Addiction Treatment – Steps of Treatment and Recovery

When an individual is dealing with and struggling with an addiction to drugs and/or alcohol, the prospect of finding sobriety and long-term recovery may seem impossible.  Addiction is both a chronic and progressive disease in which an individual’s physical, psychological and spiritual well-being is comprised by the abuse of substances.  Once vibrant, happy and productive people slowly over time become consumed with the procurement and use of drugs and/or alcohol and their daily activities revolve around using substances and being around others who use.

Despite the debilitating nature of addiction, recovery is possible.  However, the prospect of knowing where to find help and what steps that need to be taken can be a daunting experience.  It may happen that the individual and their family may be exploring these options for the first time.  It may also be true that an individual has attempted to get sober only to relapse and fall back into old, familiar and dangerous patterns.

The important take-away message is that despite the pitfalls and setbacks that may occur, the individual who is addicted to drugs and/or alcohol should not give up.

In order to fully understand the process of addiction recovery, one needs to both understand what the steps in addiction care and recovery are as well as the underlying goals of each step.  It is important to note that the journey to sobriety and recovery is different for each addict and what may work for them may not work in the same ways for others.

Drug and Alcohol Intervention

drug and alcohol interventionAs stated at the beginning of this chapter, there are formidable challenge in finding help for oneself or a loved one who is struggling with substance abuse.  There can be times where a direct and heart-to-heart conversation can spark the addict to start their own path to recovery.  In the case of drug and/or alcohol addiction, a focused approach to this candid conversation is often needed in order to achieve the best possible outcomes.  This focused approach is called an intervention.

An intervention is a carefully choreographed process that involves family, friends and others who are concerned about the welfare of the struggling addict.  People who struggle with addiction oftentimes are in denial regarding their situation and are often unwilling or unable to seek help or treatment on their own volition.  Additionally, the addict is not aware of the negative consequences their behavior has on themselves and others.  In the intervention process, these people will come together to confront the addict about the consequences of their addiction and ultimately ask them to accept treatment.

The intervention serves three purposes:

  1. Provides specific examples of destructive behaviors and their impact on the addicted person and their loved ones.
  2. Offers a pre-arranged treatment plan with clearly demarcated steps, goals and guidelines.
  3. Spells out what each person will do if a loved one refuses the offer of treatment.

What are the Steps of an Intervention?

While there can be differences in philosophies and means of presentation, interventions usually involve the following steps:

  1. A family member or friend proposes an intervention and forms a planning group. It’s best there is consultation with an intervention professional (interventionist), a qualified professional counselor or a social worker when planning an intervention. An intervention is a highly charged situation and has the potential to cause anger, resentment or a sense of betrayal. If there are concerns that the intervention may trigger anger or violent behavior, consult an intervention professional before taking any action.
  2. Gathering information – The group members find out about the extent of the loved one’s problem and research the condition and treatment programs. The group may make arrangements to enroll the loved one in a specific treatment program.
  3. Forming the intervention team – The planning group forms a team that will personally participate in the intervention. Team members set a date and location and work together to present a consistent, rehearsed message and a structured treatment plan. Do not let your loved one know what you are doing until the day of the intervention.
  4. Deciding on specific consequences – If your loved one doesn’t accept treatment, each person on the team needs to decide what action he or she will take. Examples include asking your loved one to move out or taking away contact with children.
  5. Writing down what to say – Each member of the intervention team should detail specific incidents where the addiction has resulted in problems, such as emotional or financial issues. The goal here is to present these specific situations in a way that is firm but expressing both care and concern.
  6. The intervention meeting – Without revealing the reason, the loved one is asked to the intervention site. Members of the core team then take turns expressing their concerns and feelings. The loved one is presented with a treatment option and asked to accept that option on the spot. Each team member will say what specific changes they will make if the addicted person doesn’t accept the plan.
  7. Follow-up.Involving a spouse, family members or others is critical in helping someone with an addiction stay in treatment and avoid relapsing. This can include changing patterns of everyday living to make it easier to avoid destructive behavior, offering to participate in counseling with your loved one, seeking your own therapist and recovery support, and knowing what to do if relapse occurs.

It is important to note that the intervention must be planned carefully and meticulously.  Those interventions that are poorly planned have the potential to make the situation worse.  It is highly advisable that professional help (through an interventionist, psychologist or mental health professional) is sought out.  This is especially true if the loved one has a history of serious mental illness, a history of violence, under the influence of substances or have displayed suicidal thoughts.

Drug and Alcohol Detoxification

drug and alcohol detoxificationA crucial early step in the recovery process to consider is the detoxification process.  The detoxification process can be generally defined as a set of interventions whose purpose is the management of both acute intoxication and the withdrawal symptoms that can be experienced by addicts.  Detoxification allows the clearing from the body the toxins that have accumulated during the addict’s period of substance use and abuse.

Ideally, this process should be undertaken medically and its’ purpose is not to resolve the long standing and underlying psychological, social and behavioral problems associated with addiction and abuse.  There are three objectives of detoxification and they are the following:

  1. Evaluation – evaluation entails the testing of the bloodstream for substances that are being abused, measuring their concentration as well as screening for any co-occurring mental and physical conditions that may be the underlying factors for an individual’s substance abuse. Additionally, there is a comprehensive evaluation of both a patient’s medical and psychological conditions as well as the social situations.  From these assessments the foundation for an initial substance abuse plan is created.
  2. Stabilization – stabilization includes both the medical and psychological processes of assisting the addict through the acute intoxication and withdrawal to a state where the addict is in a substance-free state. Also included in the stabilization phase is the familiarization of the treatment process and what their role is in that process.  It is also during this phase that family, friends, employers and others in the addict’s support system can become involved.
  3. Entry into Treatment – this third phase involved preparing the addict for entry into a substance abuse treatment program. It is stressed to the addict the importance of follow-through regarding the entire continuum of substance abuse treatment and care.  For those who may have completed detoxification in the past but have not followed through with treatment, a written treatment contract may be written up where the patient agrees to participate in a care plan.

Options and Levels of Detoxification Care

There are several options that are available regarding the types of detoxification services that a recovering addict can pursue.

  1. Medically Monitored Inpatient Detoxification – provides around the clock supervision, observation and support. This level of care is more restrictive and the underlying foundation of this option is ensuring the patient is medically stable as well as stable psychologically and socially.  Physicians are available 24 hours a day by telephone and there are licensed and accredited staff that oversee each patient and closely monitors their progress
  2. Clinically Managed Residential Detoxification – these types of settings vary in levels of care with some adopting the medically monitored model while others may have minimal medical oversight. With these minimal oversights, there should be clear procedures in place regarding the implementation and pursuing the appropriate medical referrals.  However, there is 24-hour supervision, observation and support for those experiencing withdrawal or experiencing intoxication.
  3. Intensive Outpatient or Partial Hospitalization Programs – these programs may be appropriate for those who are experiencing moderate to mild withdrawal symptoms. Many of these programs are tied to or linked to hospitals.  These types of programs can provide “triage” type services to higher levels of care if needed.

Substance Abuse Treatment

substance abuse treatmentSubstance abuse treatment can be seen as an intervention which is intended to help those who are struggling with substance abuse issues stop those compulsive behaviors that are associated with such use.

In regards to substance abuse treatment, there are many different types of options that can take place in a variety of settings and involves a myriad of therapeutic and clinical protocols.  Because of the complex nature of addiction itself short-term “one time only” approaches usually will not work.  Treatment for substance abuse addiction is a longer-term process that involves lifestyle change and ongoing monitoring.

The following, which will be outlined in greater detail, is what can be expected when an individual enters substance abuse treatment at an inpatient facility.  Ideally, the best outcomes regarding long-term sobriety and recovery are achievable when individuals undergo intensive drug treatment at a facility where they will reside for a considerable period of time.  The length of stay that is suggested and is used as a rule of thumb is 90 days; however, that time frame can be shortened or lengthened depending on a number of factors including insurance concerns, how an individual is responding to treatment, and the history of an individual’s drug abuse and recovery attempts among others.

Inpatient drug treatment begins with a comprehensive clinical assessment of an individual’s specific treatment needs.  This assessment is an essential foundation of the development of an effective treatment plan that will be tailored to the needs of the individual.

Once assessment has been completed, many inpatient treatment facilities have medical facilities onsite or in close proximity (such as hospitals or clinics) where immediate medical needs can be addressed.  Some of these needs can include medical detoxification as well as screening and treatment for other medical disorders and conditions such as hepatitis and HIV/AIDS among others.  It is important to screen for and treat other medical disorders, especially if these disorders have the potential to significantly impact the health and well-being of the patient, others in treatment as well as staff.

In the initial phases of treatment, the main focus is centered on motivating the addicted individual to stop using drugs and/or alcohol.  This is accomplished through counseling and therapy sessions in both group and one-on-one settings.  The goals of these sessions are the following:

  • Help the individual see the problems caused by substance abuse and find the motivation to change
  • Change his or her behavior
  • Repair relationships with both family and friends
  • Build new relationships with people who don’t use drugs and/or alcohol
  • Help the individual create a lifestyle based on recovery

Along with group and individual counseling, there may also be behavioral therapy treatments that can further help the newly recovering individual modify attitudes and help change their mindset from one of addiction to a mindset of sobriety and recovery.  Some examples of these behavioral therapies can include the following:

  1. Cognitive-behavioral therapy—cognitive-behavioral therapy (CBT) is a form of treatment that focuses on examining the relationships between thoughts, feelings and behaviors. By exploring patterns of thinking that lead to self-destructive actions and the beliefs that direct these thoughts, people with substance abuse issues can modify their patterns of thinking to improve coping. In this type of therapy the therapist and the patient actively work together to help the patient recovery.
  2. Family Therapy– Family therapy in substance abuse treatment has two main purposes. First, it seeks to use the family’s strengths and resources to help find or develop ways to live without substances of abuse. Second, it helps lessen the impact of chemical dependency on both the individual as well as the family.
  3. Motivational Interviewing—motivational interviewing in the scope of substance abuse treatment is both collaborative between patient and therapist and centered on the individual. The purpose of this therapy is to elicit and strengthen motivation for change. It is an empathic, supportive counseling style that supports the conditions for change. Practitioners are careful to avoid arguments and confrontation, which tend to increase a person’s defensiveness and resistance.
  4. Contingency Management—also known as motivational incentives, this therapeutic technique gives positive reinforcement to motivate individuals to move away from behaviors and attitudes centered on substance use and abuse. This is accomplished through the implementation of tangible rewards.

Another significant focus of inpatient drug treatment is the acquisition of the necessary life skills that are needed to function as a recovering person once treatment has been completed.  This life skills training can include the following:

  • Learning and practicing of employment skills (resume writing, interviewing skills, etc.)
  • Acquiring of hobbies and leisure activities that give the recovering person healthy outlets
  • The formation of healthy and proactive social and communication skills
  • Anger and stress management
  • Money and time management

As an individual is entering the later stages of inpatient treatment and starting to transition to the appropriate aftercare options, the focus while in inpatient treatment shifts to relapse prevention training.  Relapse prevention training is designed to help people identify those stimuli (triggers) in their day-to-day environments that have the potential for relapse.  Along with the identification of those triggers, those in treatment will also learn how to deal with cravings in addition to how to handle stressful situations and what to do if there is a relapse.

While undergoing inpatient treatment, individuals are also oriented towards self-help groups such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA) and Cocaine Anonymous (CA) among others.  There are other treatment groups that may be available to individuals such as SMART recovery.

The main focus on familiarizing those early in recovery with these self-help groups is to help individuals understand the importance of peer support.  Having the support of those who are on a similar journey and finding empowerment within these groups is essential to long-term recovery outcomes once formal treatment has been completed.

Additionally, inpatient drug treatment places emphasis on the treatment of any co-occurring mental disorders that could be at the root of an individual’s substance abuse.  Many people that have substance abuse issues suffer from depression, anxiety, or post-traumatic stress disorder (PTSD).  Adolescents who may be in treatment have behavior problems such as conduct disorders or attention deficit and hyperactivity disorders.  Treating both the substance abuse and the underlying mental disorder can greatly improve the odds of long-term recovery.

Ultimately, there are many different settings where more formal treatment can take place.  In addition to intensive inpatient treatment as described above, there may be other options that may be available for individuals seeking treatment.  Some of those options may include the following:

  1. Residential treatment programs – similar to intensive inpatient but with the added element of the upkeep and maintenance of the facilities by the patients themselves. The typical length of stay is usually 7 to 30 days.
  2. Halfway Houses – has around the clock monitoring by nonmedical staff or those who have sustained recovery. In these programs, patients usually are working outside the facility and participate in counseling and therapy in the evening.
  3. Day Treatment – day treatment, which can also include partial hospitalization programs, use a combination of both medical and non-medical staff to deliver a high concentration of counseling services during the daytime and allowing patients to return home in the evenings.
  4. Intensive Outpatient – usually done in a clinical setting, patients receive approximately 6 to 9 hours of counseling services weekly.  In comparison, traditional outpatient services delivered typically by counselors in a clinical setting and provide fewer hours of service.

Aftercare Programs and Maintaining Long Lifelong Recovery

aftercare and long term recoveryOnce formal treatment programs have been completed, the transition to independent living can be marked by difficulties in adjusting to the normal routines and stresses in day-to-day living.  Aftercare programs give the newly recovered addict opportunities to adjust to these new changes and therefore ease their transition back into their normal lives and routines with the empowerment and support they need.

There are several options that individuals can pursue in regards to aftercare programs following treatment.  The type of aftercare that will work best depends on the individual.  Some common aftercare options that are available include the following:

Counseling– The primary goal of counseling in an aftercare program is to help patients identify the reasons for their addictions. This is typically done in a group setting, where patients can share common experiences during the counseling sessions. Group therapy also reduces the cost of counseling, although individual sessions may be required when patients have unusual psychological issues related to their drug addictions. The majority of drug counseling sessions take place on a regular schedule. Counseling in an aftercare program typically begins with a high frequency of counseling sessions, often on a daily basis. The frequency of these sessions will typically decrease over time as the patient progresses in their recovery. Some programs provide drop-in counseling when the patient feels the need for counseling but can’t until the next scheduled session. Emergency counseling, otherwise known as crisis counseling, may also be required when the patient is at a particular risk of relapse.

Relapse Prevention—the use of counseling and therapy surrounding relapse prevention can be seen as a continuation of what was started initially in drug treatment.  Usually, relapse prevention counseling is based in cognitive-behavioral therapy and centers on four types of psychological and social processes.  They include attributions for causality, decision making processes, outcome expectancy, and self-efficacy.

Attributions of causality are defined as beliefs that a relapse is due to internal causes. They may include the belief that exceptions to sobriety are permissible circumstances that an individual considers to be unusual. A decision-making process consists of the multiple individual decisions that result in the intake of drugs.  Self-efficacy is the patient’s ability to deal effectively with situations that carry a high risk of relapse. Outcome expectancies are the patient’s expectations regarding an addictive substance’s psychoactive effects.

Sober Living Environments– Sober living houses are another tool for those new in recovery to actively utilize the life skills that were learned while in intensive inpatient treatment as they transition back into society.  Sober living houses are alcohol and drug free environments for those individuals who completed treatment and are looking to continue on the path of recovery and abstinence.  Those who live in sober living houses generally can stay as long as they wish and the residences themselves are sustained through resident fees.  Sober living situations can be seen as the final transition point between inpatient care and fully integrating back into normal life.

Sober living homes are alcohol and drug-free environments for those who have completed intensive inpatient treatment and are transitioning back into their normal lives and day-to-day routines.  While most sober-living houses are privately owned and will bill directly for services, though some do accept insurance payments or even Medicaid.  Sober living environments bring together people that are in various stages of recovery.

Sober living is structured to be a supplement to the total recovery process.  The environment has less supervision when compared to inpatient treatment, but those who staff these living facilities are those who have significant recovery time and may be employed by the health care facility or private organization that runs them.  The people that live in these sober living environments, as stated earlier, are in various stages of recovery and by design there is more consistent peer interaction and support which can help everyone’s recovery and all who reside in these types of facilities are held accountable.

Residents are also encouraged to avoid friends and family that may encourage them to use alcohol and drugs, particularly individuals with whom they have used drugs and/or in the past. Residents are usually required or strongly encouraged to attend meetings and actively work a 12-step recovery program.

Those who enter into a sober living home are expected to be proactive in working their recovery program.  While sober living homes do allow the recovering addict the space they need to start formulating their new sober lifestyles, this type of living situation is not for individuals who sit idly and “wait out their time”.  With peer encouragement and support, those who live in sober living houses are able to do the following:

  • Organize a job search: Looking for employment will be easier for a person in recovery knowing that a support system is in place. There is scheduled time during the day for individuals to search for employment, including interviews and pre-employment drug screenings.
  • Adjust to sobriety: While housed in a residential inpatient program, a patient often has very few liberties. On the other hand, if an individual is back at home, the prospect of making responsible decisions can be difficult for them to handle. A sober house program will have rules to follow, but these rules always have an emphasis on the eventual transition back to independence.
  • Arrange housing: Many residents come to their sober-living communities without any other homes to speak of. Time spent in a halfway house can be put to an apartment search with lots of feedback from other residents and the staff regarding what to look out for.
  • Mend fences: An important step in the recovery process is to make amends to those who have been affected by the addict’s actions. The support one finds in the community of fellow addicts in a sober living house will help guide the resident through the process of rebuilding relationships.