Addictions: Alcohol and Substance Abuse
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Levels of Care Available

Mark Dombeck, Ph.D.

Usually, care for a drug or alcohhol dependence problem begins with a short, more intensive professional intervention, and then continues indefinitely with a less intensive professional intervention. Participation in peer self-help support groups is helpful (if not necessary) throughout this process.

Hospital Care

While detoxification and preliminary psychiatric medication provision is sometimes done in a hospital setting, little actual therapy gets done in an inpatient setting. Patients are almost always discharged as soon as possible, and sent out to participate in one or more forms of psychosocial therapy, peer-support groups and the like.

Substance Abuse Rehabilitation Programs

Rehabilitation ("Rehab") programs are the second most intensive sort of drug and alcohol dependence care, next to hospitalization. The typical 'Minnesota- model' rehab program lasts for several weeks to one month, and plays out in the context of an inpatient environment (the patient lives at the rehab clinic for the period of treatment). Patients detoxify for the first few days of their rehab experience. Thereafter, they spend their days participating in a combination of individual and group psychotherapy, twelve step meeting participation, and recreational and occupational therapy. Rehab is most useful at the beginning of a treatment cycle as an intensive and immersive way to interrupt the drug or alcohol dependent patient's substance abusing lifestyle. Good rehab programs will help a patient plan for aftercare in the form of intensive outpatient programs, continuing psychotherapy and twelve step attendance.

Partial Hospitalization/Intensive Outpatient Programs)

Partial Hospitalization Programs (PHP) and Intensive Outpatient Programs (IOP) are programs where patients come to a hospital or outpatient clinic setting for several hours (IOP) or a full day (PHP) and participate in a range of psychosocial interventions that commonly include psychotherapy in supportive, coping-skills/relapse prevention, and social skills/interpersonal/growth group formats, consultation with a psychiatrist for medication management, and twice-weekly drug screening. Social work consultations and case management (where a social worker will act as an advocate for patients, hooking them up with social services in the community) may also be present, particularly in a partial hospital settings.

IOP programs are a good transitional step for patients leaving rehab, helping them to make a more managed transition to assuming responsibility for their own sobriety than simply dropping them into once weekly psychotherapy would allow. Despite the fact that PHP and IOP programs are extremely helpful to recovering addicts, particularly in the early stages of recovery, they are increasingly rare (as health insurance companies don't like to pay for this level of care if they don't have to).

Residential Centers And Halfway Houses

Some recovering persons require special extended support to help them maintain their sobriety (e.g., they are homeless, they are severely impaired and cannot manage their own living situations, they live with actively drug abusing people and to return to that environment would almost certainly assure relapse). Social workers can help recovering persons to get placement in a variety of sober housing facilities where they can live communally in relative safety, and in an environment that encourages sobriety and twelve step meeting attendance. Usually, recovering people loses this housing if they relapse, providing further incentive for their maintaining sobriety.