How Heavily Do Inpatient Programs Rely on Therapy?
When a person struggles with addiction, one of the most important steps in their treatment is to enter a rehabilitation program.
Ultimately, the decision between an inpatient and outpatient rehabilitation program is made on a very individual basis; however, for people who need to get out of their current environment to overcome their addiction, inpatient rehabilitation programs are often the best answer.
All rehabilitation programs focus on counseling and therapy to help the individual understand how their addiction was triggered and how they can avoid relapse in the future. Inpatient rehabilitation is unique, however, because the individual is present at the facility every day for several weeks. This gives the individual in the program greater access to many types of therapy every day. The treatment process is intense and very beneficial for clients.
The Therapy Schedule in Inpatient Rehabilitation
An inpatient or residential treatment program is designed to offer social support to help a person overcome their addiction through better understanding and the acquisition of new habits. By entering a new environment, the person is given a fresh daily routine that focuses on overcoming problems with their behavior and their original environment, which may have contributed to substance abuse.
A large part of the daily routine in an inpatient treatment program involves creating a new structure, but just as importantly, the person attends several therapy sessions. Many of these are group therapy sessions; one measurement noted that 93 percent of treatment programs in the US relied on group therapy to facilitate long-term sobriety and relapse prevention. However, treatment programs also offer individual therapy, either “as needed,” in conjunction with group therapy, or as an alternative to group therapy, which may involve too much disclosure of personal information for some people.
Here is an outline of a potential daily routine for a person in an inpatient treatment program:
- Morning: breakfast, chores, take medications, checkups with doctors or nurses
- Mid-morning: first group therapy session, then journaling
- Afternoon: lunch, individual counseling and/or a secondary group counseling session; additional medications if needed; free time or exercise
- Early evening: visitation time, family therapy or other group therapy
- Later evening: social time, dinner, phone calls, final medications, quiet time
While the specific details, like exercise and free time, can differ between rehabilitation facilities, a person attending an inpatient rehabilitation program spends most of the day focusing on therapy sessions or revolving other treatment options around therapy. Types of therapy can change by day of the week too; for example, Monday, Wednesday, and Friday could focus on group therapy sessions, while Tuesday and Thursday focus on individual therapy sessions, and Saturdays could be family therapy sessions.
Types of Therapy in Inpatient Rehabilitationm
There are a variety of types of therapy that can be applied during inpatient treatment. NIDA lists options including:
- Cognitive Behavioral Therapy: This type of therapy focuses on relapse prevention by identifying problem behaviors, which are maladaptive reactions to stress. The individual and their therapist will then create strategies to cope with the emotions differently and learn a new behavior that is positive. This is geared toward enhancing the person’s self-control, so they can maintain sobriety.
- Contingency Management: This therapy involves not just learning more positive behaviors, but also rewarding choices that reinforce abstinence and healthy living. Essentially, Contingency Management focuses on the brain’s risk/reward system, which has been changed through substance abuse, and rewires it to understand that there are benefits to choosing sobriety.
- Motivational Enhancement Therapy: This is a form of therapy designed to help people who did not enter treatment voluntarily to resolve their ambivalence toward overcoming addiction. The treatment is intensive and focuses on helping the person understand the risks of continuing substance abuse and uncover personal motivation to enter a larger treatment program.
These approaches to therapeutic treatment can be applied in group, individual, or family therapy. They are also used in alternative therapy options, such as wilderness therapy or art therapy. A therapist may be trained in a specific approach, or they may change tactics depending on how their client will best respond.
Is More Therapy Better?
The National Institute on Drug Abuse (NIDA) recommends that a person overcoming addiction spend at least three months (90 days) in a rehabilitation program, but for many people, their insurance or state coverage only grants them one month (28-30 days). This coverage may be for outpatient programs specifically or for inpatient rehabilitation.
Generally, inpatient treatment involves more time in therapy than outpatient treatment, simply due to the wholly immersive nature of the program. The exact amount of time spent in therapy will be based on the individual’s issues and progress in recovery. More time in therapy has been correlated with more gains in treatment.
Inpatient programs focus on counseling and therapeutic treatment to help people modify their behaviors and their general attitude about life, so they can make healthy choices. Many scientific studies have shown that people who enter treatment to overcome an addiction maintain abstinence and avoid relapse longer when they receive ongoing therapy. For example, people who use maintenance medications like methadone or buprenorphine are more likely to taper off the medication and end their dependence on substances when therapy is part of the process compared to when just medication is used.
When trying to learn a new habit – anything from cooking healthier meals at home to giving up use of intoxicating substances – people are likely to struggle with a psychological concept called an “extinction burst.” Habits that offer immediate rewards, such as triggering a release of dopamine, are difficult to give up, as the speed and intensity of the psychological reward reinforce the behaviors. For people who struggle with addiction, working with a therapist and a group of peers can help them to understand the destructive aspects of falling into drug-seeking behavior patterns again. Therapy can also help them to find new ways to trigger the reward system in the brain to reinforce more beneficial habits.