In 2019, the National Survey on Drug Use and Health estimated that more than 20 million Americans over the age of 12 suffered from a substance use disorder (SUD) within the past year.1 If you are among this number and are struggling to stop misusing drugs or alcohol, then detox and rehab programs may provide the treatment you need.
Detox centers help people safely withdraw from drugs and alcohol in a controlled environment, after which many of them continue with or enter some form of rehab that lasts between a couple of weeks to a couple of months. There, they may receive some combination of individual and group counseling, medication-assisted treatment, and support groups to aid them in their recovery.
Many people who complete addiction treatment are able to stop using drugs or alcohol. However, while substance abuse treatment builds an important foundation for obtaining sobriety, it is crucial for you to follow up with aftercare to improve your odds of maintaining long-term recovery. Relapse rates for addiction are similar to those of chronic diseases, such as asthma and diabetes—as many as 40-60% of people completing treatment will relapse and require further treatment.2
Detox: The First Step in Treatment
Detox is often the first step in substance abuse treatment since quitting specific varieties of drugs can potentially send you into physical and psychological withdrawal, the symptoms of which may be uncomfortable, dangerous, or even potentially fatal, depending on the substance you’re addicted to.
There are many detox centers in the United States, but not all are created equal. When looking for a reputable and effective program, make sure it has these components:3,4
- Qualified and experienced staff: Detox centers should have licensed and trained staff that consists of physicians, nurses, psychiatrists, and other mental health and medical professionals.
- Strict adherence to ethical standards: The center should vigilantly observe the ethical standards set in place for medical and addiction treatment professionals.
- Certifications with accreditation programs: Look for a detox center that is certified by a professional agency, such as the Commission on Accreditation of Rehabilitation Facilities (CARF), which ensures compliance with ethical and business standards for treatment centers.
- Evidence-based treatment protocols: Evidence-based treatment means that the efficacy of a specific therapeutic modality is backed by scientific evidence. There are many experimental treatments out there that have not been adequately evaluated and may have unknown outcomes or even result in negative consequences. Additionally, this field is not fully regulated in every state, so you must take it upon yourself to learn what treatments a given detox center employs and what research exists to support its efficacy.
- Medical supervision: Medical supervision is crucial to quality detox care since you may experience many painful and potentially dangerous withdrawal symptoms during the detox phase. Medical professionals should provide ongoing supervision and care during the withdrawal period to help minimize unpleasant symptoms and address any complications that may arise.
Outpatient Programs for Addiction
Following the successful completion of detox treatment, some people opt to continue their recovery efforts through outpatient addiction treatment. If you are of one of them, once you’ve safely navigated the withdrawal period, you might attend some form of ongoing outpatient treatment in one of a number of settings: at a standalone rehab facility, a community mental health center, a hospital, or a physician or therapist’s office. Outpatient programs may be designed to last a few weeks to a few months, depending on the intensity of treatment you need.
These types of post-detox rehabilitation are often a first choice for many people, since they may be relatively less expensive and generally allow them more freedom than their inpatient or residential program counterparts. When you attend an outpatient program, you go to treatment several days a week but live at home and may be able to continue working or attending school. This flexibility allows many people to stay with the program longer, as opposed to an inpatient program, for which you must live at the treatment facility for a set time.
Some outpatient programs are relatively low-intensity and may meet for a few hours throughout the week to provide drug education and substance abuse counseling, while intensive outpatient programs (IOPs) often provide care comparable to inpatient rehab in terms of intensity.5 Most people attend an IOP for 4-8 hours a day, 4-6 days a week.6
Quality outpatient care should consist of all the same elements as detox, including experienced clinical and medical staff, professional certifications or accreditations, a commitment to clearly stated ethical standards, and evidence-based treatment modalities.
Outpatient treatment may encompass a variety of therapies and treatment modalities, such as:5-7
- Individual and group counseling.
- Family therapy.
- 12-step or other forms of support groups (including Alcoholics Anonymous, Narcotics Anonymous, and SMART Recovery).
- Cognitive behavioral therapy (CBT). CBT helps individuals identify and correct harmful behaviors and teaches them skills so they can identify triggers for their substance abuse and develop coping strategies.
- Motivational interviewing (MI). MI helps motivate people who are hesitant to change. Individual therapy sessions assist patients in building a plan for change and developing coping strategies.
- Pharmacotherapy management.
- Aftercare planning.
While for many people IOPs may be just as effective as inpatient treatment, they are not suitable for everyone. Those with severe addictions or co-occurring mental health conditions may do better with the around-the-clock supervision and added therapeutic intensity of an inpatient program.6
What Are Residential Inpatient Programs?
Inpatient rehab differs from outpatient programs primarily in that it takes place in a live-in setting 24 hours a day, 7 days a week for a designated period of time. You may attend inpatient treatment in a hospital, a psychiatric unit, a residential drug rehab center, or a therapeutic community. Short-term residential treatment typically lasts between 3 and 6 weeks, while long-term inpatient rehab can go for as long as 6 to 12 months.5
For many people, inpatient drug rehab is the preferred setting in which to get sober since it provides an added measure of safety and support for those who need it, such as for those with severe opioid and sedative addictions. Inpatient programs are also a safer place to recover for people with significant mental and physical health issues, such as severe depression, anxiety, or chronic pain. The constant supervision and care these rehabs provide allows anyone with a complicated psychiatric or physical diagnosis to get sober safely.
Additionally, many inpatient rehabs offer in-house detox services that transition directly into long-term care. Since this would be dangerous and inadvisable in an outpatient setting for those with certain addictions—for example, where withdrawal symptoms are either inherently dangerous (e.g., the seizures sometimes associated with alcohol withdrawal) or so difficult to endure that the risk for relapse is very high (e.g., opioid withdrawal symptoms)—inpatient care is an important option.
Inpatient programs typically offer most of the same types of treatment modalities and options as outpatient programs, including:5,7
- In-house medical detox services.
- Cognitive behavioral therapy (CBT).
- Motivational interviewing (MI).
- Individual and group counseling.
- Family therapy.
- Medication-assisted treatment.
- 12-step facilitation.
- Support group attendance.
- Complementary and holistic treatments (yoga, meditation, Reiki).
- Discharge planning.
- Aftercare programs.
Those with relatively mild addictions may not necessarily need the full intensity of a long-duration, inpatient treatment program to kick start their recovery. Residential rehab may also prove difficult for those who need to continue to work, go to school, or take care of personal matters during treatment; an IOP may be a better option in these cases.
Specialty Rehab Programs
There are many treatment programs available that are geared toward special populations and their unique needs, such as:
- Gender-specific: Some rehab programs only admit men while others only admit women. By keeping genders separate, addiction professionals can cater to the unique needs of each one while providing a safe environment that minimizes distractions that could hinder the recovery process.
- Faith-based: For a treatment modality to be truly effective, the addicted person must believe in its ability to help them. If the philosophy of the rehab center is not in alignment with the person’s beliefs and values, they may struggle with it. Faith-based treatment centers operate under specific religions and belief systems and incorporate their higher power as a means of healing and inspiration.
- Holistic: These treatment centers approach addiction from a holistic perspective that encompasses all aspects of the human experience: mental, emotional, physical, and spiritual. Some specialized treatment options that may be offered at a holistic rehab include:
- Nutrition planning.
- Healthy meals.
- Physical fitness.
- Yoga and meditation.
- Nature therapy.
- Spiritual services.
- Executive: CEOs and others with demanding jobs and workplace responsibilities may choose to attend an executive treatment center since it provides specialized services for those in treatment to help them remain active in their jobs during the rehabilitation process. Executive rehabs often provide seclusion, private rooms, computer and phone access, conference rooms, work-related therapies, and travel assistance.
- Luxury: These rehab facilities provide luxury amenities and services for patients, which may include:
- Private rooms.
- Gourmet meals.
- Massage and spa treatments.
- Fitness centers and physical trainers.
- Pools or hot tubs.
- Exotic locations.
- Pristine views.
- Holistic therapies.
- Treatment for mothers: Some treatment centers offer specialized services to pregnant women or women with small children. Rehab facilities for women with small children typically provide accommodation and daycare services for the children while mom is in treatment. Treatment centers for pregnant women provide specialized services such as:
- Medical monitoring of mom and the fetus during withdrawal.
- Prenatal care.
- Pregnancy education and counseling.
- Parenting classes.
- Job services.
- Substance Abuse and Mental Health Services Administration. (2019). Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): How effective is drug addiction treatment?
- CARF International. (2017). Why Does Accreditation Matter?
- Edwards, S. & Rawson, R. (2011). Evidence-Based Practices in Addiction Treatment: Review and Recommendations for Public Policy. Health Policy, 97(2–3), 93–104.
- National Institute on Drug Abuse. (2012). Types of Treatment Programs.
- McCarty, D., Braude, L., et. al. (2015). Substance Abuse Intensive Outpatient Programs: Assessing the Evidence. Psychiatric Services, 65(6), 718–26.
- Jhanjee, S. (2014). Evidence Based Psychosocial Interventions in Substance Abuse. Indian Journal of Psychological Medicine, 36(2), 112–18.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).