Chapter 6

Paths To Recovery

Choosing What Type of Help is Best For You

Written by Dr. Dina Macaluso, Psy.D, L.M.H.C., Alan Boyd, & Sharon Therien

Paths To Recovery

You’re in the process of fighting your addiction to a drug or alcohol.

You’ve gotten past your acute withdrawal from the substance through detoxification, which is generally the first component of treatment, and you might still be experiencing the longer lasting symptoms of PAWS. (See the previous part of this guide for more information about acute withdrawal and PAWS.)

Once you are past the detoxification phase, are you in recovery from an addiction?

“Detoxification alone does not address the psychological, social, and behavioral problems associated with addiction and therefore does not typically produce lasting behavioral changes necessary for recovery,” says the National Institute on Drug Abuse.

This is why you should have a professional evaluation and participate in additional components of treatment after the detoxification process. Many paths to recovery are available to you.

Depending on your needs, you might participate in one type of treatment program or in a few within a continuum of care.

The Treatment Process

What does treatment look like? Overall, treatment should be “designed to enable the affected individual to achieve and maintain sobriety, physical and mental health, and a maximum functional ability,” according to the American Society of Addiction Medicine.

But this can mean different things for different people. The treatment needed really depends on each individual. This might not sound very helpful, but everyone is unique and has differing experiences with substances, as well as different responsibilities, lifestyles and other needs.

Because of these differences, one treatment plan might not work for you while another one will. Many treatment centers understand this and create a customized treatment plan to try to fit your personal needs. It will help your success if you’re honest with yourself and think about what you would need from treatment, and also follow the recommendation of a professional assessment.

There are different reasons for needing one type of treatment over another. For instance, you might need an outpatient treatment program to work around your other responsibilities or you might need to enter an inpatient program because it’s the only way you’ll be able to break free of the triggers that encourage your substance use.

If one type of treatment program doesn’t work for you, try to learn from that experience and try again with another type

And in the end, a successful recovery often comes by participating in more than one type of treatment. Instead of limiting themselves to an outpatient program, meetings or another single type of treatment, many people participate in a step-down approach that takes you in order through these stages or some version of it:

  • Residential rehab
  • Intensive outpatient rehab
  • Outpatient rehab
  • Halfway house
  • Sober living home
  • Meetings

It’s also possible that you might enter treatment at a certain level and then need to step up on the continuum of care if a more intensive level of treatment is required, explains Treatment Improvement Protocols from SAMHSA.

Types of Treatment Programs

Let’s take a look at different treatment programs and some of their pros and cons. This gives you an idea of what to expect from each type:

  •   Residential TreatmentThis option involves staying in a specialized treatment center, which is usually separate from a hospital. While staying in the facility, you participate in intensive treatment.You could live in the facility for a month or have an extended stay up to a year. Short-term options usually go from one to three months, while long-term ones last from six months to a year.
     The National Institute on Drug Abuse explains,

    “The best-known residential treatment model is the therapeutic community (TC), with planned lengths of stay of between 6 and 12 months.”

    The therapeutic community model provides support of a community of staff members and others staying in the facility. In addition to this social component, “treatment focuses on developing personal accountability and responsibility as well as socially productive lives.”

     The treatment helps you work on your problematic ideas and behaviors, and helps you come up with better ones to replace them. In addition, these communities often provide helpful services such as supporting you in finding employment, and they can be customized to your particular needs.
    Residential treatment can be a smart option if you need to get away from your life, including your friends, stresses and way of living, to be successful with recovery. It also takes you away from the substance.

    This is often the right choice when your addiction is severe and/or long-running, and if you have a dual diagnosis with a mental disorder. At many residential facilities, it’s even possible to start the detox process and then continue with other components of treatment in the same facility.

    Plus, many people have success with residential programs if they do not succeed with outpatient ones. Steven Gifford, LICDC, LPC, says on the PsychCentral website, “Often, patients who have attempted outpatient treatment programs but have ultimately relapsed back into drug and alcohol use, or have found outpatient programs difficult to complete, achieve success in a residential program.”

    Nonetheless, this option can be difficult for many people because it requires you to leave your family, job and other responsibilities for the length of time you’ll be staying in the facility. It requires a lot of effort and commitment, but it can be worth it if it enables you to finally beat your addiction.

      Intensive Outpatient Program (IOP)This type of treatment does not require you to live in the facility like residential treatment does, but it still requires a lot of your time and effort.

    Option 1You would take part in an outpatient program at a facility or you could visit with a mental health, behavioral health or addiction counselor in an office setting. You generally visit the program or counselor for a few hours a day three or more times per week.

    Option 2Alternatively, at this stage of treatment, you might take part in partial hospitalization, which provides continuous medical supervision if you require it, while allowing you to stay at home part of the time. With this type of program, you would generally visit the hospital for a few hours a day a few days per week.

    You might find an intensive outpatient program beneficial if you need an involved treatment program but cannot stay in a residential program for a period of time. Or you could use an intensive outpatient program as a step down from a residential treatment program during your treatment process

    These programs allow you the flexibility to continue with work, school and/or other daily responsibilities. They give you similar types of treatment you would receive in a residential program, and these options are enough for people who don’t need to leave their lives to successfully recover.

    A plus is that you generally spend much less money on these programs compared to inpatient ones. Another benefit is that you can generally participate in an outpatient program without too many people knowing about it.

    Steven Gifford explains that in an outpatient program, you

    “often do not need to explain a prolonged absence to friends, coworkers, or family members.”

    On the flip side of the coin, these programs don’t take you away from triggers that could encourage you to use substances, so your recovery could be more difficult or you could be more likely to relapse. Nonetheless, you do receive support that could help you get through difficult moments.

  •   Additional Outpatient ModelsAnother option is to go to a less intensive outpatient program. These programs vary in what they offer, sometimes providing minimal services such as basic education. Many of these options put a large emphasis on group counseling, but might also offer:

    Individual counseling

    Family counseling

    Other types of support

    Instead of going to an outpatient facility, outpatient care could instead involve individual counseling sessions with a counselor, such as a behavioral health counselor, in an office setting.

    Your counseling would most likely include cognitive-behavioral therapy and potentially some other types of therapy as well. During your sessions, your counselor will help with problem areas in your life, coping skills and other strategies, and he or she might also refer you to additional support you might require.

    The more intensive outpatient programs generally require a few visits a week. But when you’re in a less intensive form of outpatient treatment, whether you go to a program at a facility or have office visits with a counselor, you taper down to more sporadic visits with the intension of continuing your recovery and preventing relapse.

    On the downside, this type of outpatient care might not provide treatment that is comprehensive enough on its own to help you successfully reach sobriety. Your chances of success will depend on your needs and what the specific program offers.

    These programs are a good bet if you need a more affordable treatment option or you are not able to devote as much time as you would need for an intensive outpatient or inpatient program.

    Or, the National Institute on Drug Abuse explains that outpatient programs can be useful after attending a residential program, as “these programs help to reduce the risk of relapse once a patient leaves the residential setting.”

    In the same way, they can work well as the next step after an intensive outpatient program.

  •   Sober Living OptionsAfter residential, intensive outpatient and/or other outpatient care, you might live in a sober setting for a period of time before going back to life on your own. During this phase, you live with other people going through a similar situation and give each other support while living without substances.

    Halfway HousesOne option is a halfway house, which often includes continuing rehabilitation with counseling. During your stay of up to six months, you focus on establishing a place to live and a place to work.

    Sober Living HousesRecovery residences or sober living homes are a bit different because they are intended more as a sober environment to encourage your recovery and prevent relapse than a place where you gain rehabilitation — you might have some rules to follow during your stay. You could go to one or the other, or you might continue the step-down approach by first living in a halfway house and then a sober living home or recovery residence.

    In the Journal of Psychoactive Drugs, researchers Douglas L. Polcin, Ed.D. et al. looked at sober living homes and found that there were certain benefits that put these above the established halfway house model.

    For instance, sober living homes let you stay as long as you need to, which is important because “the resident is able to decide when he or she is ready to transition to more independence,” explained the study authors.

    But once again, your success would depend on your needs, such as how well you can do with more freedom or whether you require more support.

    Generally, people go to these kinds of houses after already participating in a rehabilitation program. Whether you choose halfway houses or sober living homes, these options can help you adjust yourself to life away from rehab before you put yourself back into everyday life where you could face various triggers.

    These in-between options provide the benefit of helping prevent relapse after going through a treatment program. They also provide you with a helpful option to figure out your next steps if you’re currently out of housing.

     MeetingsDuring your treatment process, you can also attend meetings that provide support and guidance. Alcoholics Anonymous is a pillar, but you can also choose from specific support group meetings based on your needs. These include Narcotics Anonymous, groups for certain professions and other options.

    Some of these groups use spiritual beliefs to help with recovery, while others do not have an emphasis on that.

    “A person should consider trying several different meetings prior to deciding upon the value of mutual support group participation in his or her recovery,” says A. Thomas McLellan, Ph.D.

    Some people are able to recover with meetings alone, but many people will also require other types of rehabilitation that provide more professional help and intensive methods, such as therapy and medication.

    This type of treatment gives you social support and can help prevent relapse after other treatment. These meetings also often give you guidelines for living without substances, such as the 12-step model.

Components of Treatment

During the treatment process, you will engage in many components that can help you recover. You will often participate in various types of therapy, including individual, group and/or family.

“Therapy can help you identify the root causes of your drug use, repair your relationships, and learn healthier coping skills,” explains Melinda Smith, M.A. and Jeanne Segal, Ph.D. in a HelpGuide overview.

Your treatment program could also include medication that provides one or more of the following actions:

Cuts your cravings

Helps with ongoing PAWS symptoms

Provides help with a dual diagnosis of a mental disorder

Further, your program should give you tools, guidance and support for creating a new life that doesn’t include substances. Some programs can also help you create your new life without substances by guiding and supporting you with employment and other aspects of living.

You should also engage in some kind of continuing care or follow-up care after your treatment, so you can minimize your risk of relapse. This time can include periodic therapy sessions, which may be by telephone, and other types of support.

Whether you engage in one type of treatment or take part in a step-down program after detoxification, having a successful recovery is all about finding the right treatment program for your needs. A professional evaluation can help you accomplish this.

Also, remember that it’s always possible to step up or step down in the continuum of addiction care if you need to be at a different level to find success. The important thing is that you enter treatment and stick with it.

As you can see, the many levels and types of treatment can help you meet your needs at each moment and prevent relapse. Through the many treatment options available, recovery is possible for you or someone in your life.

Continue reading this guide to learn tools and tips that can help you move toward recovery and prevent relapse.