Addiction is a chronic disease that changes structures in the brain, leading to impulsivity problems and compulsive behaviors, often around intoxicating substances but sometimes around “instant gratification” behaviors like gambling or shopping. Managing addiction is very possible – thousands of people every year overcome the condition and lead healthy lives – but it is important that several methods of treatment are available.
Since addiction involves changes in the brain, the National Institute on Drug Abuse (NIDA) notes that no one approach to treatment will be right for everyone, so it is important to offer diverse options that are easy to access. The primary goals of effective drug addiction treatment are to:
- Safely detox from and stop using drugs
- Remain abstinent from drugs and alcohol
- Become a healthy, contributing member of the community
With these goals in mind, a general approach to treatment involves medically supervised detox and then entering a rehabilitation program that focuses on therapy and counseling to change behaviors around substances and improve the individual’s understanding of their addiction. Part of this includes education to reduce the risk of relapse, and it may include prescription medicines like buprenorphine to ease withdrawal symptoms and slowly wean the person off physical dependence on drugs. More people successfully maintain abstinence when they leave rehabilitation by sticking with support groups, led by peers, who emotionally support each other’s ongoing recovery.
This general course of treatment must be modified by doctors and therapists continually, starting with the individual’s initial assessment and then several times over the course of rehabilitation and after. Some people will be able to detox safely within a few days; others will need much longer, more intensive courses of treatment. For those who have struggled for a long time with substance abuse problems, who need medical supervision for chronic health concerns, or who need to be removed from environmental triggers in their home, a residential rehabilitation program may provide the best treatment.
How Is Residential Rehab Different from Outpatient Treatment?
Residential rehabilitation exists to provide those most at risk with a safe environment to become stable and learn skills to re-enter the world while maintaining emotional, mental, and physical stability. Services are delivered by case workers, nurses, therapists, and doctors who help to manage the individual’s overall health. For people overcoming substance abuse, access to therapy to change behaviors is the most important part of residential treatment, whether it lasts a few weeks or a few years. The person should demonstrate a need to be removed from their existing home and work environment, and stay in a place that restricts access to drugs and limits emotional triggers.
Residential or inpatient programs focus on social models of recovery, although they can provide many additional options on top of group and individual therapy. Some inpatient programs are associated with special units in hospitals while others are entirely separate facilities. Some boast beautiful views and access to luxury programs, like equine-assisted therapy or spiritual coaching, while others focus on evidence-based approaches to psychotherapy and medication. Some may focus on quickly resolving acute physical problems and then referring the individual to a different type of treatment after this stay has been completed.
The primary difference between inpatient and outpatient rehabilitation is whether or not the person lives in the facility. Residential treatment programs, as their name implies, provide a safe residence for those in recovery; outpatient programs give the person the option of living at home or in a safe facility like a sober living home nearby.
Some outpatient programs, like intensive outpatient rehabilitation, provide a similar number of hours of therapy while a traditional outpatient program only requires a few hours of therapy per week. Residential programs involve many hours of therapy, and the individual’s day will be structured around therapy sessions and programs that enhance the effects of those sessions.
Types of Residential Drug Rehab and Their Services
There are a few types of residential rehabilitation that offer different levels of care. A standard inpatient treatment facility is licensed by the state, has credentialed staff members available around the clock, and offers drug-free premises. However, the specifics of these options differ from community to community. Some types of residential treatment are outlined below.
- Therapeutic communities:These highly structured programs are designed to help those with serious mental and behavioral problems. An individual will likely stay in this type of program for at least six months and sometimes up to one full year. This gives the person access to therapists and doctors for a long time, allowing these professionals to monitor mental health and medical conditions, until they have successfully changed behaviors and are physically safe to complete the program. People who enter these communities will benefit from transitioning to sober housing after completing the rehabilitation program. In a sober living home, they will remain in a drug-free residence but can focus on re-entering the community by getting a job or pursuing educational opportunities.
- Recovery housing:This is supervised short-term living that follows protocols that are similar to those used in therapeutic communities or other inpatient programs. For many, this is a step from an inpatient program back into real life; for others, it is the level of care they need initially.
- Short-term inpatient treatment:The focus of these programs is supervised detox, with intensive counseling offered at the end of that process. While attending only this kind of residential treatment can be enough for some, many people will benefit from transitioning to an outpatient program, a different inpatient program, or peer support groups. A counselor should be available to refer the individual to appropriate treatment after this residential program is complete. The original version of short-term residential treatment was only 3-6 weeks, with the intention of the individual moving to a different form of therapy. The current minimum for residential treatment is 28 days, or about one month.
An Average Day in a Residential Rehab Program
Depending on what services are offered by the residential program, an average day can look very different. However, the main characteristic of inpatient treatment is therapy and activities that bolster the effectiveness of group and individual therapy sessions. An individual in treatment may have a daily schedule that looks something like this:
- 7 a.m.: breakfast in the dining hall
- 8:30 a.m.: chores and medication
- 10 a.m.: first group therapy session
- 11 a.m.: break for individual journaling and quiet reflection
- 12 p.m.: lunch in the dining hall
- 1 p.m.: group exercise, like walking or yoga
- 2 p.m.: second therapy session, often an individual session
- 3 p.m.: afternoon medications and physical checkups with a doctor or nurse
- 4 p.m.: third therapy session, often group or family therapy
- 5 p.m.: more reflection, mindfulness practice, or journaling
- 6 p.m.: evening chores and getting ready for dinner
- 7 p.m.: dinner in the dining hall
- 8:30 p.m.: evening group activities like a movie or games, or solitary time to journal and reflect
- 10 or 11 p.m.: curfew and lights out
Residential rehab provides meals, toiletries, and any other necessaries, like towels and exercise equipment. Meals are designed to be healthy since many people who have dealt with substance abuse or addiction for a long time struggle with vitamin deficiencies, rapid weight loss, and even malnutrition.
Some programs require more than three therapy sessions per day or have longer sessions. Other programs offer complementary treatments, like massage therapy, yoga, reiki, equine-assisted or animal therapy, dancing, or art therapy. These are considered forms of therapy, and they can do a lot to enhance a person’s experience of cognitive-behavioral and motivational therapy sessions. Some residential programs may offer vocational training, conflict resolution sessions, social time with visiting family and friends, or a different balance of alone time versus group activities.
Long-term residential programs, intended for several months or a few years of treatment, may provide group trips off campus to art exhibits, 12-Step meetings, or other activities.
Who Benefits from Residential Drug Rehab?
People who have developed a physical dependence on a high dose of a substance for a long period of time may benefit from the constant medical supervision offered by residential rehabilitation. Staff members who are available 24/7 can offer support if the person experiences cravings, psychological withdrawal symptoms, or post-acute withdrawal syndrome (PAWS). Residential rehab will be more likely have physicians available in person at least a few days per week and a pharmacist available to dispense prescription medications, like buprenorphine, with oversight.
Those who have co-occurring mental illness and substance use disorders greatly benefit from being in the safe, structured environment of residential rehab. Whether these mental health conditions involve bipolar disorder, depression, antisocial values or personality disorder, a history in the criminal justice system in part due to drugs, or abusive, chaotic, or unsupportive interpersonal relationships, staying in residential rehabilitation can keep people safe mentally, emotionally, and physically.
People who have gone through other rehabilitation programs, like an outpatient program, but who have not successfully maintained abstinence from drugs or alcohol can benefit from the intensity of a residential program. Of course, relapse occurs about half the time among all people who complete a rehabilitation program, either inpatient or outpatient, but a lack of success may also indicate that there are environmental factors preventing the person from successfully avoiding consumption drugs or alcohol.
Many residential rehabilitation programs offer detox assistance and supervision, but not all of them do. It is worth investigating a specific program first to ensure the program offers treatments that will be of benefit.
Success Rates for Residential Drug Rehab
Because addiction is a chronic disease, it often require consistent treatment for a person’s lifetime. When considered with other chronic diseases, like diabetes or hypertension, relapse rates for addiction recovery are not significantly different. These conditions, too, require specific therapies and interventions, involve relapse of symptoms, and require reconsideration of the overall treatment plan at various points in an individual’s life.
Too many people assume that relapse means that one course of addiction treatment has been a failure, but this is not true. This makes success rates hard to quantify, but as NIDA clearly states, diverse kinds of addiction treatment work better for different populations. Residential rehab will likely reinforce changes in behavior in a way that outpatient rehabilitation does not, which makes it an appropriate solution for people who have not shown long-term benefits from outpatient programs in the past. However, this does not invalidate outpatient or short-term rehabilitation programs; it only highlights that some populations have more specific needs and can benefit from leaving their current environment to enter a safe space.
Residential rehab may also improve treatment retention rates. As an article in TIME Magazine points out, too many people stop attending rehabilitation programs before the NIDA-recommended 90-day timeline and do not pursue any continuum of care, like peer support groups. As they offer accommodations, nutrition, peer support, and therapy in one package, more people may benefit from residential programs compared outpatient programs. Again, this is tough to quantify.
Paying for Residential Drug Rehab
Insurance will typically cover part of a residential stay, but not the full cost of the program. Fortunately, there are a few payment options available at many residential programs. Some facilities may offer sliding scale fees, installment payment plans, or even low-cost or free options. Many people who have serious, long-term problems related to substance abuse require inpatient care, so it is important that they have access to high-quality, evidence-based care that is affordable. For those with insurance, however, working with an in-network provider will increase the likelihood of insurance coverage for part of the program; contacting the insurance company, through a physician, to request preapproval for the program is helpful.
If a particular program isn’t covered by insurance but is desirable, they may offer a payment plan to ease the financial burden. Contact them to ask about financial assistance. Additionally, supportive friends and family may be willing to donate some money to the cause.
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