What are the Options for Substance Abuse Treatment? (Part One)

Someone seeking treatment for a Substance Use Disorder for the first time can be confused about how to proceed. There are many options. If you ask for advice from someone who got help for themselves, they will often recommend what worked for them. That doesn’t necessarily mean that same treatment will be best for you. If you go to a treatment provider that only provides one option for treatment, guess what will likely be recommended for you. It’s important to be educated about making an informed choice that is best for you and will likely be effective. Let’s begin by discussing some of the more common treatment options or what we call levels of care. The options for treatment that I will be discussing include: medical detoxification, residential services, outpatient services, online treatment, addiction medicines, and self-help.

Let’s start with the most intensive and costly treatment options and progress to the least restrictive options. The most intensive option, or level of care, is known as medical detoxification or detox. This treatment is generally recommended for individuals who are heavy users or daily users of substances leading to physical addiction. A physical addiction is characterized by withdrawal symptoms (e.g., shakes, sweats, changes in blood pressure, fever) when discontinuing the substance and, when actively using the substance, high levels of tolerance (i.e., needing greater amounts of the substance to get to a state of intoxication). The setting for this treatment is typically a medical facility (e.g., hospital, private medical office) where your treatment is managed and monitored by medical staff, including doctors and nurses. Patients typically remain in this level of care for a few days (i.e., 2 to 5 days) depending on the severity of the medical condition. In our current health care model, insurance companies are often selective as to which substances are considered eligible for medical detox. Typically, the substances considered to lead to physical addiction with potentially harmful withdrawal symptoms include alcohol and sedatives from the benzodiazepine family (e.g., Valium, Xanax, Klonopin, Ativan). Opioids, which are pain killers, are also considered to lead to physical addiction. Opioids include heroin, codeine, morphine, methadone, oxycodone, hydrocodone, fentanyl, and buprenorphine, to name a few. However, because withdrawal from these substances, while unpleasant, is not considered life-threatening, many managed care companies will not authorize an inpatient medical detoxification for opioids, preferring treatment in what is known as an ambulatory or outpatient detoxification. Ambulatory detox involves going to a clinic each day for medication and monitoring of withdrawal symptoms for several days to a few weeks. Other substances, such as cocaine, methamphetamine, marijuana and hallucinogenic drugs, are not thought to lead to potentially harmful or life- threatening situations during withdrawal from heavy and chronic use patterns. Consequently, these substances are not usually authorized by managed care companies for inpatient medical detoxification.

Residential treatment services are the next option for care. Residential treatment involves entering a controlled environment where you will live for a specific duration of time, typically from 2 weeks to several months. There are a variety of residential treatment options. The most popular is the 28-day rehabilitation program, which has gotten a lot of publicity due to the number of celebrities who have participated in this form of treatment. The inpatient rehab model typically involves a daily, structured schedule of treatment activities, including specialized groups (e.g., cognitive-behavioral, trauma, relaxation, etc.), individual counseling, educational workshops on recovery-related issues, and reading and writing assignments. The quality of these programs, and the cost, varies greatly, and you will need to do a thorough review before choosing one. Your review should include what will and will not be covered by your health insurance plan, and you should obtain a copy of a typical schedule of activities, the current demographics of the population, the program’s treatment philosophy, and its reputation among former patients and addiction professionals. Usually, residential treatment is recommended for individuals who are unable to refrain from substance use for any extended period of time. If you are unable to abstain from a problem substance for at least three consecutive days, and are not exhibiting a physical addiction to alcohol, sedatives, or opioids, this level of care may be an option for you. Some residential programs combine medical detoxification services with the less intensive residential treatment services. Other residential services include an extended-care model, in which participants live in a sober environment for several months, and sober houses that do not provide treatment, but only provide a sober and supportive living environment. In Part Two of this blog, I will explore other, less intensive treatment options.


Nicholas Lessa is the Clinical Director of Chat2Recovery, an online substance abuse treatment program, and Inter-Care, a leading substance abuse treatment program in New York City. He has been in the field of substance abuse treatment for over 30 years. He is the lead author of two books, Wiley’s Concise Guide to Mental Health: Substance Use Disorders and Living with Alcoholism and Drug Addiction.

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