You know you or a loved one needs help with their use of alcohol or drugs—but what form should that help take?
In the movies, substance use treatment is often depicted as someone being driven away to a distant rehab facility or going to a meeting in a church basement. While those options exist, they’re not the only ones out there. There are a variety of ways to get treatment for a substance use disorder, and it’s important to find the one that is right for you or your loved one.
We talked to Dan Velez, MSW, a licensed clinical social worker and clinical supervisor at UNC Substance Treatment and Recovery (STAR), an outpatient program, about some of the questions to consider about treatment programs.
1. Should I choose inpatient or outpatient treatment?
Substance use treatment can be outpatient, meaning you go in to a clinic or facility for treatment but go home at night, or inpatient, where you stay overnight.
If you need medical assistance stopping drugs that typically starts with detox, which is when doctors and nurses help you stop using substances and monitor your health during withdrawal.
Some programs offer a combination of these options, so you start with detox and then move directly into inpatient treatment.
“The search will be different for someone who is ill from substance use or withdrawing from the substance than someone who is relatively stable in their physical health,” Velez says, noting that detox isn’t always necessary. “Many people stop using on their own but don’t stay stopped and need help to sustain the change.”
With inpatient care, you’ll live at a facility for a set number of days, typically in 30-day increments.
“Some folks really need to get out of their environment and restrict access to certain friends, family members, the internet,” Velez says.
Inpatient programs, sometimes known as “rehab,” have different expectations and restrictions. In past decades, it was common for these programs to cut off all contact with the outside world, Velez says. Now you’re more likely to find options that allow some access to computers and phones.
Outpatient treatment can vary in how much of the day you spend in therapy. With a partial hospitalization program, or day treatment, you typically spend the entire day at a facility, usually five days per week, though you sleep at home—think of it like a full-time job.
An intensive outpatient program might be more like a part-time job, requiring several hours per day, several days per week in treatment. There are also outpatient programs that provide routine, structured care for a designated period of time, which can include weekly therapy appointments and support group meetings. These two options may allow you a little more flexibility to work or attend school part-time.
Talking to someone from these programs can help you determine the right fit for your situation.
“We complete a robust assessment to see if someone meets the criteria for our level of care and would be a good fit for what we offer,” Velez says. “We’d recommend a higher level of care if that’s what someone needs.”
As you might imagine, the costs for such different programs vary widely. Some programs take insurance.
“In a perfect world, this wouldn’t have to be a financial decision, but it’s important to ask about all costs,” Velez says.
2. What will treatment be like?
Every facility will have its own approach to care, so it’s important to ask what a typical day or week looks like and how long treatment is expected to last.
Whether you’re inpatient or outpatient, expect a mix of individual therapy and group sessions.
It’s important to ask what kind of therapies and sessions the program offers. Cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), acceptance and commitment therapy (ACT), and eye moment desensitization and reprocessing therapy (EMDR) are used in treatment programs because they are evidence-based, meaning there is research showing they are effective at helping people meet their goals.
One-on-one counseling with a professional can help you address your specific concerns and feelings about substance use and identify steps to get better.
Group sessions might be educational, so that you learn more about addiction and recovery, or focused on building skills related to managing stress or understanding triggers for a relapse. In a treatment program, they are led by a professional therapist, as opposed to community groups, which provide peer support and accountability but may not have a trained facilitator.
Programs may have specialties that fit your specific needs, such as a trauma-informed approach, facilitating care for another mental health disorder, medication-assisted treatment for addiction or working with teenagers. Inpatient programs sometimes offer opportunities for fitness or recreation.
No matter the type, you’ll want to ask if the program you’re checking out uses the “12 steps,” an approach first introduced by Alcoholics Anonymous. That method includes a spiritual focus which may not be appropriate for everyone.
3. What are my goals and needs for treatment?
Treatment for substance use isn’t one-size-fits-all: You need to consider whether a facility’s approach will support your specific situation.
“At our program, no two treatment plans look alike,” Velez says. “Modern treatment needs to be person-centered, and the goals of one person vary significantly despite being in the same program.”
It might seem that the only goal would be learning to abstain from alcohol or drug use, and while it is a requirement for some programs, Velez says there is nuance at others.
“Total abstinence is a common goal, and we can create a plan that might include drug screens, building motivation and working on a relapse prevention plan,” he says. “We can also support goals related to moderation or harm reduction, and that way we can reach more people who need treatment.”
Velez says it’s common for a family member to be confused or worried when a program acknowledges that a person might use a substance again or teaches ways to use substances more safely.
“Abstinence can work in the short-term, so that people don’t use while they’re in treatment, but once they’re done with the program, they might return to use,” he says. “It can be more effective to provide education on relapse or harm reduction as part of the treatment. It’s not giving permission to relapse, but preparing for the possibility and learning how to return from that.”
Other goals may relate to the feelings or conditions that drive the substance use.
“Some people may have goals related to depression or panic attacks, so that might involve creating a plan that incorporates education about anxiety, mindfulness therapies or opportunities to build coping skills,” Velez says.
You might have goals related to your ability to show up for your family, succeed in your work or find activities that can take the place of substance use.
No matter which kind of treatment for substance use you choose, one thing is the same: The work you do has to be a focus, even if you’re trying to balance it with other responsibilities.
“It’s absolutely a commitment, and people shouldn’t take lightly how hard it is to make this change,” Velez says. “If the treatment is not a priority, all other aspects of life will eventually suffer.”
If you have questions or concerns about alcohol or substance use, talk to your doctor. Need a doctor? Find one near you.