How Are Drug Recovery Plans Created for Inpatient Clients?
An addiction treatment plan provides a recovering client with a comprehensive, individualized program to achieve and maintain abstinence.
To be effective, a treatment plan must be put into action. There are several stakeholders in the treatment plan process, including the recovering person, clinicians, the addiction treatment team, loved ones, and anyone else affected by the addiction (e.g. an employer, a sports team, a social group). Each stakeholder has an important role to play, and treatment plans must be adequately supported.
Since treatment plans are tailored to the individual client, plans vary in size, complexity, form, and content. However, there are some research-based treatment components that should feature into each treatment plan. According to the National Institute on Drug Abuse, treatment plans should include:
- Medication (as recommended and if agreed to)
- Therapy (both individual and group)
- Case management
- Treatment or a treatment referral for any co-existing mental health disorders or physical disorders (e.g. diabetes)
- Services that are focused on the needs of the client based on trauma (such as past or present sexual abuse or domestic violence), sexual orientation, age, race, culture, gender identification, pregnancy, and family status
Each facet of a treatment plan supports the main goal of abstinence. An effective treatment plan not only manages addiction, but also helps to physically and psychologically shift a person out of the mindset associated with substance abuse. For this reason, comprehensive treatment plans include layered services and work dynamically.
The Intake Process
When individuals are first admitted to a drug rehab center, they will go through an intake process. Intake is essentially an information-collecting session, and it provides the rehab with an opportunity to formally introduce itself to incoming clients. The information collection happens mainly through a verbal interview. Some rehabs may also provide incoming clients with a questionnaire. Whether verbal or written, the questions will all be intended to elicit information from clients regarding:
- The drugs of abuse.
- The last time any drug was abused
- The volume of the drug abuse
- The person’s specific history of drug abuse
- Mental health history, including psychiatric symptoms and any diagnoses
- Medical history, including any physical symptoms and any diagnoses (including infections disease status)
- Personal details, including parenting status, family status, sexual orientation, and gender identification
- Whether the incoming client has support from family or loved ones and basic Information about such people
- Goals for recovery
After this information is collected, the intake specialist will relay it to the addiction treatment team. The team will collaborate on a plan that is tailored to the client’s specific needs. While the plan creation is underway, new clients will usually be given a tour of the rehab center and shown to their room. Rehab centers understand that intake, as well as the next 72 hours, is a critical time of transition for each client. Every effort should be made to ensure that clients feel safe and comfortable during this time.
The two main pillars of drug recovery programs are medication (as applicable) and therapy, but there are numerous support beams. As the National Institute on Drug Abuse notes, the following are some of the most common services that are incorporated into a treatment plan:
- Group recovery meetings (e.g., Narcotics Anonymous)
- Mental health services
- Medical services
- HIV/AIDS services
- Housing services
- Vocational services
- Educational services
- Legal services
- Family services
These services do not all qualify as treatments, but they can enhance treatment outcomes and for good reason. As psychologist Abraham Harold Maslow(1908-1970) theorized, individuals must have their basic needs satisfied (e.g., food, shelter) to achieve their potential. The principle applies to recovery. An addiction treatment team, armed with information about the recovering client, may make a recommendation for one or more services to be provided. Even though an inpatient program will fulfill a client’s basic needs on site, a treatment plan is cognizant of client needs after graduation as well. Getting any one or more of the above services can help a client to make a smooth transition back to work, family, and society in general. This type of help can also decrease the risk of relapse after program completion.
Speaking broadly, rehabs provide basic, intermediate, and luxury services and amenities. An intermediate or luxury rehab will have services that are not medically necessary, but can improve or at least support treatment outcomes. Such holistic services (also called complementary treatments) include but are not limited to:
A rehab that offers holistic services will factor them into the treatment plan and daily itinerary. These services are intended to supplement but not replace medication and therapy. The rehab experience is designed to introduce recovering individuals to different approaches and to make their rehab stay enjoyable. After graduation, a recovering person will likely be able to find many local holistic services which can support the recovery process.
Once a treatment plan is in place, clients may discuss it with a member of the addiction treatment team or with a counselor. Treatment plans are modified, as needed, as clients communicate their ongoing experiences and needs to members of the treatment team. Since treatment is supervised 24/7 in an inpatient program, the addiction treatment team will always be apprised of a client’s progress and can provide the most appropriate types of care each step of the way.
Medication and Therapy
The addiction treatment team has specialized knowledge about which drugs and what circumstances warrant a recommendation for addiction medication. When medication is recommended, it is typically introduced during the detoxification phase. Medication can help to safely manage the symptoms of withdrawal, stabilize recovering clients, and help them to maintain abstinence. When a person has been abusing opiates (e.g., heroin) or opioids (e.g., prescription pain relievers such as Vicodin), medication-assisted treatment may be appropriate. Medications used include methadone, buprenorphine (Suboxone or Subutex), and naltrexone. Each medication has a different introduction time, but when any one of them is prescribed, it will usually be during the withdrawal phase (before, during, or after). The medication can then be used for maintenance for weeks, months, or a year or more.
These medications are known as opioid-replacement medications because they substitute a harmful narcotic for a safer one and support addiction-free living.
In some instances, the addiction team may recommend a taper. Individuals who are addicted to benzodiazepines are most always put on a taper. The taper is intended to manage the withdrawal process, so severe or even deadly symptoms do not manifest. Typically, a benzodiazepine is used to taper a person off a benzodiazepine. This is the case because of the realities of neurobiology; it takes a benzodiazepine taper to help a person wean off a physical dependence on benzodiazepines. In some instances, benzodiazepines may be used to help a person who is in withdrawal from alcohol addiction. There are also targeted addiction medications that are approved to help alcohol withdrawal and abstinence maintenance.In still other instances, a complete detoxification may be the most medically appropriate treatment plan (e.g., for marijuana, cocaine, or amphetamines). This means that no targeted addiction medications will be used during the withdrawal and maintenance phase. However, during withdrawal, the attending doctor may prescribe medications, such as muscle relaxers, to relieve symptoms. Over-the-counter medications may be provided as well. The goal is simply to make the person as comfortable as possible while the body detoxifies itself under the supervision of the addiction treatment team.
All treatment plans include therapy. As the National Institute on Drug Abuse discusses, there are different research-based therapy approaches that have proven effective in drug treatment programs. These therapies include but are not limited to:
- Cognitive Behavioral Therapy (CBT)
- Motivational Interviewing or Contingency Management
- Motivational Enhancement Therapy
- Community Reinforcement Approach, Plus Vouchers
- 12-Step Facilitation Therapy
- The Matrix Model
- Family Behavior Therapy
The specific rehab center determines which therapy approaches are offered. Certain approaches, such as CBT, may be used in individual or group counseling sessions. Drug rehabs typically offer those therapy approaches that are most aligned with their treatment philosophy. Inpatient clients will receive individual therapy and group therapy at least once a week but generally more often.
It is important to highlight that group recovery meetings, including those that follow the 12-Step model (e.g., Narcotics Anonymous), are not considered therapy. Group recovery meetings are not therapist-led; rather, members organize, lead, and moderate these groups. Group recovery meetings are considered an integral part of recovery programs. Most, if not all, rehabs across the US include group recovery meetings in their curriculum.