What Are the Treatment Options Available to Somebody Who Wants to Stop Drinking and
Drugging?
Dear Dr Steve:My husband
has finally agreed to address what I believe is the problem he has with drinking. Although
we disagree about what the severity of his problem is, we both agree that the time has
come to address the problem. Since it has taken us years just to get to the point of
agreeing that his drinking is a problem, I want to make sure that what we do next will be
the best decision that we can make. I’m not sure what my husband’s options are
as far as how to best treat his drinking problem. Does he need treatment? If he does need
treatment, what kind is the best kind of treatment for a person like him? How can we
figure out all the variables that go into making such a decision?
You and
your husband are to be congratulated! Making the ultimate decision to address whatever
issues your husband may have in regards to drinking alcohol is something that occurs over
time. I would imagine that you both have experienced much pain, hurt, anger, betrayal,
helplessness, and despair as you ultimately arrived at the decision that you’ve made.
You are to be congratulated for sticking things out to the point where the two of you are
still working together to address this problem. Let me explain to you the continuum of
care that exists for the standard treatment of alcohol abuse and alcohol
dependence. This is intended to inform you but you should by no means make a decision
without first consulting a qualified health care provider.
Determining
the best match for one's treatment needs should be based on a comprehensive assessment and
evaluation. The extent and duration of alcohol and other drugs abuse/dependency will have
a bearing on what treatment approach or modality is best suited to provide for your
husbands needs. It is not an undertaking that you or your husband should do alone.
Treatment may include any one single option that I list or a combination of the different
treatment options that I list. Let me repeat what I just said, in order to best decide
which treatment option(s) are best for your husband, you should consult a qualified
healthcare provider.
Inpatient
or Residential Treatment
Who
Inpatient or Residential Treatment is For
Inpatient or residential treatment is usually recommended for people who require 1.)
Intensive support for emotional, psychological, and/or physical stabilization, 2.)
Intensive supervision for medical detoxification, 3.) Intensive treatment for co-existing
medical disorders, 4.) A structured environment to insulate the program participant from
environmental and circumstantial stressors, 5.) Intensive psychological interventions to
both stabilize the program participant and support the program participant’s efforts
to fully participate in the treatment program’s educational, psychological, and
12-Step interventions, 6.) Intensive educational, psychological, and 12-Step interventions
over a long period of time for those people whose earlier attempts to achieve and maintain
abstinence have concluded in repeated relapse.
Services
Provided by Inpatient or Residential Treatment
Inpatient
or residential treatment programs provide a safe, structured, supportive environment in
which treatment is provided twenty-four hours a day. Typical services provided by
residential treatment programs are: 1.) Medical supervision of detoxification, 2.) Medical
treatment and oversight of any co-existing medical problems, 3.) Intensive involvement in
the 12-Step community, 4.) Individual and group therapy, 5.) Educational seminar on such
topics as stress management, proper nutrition, relapse prevention awareness, grief, anger
management, and conflict-resolution, 6.) Family and couples counseling, 7.) Recreational
therapy, 8.) Discharge planning, and 9.) Case-management to ensure that any health, legal,
or other social service needs are addressed.
Benefits
of a Residential or Inpatient Treatment Program
1.) The
program participant is taken out of there environment and insulated from the day to day
stressors associated with their environment.
2.) The
program participant is able to be insulated from any and all distractions so that they can
remain focused on their sobriety.
3.)
Having been removed from their environment as well as surrounded by staff members and
other program participants, participation in a residential treatment program makes it more
difficult to act impulsively and use drugs or drink.
4.) The
program participant has access to supportive people 24 hours a day, something which could
be critical in the early most vulnerable days of sobriety.
5.) The
program participant may have access to post-treatment resources of the treatment program.
Outpatient
Treatment
Who
Outpatient Treatment is For
Outpatient treatment is usually recommended for:
1.) Individuals who do not require intensive emotional, psychological, and/or medical
stabilization.
2.)
Individuals who do not require intensive medical oversight.
3.)
Individuals who do not require being removed from their environment in order to insulate
the program participant from environmental and circumstantial stressors.
4.)
Individuals who have not chronically relapsed after previous treatments and/or attempts at
sobriety through other programs.
5.) Individuals who do not require intensive round the clock emotional and psychological
support.
6.)
Individuals who are employed or have the ability to be employed.
7.)
Individuals who cannot afford to have their life interrupted by long-term hospitalization.
8.)
Individuals who have an intact support system that the program participant has access to
during the early vulnerable days of early sobriety.
9.)
Individuals who have limited financial resources or limitations on their insurance
coverage.
Outpatient
treatment can be used as a:
1.)
Transition from inpatient or residential treatment back into the program
participant’s community.
2.)
Starting point for treatment after medical detoxification either on an inpatient or
outpatient basis.
3.)
Starting point for treatment.
There are
three basic types of outpatient, drug-free programs. Traditional outpatient that is
typically 9 –14 hours of services per week that may last from 3–6 weeks. Intensive
outpatient typically provides services from nine to 20 hours a week for 2-4 weeks. Partial
hospitalization typically provides more than 20 hours per week for 2 weeks.
Services
Provided by Outpatient Treatment Programs
The
services provide by outpatient programs are similar to those provided by inpatient and
residential treatment programs. The main difference would be less focus paid to medical
detoxification and treatment for co-existing medical conditions as well as no around the
clock availability of emotional support by staff and peers. Otherwise outpatient program
services include: 1.) individual and group therapy, 2.) intensive involvement in the
12-Step community, 3.) educational seminar on such topics as stress management, proper
nutrition, relapse prevention awareness, grief, anger management, and conflict-resolution,
4.) family and couples counseling, 5.) recreational therapy, 6.) discharge planning, and
case-management to ensure that any health, legal, or other social service needs are
addressed.
Benefits
of Outpatient Treatment
1.) The
program participant is able to remain in their community and therefore minimize the
disruption to their day to day life.
2.) The
program participant is able to start their 12-Step work in the community in which they
will be returning once treatment ends.
3.) The
program participant can receive the support of other program participants.
4.) The
program participant has access to professional help to supplement their ongoing sobriety
work in their community.
5.) The
program participant has access to post-treatment resources of the treatment program.
6.) The
expense of outpatient treatment is less than the expense of inpatient.
Halfway
Houses
Halfway
houses vary in terms of their structure, services provided, and rules to be followed for
living there. Halfway houses are environments that are free of all mood-altering
substances. Halfway houses are often times used as a transitional place to live after
completing an inpatient or residential treatment program. Some individuals live in a
halfway house while being enrolled in an outpatient program. Some individuals live in a
halfway while solely attending self-help meetings. Still others require long term living
arrangements in an environment such as a halfway house whose total focus is sobriety and
sober living.
Methadone
Maintenance and
other Drug Replacement Strategies
Some treatment
programs rely on drug-replacement interventions to treat opiate dependence rather than
abstinence-focused interventions. In these programs, hoped for treatment outcomes may be:
1.) reduced drug and alcohol use rather than strict abstinence, 2.) reduced criminal
behavior, 3.) reduced drug-using related health problems, and 4.) improved interpersonal
and psychological functioning. Medications such as methadone, LAAM, naltrexone, or
buprenorphine are used by these programs. Services such as individual counseling,
vocational counseling, housing assistance, case management, etc. can be offered as a means
to improve the individual's quality of life.
Some
programs provide pharmacological treatment to augment other treatment protocols that use
abstinence as the goal of treatment. Other times, medications are used as an intervention
to either develop an aversion to the abused drug (antabuse, for example is used to create
an aversion to alcohol) or to diminish drug cravings.
Therapy/Counseling
Therapy
provided by a qualified addiction counselor is a treatment option.
People who use individual therapy as a treatment modality may have first tried quitting by
themselves and not succeeded.
People
who use individual therapy as a treatment modality may have first tried quitting on their
own and/or tried self-help meetings such as A.A. and not succeeded.
People
who use individual therapy as a treatment modality may have first completed one of the
treatment(s) listed above and are using individual therapy as an after-care treatment.
Many
addicts have found therapy beneficial following the help they received in a formal
treatment program. Relapse prevention, continued education about the 12-Steps, learning
how to live life clean and sober, exploration of feelings, and examining circumstances and
behaviors that are set-ups for relapse are the focus of the early phases of individual
therapy.
12-Step
Self-Help Programs
For some
individuals, solely attending self-help groups is an effective way to manage the disease
of alcoholism and drug addiction. At the same time, traditional treatment programs use
self-help groups as part of their treatment protocols. The 12-Step programs are the most
utilized self-help programs, with meetings available around the world daily.
Learn
how to prevent and recover from chemical dependency as well as the aftereffects of
chemical dependency on you and your family. Read Dr. Frisch’s, Psy.D. series of
Recovery books—From
Insanity to Serenity.
Pathfinder’s Checklist
1.) There is a continuum of care by which an individual can be treated for alcoholism and
drug addiction.
2.) Consult a qualified health care provider to be help you assess and evaluate the
appropriate treatment for you or your family member.
3.) Learn more about alcoholism and drug addiction.
4.) Learn more about Recovery and the resources available to you in your community.
G.B.U.
Steve
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