What to Expect from Addiction Treatment, because There are so Many Options

By Sara Lindberg

Reviewed by David Klemanski, Psy.D., M.P.H.

Acknowledging that you, or someone you love, may have a substance use disorder isn’t easy. Just the fact that you have come to this conclusion, though, is a positive step and deserves a shoutout. Now let’s get into what you really want to know: how to find the care you need.

Thankfully, there are various levels of addiction treatment programs available that can help kickstart your journey towards recovery. Just like any other medical issue (or pretty much anything else in life), it’s not a one-size-fits- all disorder, so treatment isn’t either.

What are the types of addiction treatments?

There are two main types of addiction treatments: inpatient and outpatient. Inpatient care is designed to help you safely go through withdrawal from a substance before addressing the thought patterns and behaviors that drive the addiction.1 Outpatient services can be similar, but are meant for people who don’t need to go through the additional step of withdrawal.

Most programs, both inpatient and outpatient, follow an abstinence model, which means (with help) you quit using any and all substances. With that said, complete abstinence may not work for everyone, Michele Goldman, Psy.D., a licensed clinical psychologist at Columbia Health and a media advisor for the Hope for Depression Research Foundation, tells ishonest.

So, how do you know which is best for you? It comes down to the level of care you need to safely stop or reduce your substance use. Here’s a closer look at each type of addiction treatment:

The highest level of addiction treatment is a medically managed inpatient unit, says Dr. Goldman. That’s official language for a program that provides medical professionals to monitor you round-the-clock as you go through withdrawal from prolonged use of a substance.

Known as detox, this process can lead to serious withdrawal symptoms2—such as seizures, tremors, vomiting, fever, or even hallucinations–which is why medically managed inpatient units are necessary for some people, says Dr. Goldman.

As these symptoms run their course, your doctor may recommend various medications to help make the process less brutal.3 These are based on the substance you’re withdrawing from, but range from things like methadone for opioid withdrawal (namely heroin) to benzodiazepines (commonly known as benzos) for alcohol withdrawal. If you’re in treatment for opioid, tobacco, or alcohol addiction, your doctor or medical provider may also prescribe medication for relapse prevention. Some of these medications basically stimulate the brain in a similar way to a person’s preferred substance to reduce the urge to use.4 Other medications are used in different ways, like to block the euphoric effects of certain drugs. Anytime medications are used, a medical professional will closely monitor how it’s going to ensure you’re on the right treatment path.

In addition to detox, inpatient treatment programs typically involve individual therapy to address the thought patterns, urges, and behaviors associated with substance misuse. This process can also reveal other mental health issues, such as depression or trauma, that might be contributing to your problem. Group therapy is also used to create a sense of belonging and community to help you connect and feel motivated to continue your treatment. It can also have similar benefits to individual therapy and can be useful to learn from other's experiences. You may even be asked to participate in other activities to help promote well-being, such as meditation or animal therapy.

Of course, paying for a rehab program can be a significant hurdle for many people, but there are options available. If you have private insurance, Medicare, or Medicaid, this will cover part of or all of your treatment.

If you don’t have insurance, don’t worry, you still have choices. There are state and locally funded programs that accept patients who fit certain criteria, such as those who are residents in the state and do not have insurance, and many private rehab facilities offer financial aid and financing options. Finally, there are Substance Abuse and Mental Health Services Administration (SAMHSA) grants available to certain groups of people, like pregnant or postpartum women, and nonprofit organizations. If you’re not sure where to start, SAMHSA can help put you in touch with a program in your area.

When a medically managed detox or residential program is not needed, outpatient treatment is the next level of care. This type of treatment has various levels of support, including partial hospitalization programs (PHP), intensive outpatient programs (IOP), and outpatient programs.

If you’re participating in a PHP, Dr. Goldman says you will live at home but travel to the hospital program daily, usually for multiple hours each day for individual and group addiction therapy sessions. PHPs are less restrictive than inpatient programs but still provide a high level of care and support. It’s sort of like being back in high school, but instead of cramming for your pre-calculus exam you’re learning very useful coping skills.

For some people, daily treatment isn’t necessary, and if that’s the case, your provider may recommend an IOP. Sessions are usually three hours in length, and treatment is three to four times per week for six to eight weeks.3 It’s sort of like a part-time job. Your doctor might recommend this option for you if:

• Your substance use is affecting your mood.
• You’re having trouble doing daily tasks like personal hygiene or going to work or school.
• You’re having health problems.
• Your relationships are becoming strained.3

The other reason you might be referred to this type of program is if you’ve run into trouble with the law, such as driving under the influence, says Lyndon Aguiar, Ph.D, L.C.P., clinical director at Summit Hill Wellness and Williamsville Wellness, a private rehab facility in Richmond, Virginia.

If intensive outpatient sessions are not needed, you’ll participate in general outpatient treatment, which includes things like individual addiction therapy, group therapy, and medication management. Sessions range from one to four hours per week. Think of this one as meeting a friend for coffee a few times a week.

What types of therapy play a role in addiction treatment?

As we’ve mentioned, both inpatient and outpatient programs use a variety of therapy techniques for addiction counseling. Some of the more common types of behavioral therapy methods used to treat substance use disorder include:

Why is it important to address underlying mental health issues during addiction treatment

Substance use disorders are challenging to treat on their own, but the process becomes even trickier if a separate mental health condition is spurring symptoms at the same time. According to Dr. Goldman, most substance use disorders co- occur with a second mental health diagnosis, including anxiety, depression, and trauma, among others. In fact, the National Institute on Drug Abuse reports that of the about 20 million adults with substance use disorders—nearly 38%!—also have a mental illness.

Addressing this during treatment is essential because once you’re sober, a mental health condition could surface for the first time or feel even worse than it has been. For example, if an opiate was making someone calm and they’re no longer taking it, they might have increased anxiety or agitation, according to Dr. Goldman. “This is why many substance abuse treatment programs offer a variety of group therapy modalities, individual therapy, and medication management—to address any and all symptoms that someone is experiencing.”

Addiction is considered to be a developmental process, Sydney Horton, M.S., A.T.R.-P., a resident counselor at Williamsville Wellness, tells ishonest. This is influenced by things like:

• Genetics
• Early attachment and adverse childhood experiences (ACEs), like emotional, physical, or sexual abuse
• Environmental stressors
• Trauma and instability
• Loss of loved ones
• Chronic emotional helplessness, which is a learned behavior that occurs when someone (after many years of not being able to exert control over their life) gives up on trying to change their situation or environment even when they can

With this in mind, Horton says addictive behavior can be a dysfunctional coping response to unresolved mental health issues. “If treatment only addresses the substance use, and it fails to consider underlying mental health issues such as depression, anxiety, bipolar disorder, PTSD, OCD, then the individual would be highly prone to another type of addiction,” she explains.

What happens after addiction treatment?

Completing an addiction treatment program is a significant accomplishment. But once you leave the structure of a formal program, finding the right support is critical to stay sober. This can look different depending on the severity of the addiction before treatment, previous relationships that may have triggered substance use, or other patterns of behavior that lead down the path to addiction, but two options to consider are support groups and sober living homes.

Sober living homes (or recovery homes) are a good option if your home environment is strained, unstable, or there is continued alcohol or substance use by others. “Sober living homes offer safe and stable housing, with an accountability system that is essential for those in early recovery,” says Horton.

With that said, one of the most important pieces to addiction recovery is building healthy relationships to help support you, both in and outside the recovery community. “It’s important that people feel they have stable, consistent, and reliable support in their corner that offers a sense of accountability, as well as unconditionality,” Horton says.

Dr. Goldman says that outpatient therapy support groups provide an ongoing space to discuss things like:

• Triggers
• Cravings
• How to rebuild relationships
• How to navigate life in a sober way
• Process guilt, shame, or other difficult emotions that might relate to substance abuse

“When individuals are in the addiction mode, they may isolate or gravitate toward toxic people or situations,” Dr. Aguiar says. That’s why connections with sober individuals and positive support are critical to early recovery from alcohol or substance use.

Where to find help for addiction

Asking for help is the first step toward getting better. Your doctor or health care provider can assist with finding local treatment programs, including ones that have a sliding scale payment or offer financial aid or financing. Additionally, there are several resources online that provide information on inpatient programs, outpatient treatment, individual therapy, and group support programs.

Here are some organizations to help you get started:

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