Addiction Treatment Levels of Care: Don’t be “Spooked” about Understanding these Options!

Addiction Treatment Levels of Care: Don’t be “Spooked” about Understanding these Options!

There is an endless and overwhelming amount of information on the Internet about addiction treatment options.  Some of this information can be promotional and therefore it is difficult to know which resources are legitimate.  Many people have no idea where to begin or what type of care that they or their loved one may need. There is common terminology that are important to understand when searching for help. 

It can also be helpful to obtain a substance abuse assessment by an outpatient addiction therapist in order to help determine a treatment plan that is appropriate.  However, if an individual is physically addicted to alcohol and/or Benzodiazepines (Xanax, Ativan, Klonopin) it is imperative that they receive medical attention before completely abstaining because, unlike other drug classes, the withdrawal symptoms can be potentially fatal.  This person could be seen and assessed at any local ER and many addiction programs require that an individual is “medically cleared or stabilized” by an ER before they admit that person for further treatment.  ER’s can sometimes be helpful in finding an available detox bed for the individual as well. Additionally, contacting your Primary Care Physician for referral suggestions can be a great place to start.

The following levels of care are listed in order from the lowest to the highest level of care. 

Outpatient services:  Individual and group therapy are often the most desirable for those who want to seek out discreet treatment.  Outpatient care may involve and individual and/or family receiving therapy services from a therapist, psychiatrist (prescribing medication), psychiatric nurse practitioner, or addiction counselor in private practice or who may be part of a clinic.  They may or may not be in network with insurance providers.  

Intensive outpatient program (IOP):  An IOP is a program that is also generally run out of a clinic or hospital and generally is about 3-4 hours per day, allowing for individuals to also attend part time work or school.  Some IOP programs are in the evening, allowing for individuals to maintain full time work. These programs typically involve group therapy, along with individual therapy, case management and medication management.   These programs can last for various lengths of time (weeks-months), as individuals are able to engage in work, volunteering or academics simultaneously. They are mostly covered by insurance. 

Partial Hospitalization program (“day treatment”):  These programs are run out of clinics or hospitals and allow an individual to attend treatment throughout the day while living at home.  Individuals who are attending a partial program generally need to take time off from work or are not currently working in order to attend, as the hours can run from about 9:00am-3:00pm.  These programs involve mainly group therapy, along with individual therapy/case management and medication management (if needed). Individuals attend partial programs for generally about 2 weeks depending on the program and insurance coverage.  

In-Home Addiction Treatment (IHAT):  This is one of the newest and most innovative types of care.  Services are delivered directly to the client and are able to meet them in various locations (i.e., at home, coffee shop, college, etc.).  More insurance companies are beginning to fully cover a year of the IHAT treatment programs and they are currently located in Connecticut, New Hampshire, Maine and Florida. These programs provide comprehensive care and psychoeducation for individuals and families that include recovery coaching with a year-long curriculum, care coordination, medication management, vocational counseling, family coaching and vetting appropriate community resources.  The IHAT Institute is now training addiction treatment professionals in how best to administer these services.   

Sober living:  Sober living provides a place for those recovering from addictive issues to reside.  They do not and are not permitted to offer any clinical services in-house- but alcohol/drug testing is standard.  Many sober houses require that those residing there will be engaged in at least 20-25 hours of activities outside of the house per week.   Houses are usually gender specific. Insurance most often does not pay for sober living, and there are a range of prices for this type of housing.  

Transitional sober living programs:  Individuals are generally expected to stay in this type of program for several months, as this is intended as a bridge from treatment to the real world.   These programs require that individuals will be living at the program, engaging in various forms of treatment such as individual, group therapy and medication management as needed. More comprehensive case management and vocational coaching services are most often provided in this level of care. Additionally, it is expected that they will seek out vocational and/or academic pursuits that they can then continue once they leave the program.  

Residential treatment (“rehab”):  All residential treatment programs require that an individual live at the program during treatment, but the treatment is voluntary.  There are many types of programs and locations to choose from in terms of this type of care, as well as various price points. These programs typically involve attending group therapy much of the day, individual therapy sessions, and medication management (if needed).  Some programs offer alternative forms of treatment such as equine therapy, wilderness excursions, acupuncture, yoga, massage, expressive therapy and many others.   Many programs do take insurance, but some are self-pay. Most are 30-45 days in length, and it is crucial that comprehensive aftercare is established.

Detoxification (“detox”) and Inpatient treatment:  This is the highest level of care and individuals are placed in a locked unit generally in a hospital setting in order to be medically monitored while they are detoxifying from alcohol.  They will meet with a therapist/case manager, psychiatrist and may attend minimal groups. However, this level of care is not intended to be “treatment” for addiction, it is the beginning of the process in that it leads to physical sobriety, but true recovery is a longer journey.  An individual’s length of stay is based on medical necessity and insurance coverage. 

By: Sarah Allen Benton, MS, LMHC, LPC, AADC 

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