Published post on Psychology Today.com by Sarah Benton
There is an overwhelming amount of information on the internet about addiction treatment. Many people email me and 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. In doing a “Google search” for the terms ‘addiction treatment levels of care’ I was unable to find a Website that explained this information. Therefore, I wanted to briefly describe the various types of addiction treatment based on levels of care, starting from the most intensive and ending with the least intensive.
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 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 and the length of stay is based on the medical necessity and insurance coverage.
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 30 days 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.
Transitional 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. There seem to be fewer of these types of programs. 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 and group therapy. 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.
Sober living: There are many sober living houses around the country, with a large number located in California and Florida. Sober living is the lowest level of residential care in terms and generally no clinical services are provided within those houses- 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 www.oxfordhouse.org.
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.
Intensive outpatient programs (IOP): An IOP is a program that is also generally run out of a clinic or hospital and generally is about 3-4 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 involve mainly group therapy, along with individual therapy/case management and medication management as well. These programs can run 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.
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 (ie, 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 individual therapy and case management, medication management, vocational counseling, family meetings, etc.
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 take insurance. 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 (ie, A.A., SMART 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. I presently conduct indivirdual, family and group outpatient services at Insight Counseling in Ridgefield, CT www.insightcounselingllc.com
Often, insurance companies will not cover treatment for individuals requesting a higher level of care, such as residential , without the individual had 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 ER and many addiction programs require that an individual is “medically cleared” by an ER before they admit that person for further treatment. ER’s can sometimes be helpful in finding an available detox bed for the individual as well. Additionally, contacting your Primary Care Physician (PCP) for addiction referral suggestions can be a great place to start. I am fortunate to work at McLean Hospital in Belmont, MA, as they offer a many of levels of care mentioned above as well as both insurance based and self-pay programs which are all listed in a pdf grid available at: http://www.mclean.harvard.edu/patient/adult/adatp.php