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As with other health conditions, most people start treatment with a counselor who does an assessment to determine the best approach to treatment. At this appointment, a counselor or doctor will ask questions about your situation, provide a diagnosis of the problem or problems and make recommendations for the kind of medications and counseling that is right for you. This is a good time to ask questions about different treatment options. Your counselor or doctor may discuss your health insurance coverage and what you can expect to pay for services. It is fine to ask questions about what you will need to pay and not to be pressured to sign a payment agreement until you are sure the treatment is the right fit for you. Reputable treatment programs will answer your questions and not rush you into a decision.
Assessment is the initial phase of treatment where your counselor or doctor asks questions about your problems or concerns. They will ask about your alcohol or drug use, depression, anxiety, or other mental health symptoms, eating, sleeping, social life, and other personal questions. The more honest you are in answering the questions, the better your counselor will be able to recommend a treatment program that is right for you.
Diagnosis of a substance use disorder, like a medical diagnosis, is a way to describe your symptoms and the kinds of treatment that are likely to be most helpful. Diagnoses are also used to bill insurance companies. An accurate diagnosis will help you to make sense of your experiences. You are free to ask your counselor any questions you may have about your diagnosis.
Your counselor or doctor will work with you to develop a treatment plan. This is a roadmap developed by you and your counselor that will guide your treatment. Your treatment plan spells out all the services you will receive and may include group counseling, family counseling, and medications in addition to individual counseling. For people who are addicted to alcohol or opioids, medications may be prescribed to help with craving or withdrawal. A doctor, physician assistant, or specially trained nurse must prescribe the medications used to treat alcohol or opioid addiction. It is important that these medications be paired with professional counseling or support rather than used on their own.
In some cases, your doctor or counselor may believe that you have a mental health diagnosis that could benefit from treatment with medications. Medication prescriptions require an initial interview with a doctor or other prescriber and follow-ups every few months.
Counseling is designed to help you understand the physical and mental components of withdrawal from drugs or alcohol and to identify and manage symptoms that interfere with staying on a path to change. During counseling, you may discuss a range of topics designed to help you attain your goals. Counseling can be done in individual sessions, in groups, or using a combination of individual and group. It can include specific strategies to manage anxiety or craving, ways to get support from friends and family, or changes to your eating or sleeping habits that will help you avoid relapse.
In addition, it is common that people in treatment for alcohol or drug use participate in urine drug testing, breath testing or the use of drug patches. This type of screening is done to ensure that you do not put yourself in danger by using alcohol or drugs in combination with medications and help you feel supported in remaining drug free.
Assessment, medication, counseling, and support can all be provided in an outpatient setting or in a hospital or residential treatment program. No one setting is better than another. As with physical health care, residential and inpatient treatment is generally reserved for people who are not able to receive treatment in the community, such as those who have a serious medical need. Outpatient treatment can be very intensive, ranging from one to five times a week and can provide the opportunity for people to participate in treatment while continuing to work and live at home.
Withdrawal from alcohol and certain types of drugs after long-term use in high quantities can create risk for seizures or other complications when someone stops drinking or using. In these cases, a residential or inpatient withdrawal management or detoxification program may be recommended for three to seven days and is usually followed by outpatient treatment.
Although the length of treatment should be based on individual needs, most people find that staying in some type of counseling for six to nine months is ideal. In most cases outpatient treatment is followed by support groups such as 12- step programs or just staying in close touch with people who understand the challenges of changing alcohol and drug use. Some people find participating in church, clubs, sports, or other social activities helps them stay on track. Medications that treat alcohol addiction are usually continued only for weeks or a few months, but medications for opioid addiction can be continued for months or years.
Even though “28-day rehab” programs receive a lot of attention in the media and in movies, ongoing residential or inpatient treatment is not usually recommended for people unless they have serious medical or mental health complications that puts them at risk in the community. The type and length of treatment received should be tailored to an individual’s needs. Explore more about the history of the 28-day residential treatment model and why this specific type of program may not be right for everyone.
Content by Ben Allen, Kaiser Health News. Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.
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