The Steps to Getting Your Life on Track
For anyone contemplating entering rehab for drub abuse or addiction, knowing what the process is like can make it easier to take that first step toward recovery. Most people, however, don’t know what to expect. As a result, they may hesitate due to nervousness about the symptoms of withdrawal, the elements of therapy, or a fear of relapse after the process is over.
By developing a step-by-step understanding of the different kinds of rehab, the different treatments and activities involved, the timeline for treatment and recovery, and tools that can help the individual get through the challenges of triggers and cravings after treatment is over, a person who is considering rehab can be reassured about the process and may be more likely to move forward along the treatment path toward lasting recovery from drug abuse and addiction.
Understanding the Addiction Recovery Process
Substance abuse and addiction are considered to be chronic mental health disorders in which a person is physically and mentally dependent on a substance to function on a day-to-day basis. This type of chronic mental illness is similar to chronic physical illnesses in that treatment is a process of learning to manage the addiction, rather than being a cure that will make the addiction go away forever.
As described by the Journal of the American Medical Association, treating addiction can be much like treating asthma, high blood pressure, or diabetes. People with these chronic physical illnesses often experience relapse over the course of treatment that make it necessary to adjust treatment, change the types of treatment, or even consider new symptoms that might not have been recognized before.
Similarly, substance abuse results in comparable rates of relapse. So, like with chronic physical illness, if a person has a relapse after drug rehab, it is not a failure; it is simply a sign that treatment needs to be adjusted, changed, or even explored more deeply in order to get that individual on a more secure recovery path. This is the basis of the addiction recovery process, which focuses primarily on relapse prevention – on making sure that the individual has the tools and knowledge needed to bring the chances of relapse down as much as possible.
- According to the most recent National Survey on Drug Use and Health, about 27 million people 12 and older are current users of illicit drugs; 6.5 million use prescription drugs for nonmedical purposes.
- A little more than 21 million people experienced a substance use disorder of some kind; however, only about 2.5 million received the recommended specialized treatment for their disorder.
- There are more than 14,000 treatment centers of various kinds throughout the US. About 11,500 of them provide outpatient treatment, 3,400 provide outpatient treatment, and more than 700 are hospital facilities.
- Relapse rates for addiction, which are about 40-60 percent, are similar to those for asthma (50-70 percent), hypertension (50-70 percent), and type I diabetes (30-50 percent).
Most Common Treatment Options
The American Society of Addiction Medicine (ASAM) has established levels of care that define the basic types of addiction treatment. The most often used treatment options are outpatient, partial hospitalization or intensive outpatient, and inpatient services. Which kind of treatment is used depends on the severity of addiction, the individual’s motivation to recover, and other factors that may affect the person’s relapse risk.
Outpatient treatment is generally recommended for people who have a lower risk of relapse. This may be viable for someone who is abusing substances but is not yet addicted. It also may be a viable option for people with a strong motivation to change and life circumstances that provide a great deal of support for recovery. It usually involves fewer than nine hours per week of treatment.
Outpatient treatment may also be an option for a person who has completed inpatient treatment but does not yet feel ready to return to normal daily life. This person may have particular challenges to the ability to avoid relapse, such as:
- An unstable home situation in which support for sobriety is not consistent
- Low motivation to maintain sobriety or recovery
- Long-term addiction or polydrug addiction that requires more intense management
- Co-occurring disorders, such as depression or post-traumatic stress disorder, that need concurrent management
The ASAM criteria consider outpatient treatment to be a less-intense, lower level of treatment. For those who need more intense treatment, partial hospitalization may be used.
Partial Hospitalization or Intensive Outpatient Care
This form of treatment is similar to outpatient treatment in that the individual can still live at home. However, it requires nine hours or more per week of involvement in therapy, 12-Step sessions, and other programs that promote and teach abstinence and relapse avoidance.
Programs for partial hospitalization may include educational sessions, group discussions or presentations on topics relevant to the participants’ needs, and one-on-one or group therapy at a treatment center. The regular participation helps to keep the skills learned in the forefront of the person’s mind; at the same time, the individual is still able to go to work or school, attend to daily responsibilities, and sleep at home.
Partial hospitalization still assumes that the individual has support at home and from friends to remain abstinent. If home life or other circumstances present triggers that lead to continued substance abuse, inpatient treatment may be a better option.
Inpatient treatment allows an individual to reside at a treatment center during rehab. This provides a number of benefits that support recovery for those who may find it harder to avoid relapse. Benefits include:
- Supervision and support provided 24/7 by trained personnel
- The ability to focus on treatment without the distractions of daily life
- Time to recuperate and learn avoidance skills away from daily triggers
- Restriction from access to drugs and alcohol to promote needed abstinence
- Treatment capabilities and support for co-occurring physical or mental health conditions
Inpatient treatment may also provide other types of treatment support, such as exercise programs; alternative therapies like art, music, or animal-assisted therapies; yoga and meditation; and other programs through which the individual can develop the self-confidence and motivation to maintain recovery after the rehab period is over.
For certain individuals with long-term, heavy drug use, particularly with drugs that are dangerous in withdrawal, such as alcohol or benzodiazepines, medically supported inpatient treatment may be necessary. This is usually the most intense form of treatment, and requires availability of a licensed physician and/or nurse to monitor the person’s medical treatment.
The Treatment Process
A reputable treatment program has a series of steps that are followed to provide customized treatment for the individual. Each person has unique and personal reasons for, and causes of, substance abuse or addiction. Because of this, it’s important to personalize treatment to meet the individual’s specific needs.
The process of treatment, from diagnosis through therapy to aftercare and beyond, is to help the person understand the specific triggers and cravings that lead to substance use; develop skills and tools to manage, avoid, or circumvent those triggers and cravings; and build the self-confidence and motivation to apply those skills in the months and years after rehab, leading to long-term abstinence.
The following general process timeline outlines the steps and how they work together to help achieve lasting recovery.
When a person makes the decision to enter treatment for a drug abuse or addiction, the first step is to diagnose the severity of the disorder and determine the level of treatment that is needed in order to give the individual a positive chance of achieving recovery.
Diagnosis involves drug testing to some degree, but is more involved with learning about the circumstances of the individual’s drug use, including, but not limited to:
- How much and how often the drug is used
- Whether there is more than one drug involved
- Physical and mental symptoms
- Possible underlying or co-occurring mental health disorders
- How drug use is affecting the person’s daily life, responsibilities, relationships, and behaviors
After completing a thorough analysis, the specialist diagnoses the degree of addiction and treatment needs based on the ASAM criteria and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This helps to develop a plan for the full rehab process for that individual, which will generally include the following elements.
If the individual still has the drug (or drugs) in the body, medical detox is the next step for treatment. In some cases, if the person is experiencing acute withdrawal or life-threatening overdose, emergency or medically supported detox will begin before the full treatment diagnosis is completed. For most individuals, however, the withdrawal and detox process is managed at the beginning of the treatment program. Detox alone does not constitute substance abuse treatment, but it is often among the first steps in the recovery process.
Detox is a natural process that the body goes through when eliminating a drug from the system. It cannot be sped up, but it can be made more tolerable through medical support, as needed. Depending on the drug of abuse, medications may be provided under the watchful eye of the treatment professionals to ease cravings and other symptoms of withdrawal, making it easier to get through that process without relapsing.
Depending on the substances that have been used, this process can take a few days to two weeks or more to complete. In general, most detox periods are 5-7 days. Therapy can begin while detox is in progress for most individuals.
Once the detox process is underway, the individual can begin treatment and therapy sessions. There are various types of therapy that may be used in addiction treatment, including:
- Cognitive Behavioral Therapy: aimed at recognizing and managing triggers and cravings
- Contingency Management: directly rewards abstinence and relapse preventive behaviors
- Community Reinforcement Approach: provides incentives and positive behaviors that make drug use less desirable
- Motivational Enhancement Therapy: resolves ambivalence and increases desire for recovery
- Education: teaches about how drugs affect the individual and why abstinence is the positive choice
Other therapeutic elements involve working with family members and others to resolve relationship issues and other situations that may encourage relapse after treatment is over.
Peer Group Work
Many drug treatment programs are based on the 12-Step model, which helps by connecting the individual with others who are also struggling with addiction for support, education, and accountability. By progressing through rehab with others in this type of group, the individual often feels reassured and more confident about completing the rehab process.
Accountability and motivation are the main positive influences of 12-Step or similar peer support group programs. The person’s sponsor and the group as a whole support the individual in staying abstinent as part of interacting with the group, and they will uphold that expectation. That can be a powerful motivator for the individual to avoid relapse and stay in recovery.
In addition, the advice and support of those who have been through the same thing can help an individual work through challenging moments, such as triggering situations, and help them get motivated to try again should a relapse occur.
Other Elements of Rehab
Not all rehab programs offer additional programs and activities, but those that do can provide other means through which the individual can channel cravings or situations that might otherwise lead to relapse, and instead engage in healthy ways to stay abstinent. These elements might include:
- Exercise programs
- Nutrition programs
- Meditation or yoga
- Animal-assisted therapy
- Art or music therapy
- Journaling or writing
These elements of the rehab process not only ease the treatment process by making it more comfortable, but they enhance treatment and offer tools by which challenging moments or trigger situations can be managed without returning to substance use.
Once rehab is over, some people may become involved in an aftercare program. This allows them to return to their daily lives to some degree, while still engaging in regular therapy, 12-Step meetings, or other programs that support recovery after the rehab process is complete.
Like treatment, aftercare may involve programs, such as sober houses, that minimize access to drugs or alcohol while providing continuing education and therapy opportunities. Other programs, like Contingency Management or Motivational Enhancement Therapy, may continue after rehab to maintain the person’s motivation as situations that may serve as triggers are slowly reintroduced. Alumni programs at treatment facilities can maintain connections to staff members and peers who have been through treatment, giving access to resources and support for years beyond the rehab program’s completion.
This continuing care is considered to be an important element of long-term recovery from addiction, based on the condition’s chronic tendencies.
Long-term sobriety is ongoing recovery from drug abuse or addiction. As long as the individual is able to maintain the practices and skills learned in rehab, recovery continues.
Long-term sobriety is more likely to be achieved if the individual spends adequate time in treatment. Continuing care through aftercare, ongoing 12-Step involvement, and activities that promote overall wellness is key to increasing the likelihood that treatment will lead to a lasting recovery.
As mentioned at the beginning of this article, relapse may occur. It can help the individual to remember that relapse doesn’t mean treatment has failed; it simply means that treatment needs to be reintroduced or adjusted in order to get back on course to long-term recovery.
- How long should one stay in a treatment program?
- Is it safe to treat addiction with medication?
- Who helps in the recovery process?
- Is addiction curable?
- What is relapse prevention?
- How can family members help in the rehab process?
- What recovery services are available for those with limited resources?
How long should one stay in a treatment program?
Research demonstrates that the longer a person stays in treatment, the more likely that person is to achieve long-term sobriety and recovery. For that reason, short-term or minimal treatment programs, while they can assist to a degree, are less likely to help the person successfully avoid relapse.
Treatment length is evaluated throughout the treatment process, beginning at diagnosis. Because some drugs – like cocaine or benzodiazepines – can result in mental withdrawal symptoms that last up to a year or more, staying in rehab longer than the well-known default of 28 days can help people learn to manage cravings that will arise once rehab is over. A one-month stay is helpful, but a 90-day rehab stay might be better for some individuals. Therapeutic communities may offer treatment periods of 6-12 months. The diagnosing professional can determine what appears to be best for the situation at hand.
Is it safe to treat addiction with medication?
In certain situations, medication may be necessary to help an individual during certain parts of the recovery process. People who could potentially exhibit dangerous withdrawal symptoms, or people who have a very high risk of relapse, may be given medication to manage the withdrawal process or to minimize severe cravings. People with co-occurring conditions may need medication to manage those symptoms in order to prevent them from triggering cravings as well.
However, it is important for the additional aspects of the treatment process to be applied even in the situations where medication is used. When the person learns to manage the addiction, it can be possible to minimize or even cease use of medication, in some cases. Medication on its own does not constitute effective addiction treatment; it should only be used in combination with therapy.
Who helps in the recovery process?
Several types of treatment professionals certified in addiction treatment – as well as nonprofessionals – can help with the recovery process. These people include:
- Medical doctors and nurses
- Psychologists and psychiatrists
- Specialty therapy experts, such as art therapists, animal therapists, etc.
- Personal trainers or exercise instructors
- Intake specialists
- Program and case managers
- Sponsors in 12-Step programs
- Family and friends
The importance of the individual’s personal social circle cannot be underestimated. Their support and involvement can provide the motivation needed for the individual to keep striving for long-term recovery.
Is addiction curable?
There is no cure for addiction. Like many chronic physical and psychological illnesses, addiction can be managed, but not cured. However, by getting help through rehab and treatment for addiction, the individual can learn to maintain abstinence from drug use and achieve recovery.
All of the above treatments and levels of care are designed to meet the individual at the right place to promote effective management of substance use disorders. While there is no cure for addiction, it is possible to achieve lifelong abstinence and wellness with professional help.
What is relapse prevention?
The underlying goal of addiction treatment is relapse prevention, or helping the person manage triggers and cravings in order to be able to stay sober for the long-term.
All of the tools in rehab are designed to support relapse prevention, from the processes used during detox, to the therapies that make up the bulk of care, to the exercise, nutrition, and peer support elements utilized throughout the entire program. By applying the skills and tools learned in rehab, the individual can avoid relapse and maintain long-term recovery.
How can family members help in the rehab process?
Family members provide a strong support system and source of motivation to the individual in rehab. That alone can be a source of inspiration to continue working toward recovery and long-term sobriety. As a result, family can play an extremely important role in the recovery of a loved one.
In addition, by participating in family therapy sessions, family members can learn to understand how some relationship dysfunctions – like enabling behaviors and co-dependence – contribute to continued substance abuse. Being active in a loved one’s rehab process is a way to create a new relationship dynamic that supports ongoing recovery.
What recovery services are available for those with limited resources?
Many states have state or federally funded programs to help people who don’t have the funds needed to get the treatment services they need. These programs often provide at least detox and therapy, along with information and connections to 12-Step or similar groups.
Insurance policies often provide coverage for substance abuse treatment. In addition, admissions coordinators at a treatment facility can help individuals identify sources of financial support, such as loans or other programs that can remove some of the financial burden of treatment. By working directly with treatment personnel, individuals may find resources to support a more robust treatment program with individualized services that are more likely to lead to sobriety and result in long-term recovery.
“American Society of Addiction Medicine.” (n.d). The ASAM Criteria. Accessed September 23, 2018.
Bradbury, Allison. “Behavioral Health Treatments and Services.” (January, 2019). SAMHSA, U.S Department of Health & Human Services. Accessed September 23, 2018.
“Drug Addiction (Substance Use Disorder).” (October, 2017). Mayo Clinic, Mayo Foundation for Medical Education and Research. Accessed September 23, 2018.
“Drugs, Brains, and Behavior: The Science of Addiction.” (July, 2018). National Institute on Drug Abuse. Accessed September 23, 2018.
Gifford, S. “Differences Between Outpatient and Inpatient Treatment Programs.” (2018). Psych Central. Accessed September 23, 2018.
Gross, S. “Relapse Prevention” (2018). Psych Central. Accessed September 23, 2018.
Hedden, Sarra L, et al. “Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health.” (2015). Center for Behavioral Health Statistics and Quality. HHS Publication No. SMA 15-4927, NSDUH Series H-50. Accessed September 23, 2018.
“National Survey of Substance Abuse Treatment Services (N-SSATS).” (2014). SAMHSA, Substance Abuse and Mental Health Services Administration. Accessed September 23, 2018.
Oestreicher, A. “Art Therapy in Addiction Recovery”. (July, 2018). Psych Central. Accessed September 23, 2018.
“Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).” (January, 2018). National Institute on Drug Abuse. Accessed September 23, 2018.
Proctor, et al. “The Continuing Care Model of Substance Use Treatment: What Works, and When Is ‘Enough,” ‘Enough?”.” (March, 2014). Psychiatry Journal, Hindawi. Accessed September 23, 2018.
“Public Policy Statement on Treatment for Alcohol and Other Drug Addiction.” (n.d). ASAM, American Society of Addiction Medicine. Accessed September 23, 2018.
“Substance Use Recovery and Diet: MedlinePlus Medical Encyclopedia.” (March 23, 2018). MedlinePlus, U.S. National Library of Medicine. Accessed September 23, 2018.
“Treatment Approaches for Drug Addiction.” (January, 2019). National Institute on Drug Abuse. Accessed September 23, 2018.
“Understanding Drug Abuse and Addiction: What Science Says.” (February, 2016). National Institute on Drug Abuse. Accessed September 23, 2018.
“What Are the ASAM Levels of Care?” (July 20, 2018). ASAM Continuum | ASAM Criteria Decision Engine. Accessed September 23, 2018.