resources and ways for individuals to receive support and to get sober.  The downside is that individuals may become overwhelmed by options.  Each of these recovery models can be applied on a continuum—ranging from moderate to strict to fundamentalist.

In my personal and professional experience, I have observed clients and loved ones acquire sustained recovery in differing ways.  It has also been interesting to see how they have found ways to apply different recovery principles and coping skills to suit their beliefs, personality and lifestyle.  For some, an extreme and strict framework has been needed and for others, a moderate approach has been more appropriate.

Throughout the treatment, therapeutic and recovery process individuals learn many coping and relapse prevention strategies as well as life skills and spiritual principles intended to improve their prognosis and quality of “sober” life.  I have often compared this process to a buffet, where an individual views all of the options, samples some things they may or may not like and then settles on what they prefer. In other words, “take what you like and leave the rest.”

 In fact, the most effective way to maintain sobriety is to engage in strategies that are realistic and that an individual is likely to engage in long-term.  As therapists, we can make suggestions, but it is important to view each individual as unique and to know that they will have their own journey that will allow them to experience what they may or may not need to change along the way.  When treatment centers, addiction professionals, recovery coaches or spiritual leaders are only open to one way to view or to engage in the recovery process, it is important for individuals to be honest themselves about if that view is the right “fit” and if it is resulting in sustained recovery.  If not, then there is always the option of integrating various pieces of that approach with additional strategies.

For example, George begins individual therapy with an addiction specialist and has been sober for 1 month.  He expressed that he wants to learn different coping and relapse prevention skills and has decided to attend both Alcoholics Anonymous (A.A) and SMART Recovery meetings in addition to therapy and other self-care strategies (exercise, meditation, etc.).  The therapist recommends that the client should only attend A.A. and not SMART Recovery and that he should just follow the suggestions of the 12-Step program and then he would not need these other parts to his recovery plan.

The problem: This addiction specialist seems to have experience with the 12-Step/A.A. model, but does not appear to be open-minded to other recovery strategies and models.  It is possible to integrate differing recovery models and to find a plan that will work for individuals that suits their unique needs.  There also may be parts of some self-help programs such as A.A. and SMART Recovery that may work in combination for some individuals.  The strict version of either model may not be the best for all, and “fundamentalist” views on sobriety may turn some individuals away from ceratin approaches. Either way, if the therapist observes that an individual is having relapse issues, then the recovery plan and level of care should be revisited.

It can also be the tendency of those in early recovery to engage in “extreme” behaviors and struggle to find balance in their lives.  Therefore, it is even more important that these individuals strive towards an approach that will allow for consistency—recovery is a marathon and not a sprint!

For a fun and informative discussion about this topic and more, please visit my I-Tunes podcast with Liz Jorgensen “Straight Talk from the Sober Chicks” at Insight Counseling


January 23, 2016 17,613 Comments