The Pros and Cons of Different Addiction Treatment Options

You have many different options for addiction treatment. It can be confusing trying to decide what the appropriate treatment is for you. This is a list of the most common types of addiction treatment and a brief explanation and overview of some of the major pros and cons of each.

Some of these treatments can be used in combination or one after the other.  For example, you may want to go to a halfway house after rehab or you may want to be in group counseling along with individual counseling.

To determine the most appropriate form of treatment, I suggest that you meet with a counselor or therapist to discuss your options. To be admitted to many of these addiction treatment programs, you must meet the criteria for that program. A counselor will help you learn which treatment you meet the criteria for and which will be the best fit for your situation.

Online Counseling

This involves counseling sessions which happen over the internet, video conferencing such as Skype, telephone, email, chat or texting.

The pros

• You can do this on your own schedule, from the convenience of your home and choose your own counselor. 
  

The cons

• It is not intensive or restrictive, you could find an unqualified therapist and confidentiality could be breached.
  
• Because the sessions take place at the convenience of the client, the addict must be self-motivated to continue treatment.
  
• The addict continues to be in their home environment, which is convenient, but it may also be unhealthy or unsupportive. It is difficult for an addict to make progress when they are exposed to an environment where drugs are available.
  
• Clients also need to be wary of people calling themselves counselors, recovery coaches or therapists who are unqualified. Always check credentials. The website should have a way to verify credentials. Any qualified counselor won't be offended if you ask about their credentials. Ethically, a counselor or therapist should be licensed in order to be qualified to be an online counselor.
  
• Difficulty in maintaining confidentiality. If someone else has access to your computer, they may be able to read emails that you exchanged with your counselor. Technology is never 100% safe. Computer programs can also be hacked so someone could discover your confidential information if they are skilled with computers.

Individual Counseling

This involves meeting with a counselor one on one in an office setting. Sessions generally take place once a week. Individual counseling is usually offered by psychologists, licensed professional counselors, licensed clinical social workers or licensed marriage and family therapists.

The pros

• You can work at your own pace, choose your counselor and choose how often you see your counselor. 
  

The cons

• It is not intensive or restrictive so the addict must be self-motivated to continue.
  
• The addict continues to be in their home environment which may be unhealthy or unsupportive.
  

Individual counseling includes many of the same cons as online counseling except confidentiality should be secure.

Group Counseling

This involves meeting with other addicts and a counselor in a group setting.  The group discusses their issues and the counselor keeps the group on task and facilitates connection between group members. 

The pros

• It has been found effective with addiction and the addict can get social support along with therapy.¹
  
• Addicts can practice new behaviors in a safe environment. They are often more likely to take advice from their peers because they know other addicts understand their issues
• They can also practice communication and social skills in a group environment

The cons

• Confidentiality cannot be completely protected since it relies on group members following the rules.
• Some people are uncomfortable in groups due to anxiety and may not want to speak about personal issues with a group.
  
• The addict continues to be in their home environment which may be unhealthy or unsupportive.  The exception to this is when group therapy takes place in an inpatient facility, halfway house or three-quarter house.

Recovery Meetings

These are peer support groups run by other people in recovery.  Most of them are 12 Step groups like Narcotics Anonymous or Alcoholics Anonymous but there are other types of recovery meetings too. 

The pros

• Most cities have meetings throughout the day at various times, you can have a sponsor for individual support
• They have been proven effective.²
  

The cons

• They are not professional help so addicts with co-occurring mental health issues may want additional help. 
  
• An addict who is physically addicted to a substance like opiates may need a medical detox before recovery meetings can be effective.

Intensive Outpatient Treatment (IOP)

IOPs are counseling groups that meet up to ten hours a week.  These groups are usually about three hours, three times a week.  They may include an individual counseling session once a week.  IOPs are more intensive than regular group counseling.

The pros

• Group therapy has been found effective for addicts
  
• Addicts get the social support of group members
  

The cons

• Confidentiality cannot be completely protected since it relies on group members following the rules
  
• Some people are uncomfortable in groups
  
• The addict continues to be in their home environment which may be unhealthy or unsupportive
  

Partial Hospitalization Program

This involves group counseling on a daily basis from five to eight hours and two individual sessions a week.  Partial hospitalization programs are more intensive than group therapy or IOPs.

The pros

• Group therapy has been found effective for addicts, addicts get the social support of group members and addicts can learn about addiction and gain coping skills

The cons

• Confidentiality cannot be completely protected since it relies on group members following the rules
• Some people are uncomfortable in groups and the addict continues to be in their home environment which may be unhealthy or unsupportive
  

Medication Assisted Treatment (MAT)

Medication assisted treatment is treatment which includes medication such as Suboxone or methadone as a replacement for addicts who are physically addicted to opiates.

Addicts can take medication once a day instead of repeatedly using illicit drugs throughout the day. MAT only keeps the addict from having withdrawal symptoms and must be combined with counseling to help the addict with the psychological, social, legal, vocational and relationship issues created by the addiction.

MAT is a harm reduction treatment which means it focuses on reducing drug use, disease and criminal activity.

The pros

• The addict can stabilize physically and work on long term issues.
  

The cons

• MAT is a long term treatment which can take years to complete. Some addicts choose to remain on MAT their entire life and never complete treatment
• MAT is also prone to abuse by addicts who abuse other drugs while on MAT or sell their medication to buy other drugs
  
• Many addicts have overdosed while on MAT due to taking it with other illegal or prescribed drugs which they abuse. Methadone is especially prone to be combined with benzodiazepines which can be fatal
  
• Suboxone and methadone are both sold illegally on the street by addicts in MAT

In my opinion, since MAT is considered harm reduction treatment, it should only be used by long term addicts who have chronically relapsed.

Detox

Detox is a hospital based treatment or medically supervised treatment to safely take the addict off addictive substances such as benzodiazepines, alcohol or opiates.  Withdrawal from benzodiazepines and alcohol in particular can be dangerous and must be supervised by a qualified physician.  Depending on the detox program, the addict may be given medications to ease withdrawal symptoms.

The pros

• It is a safe way to stop using addictive drugs and will treat the physical addiction
  

The cons

• It does not usually treat the psychological aspects of addiction and should be used in combination with other treatment.
  

Inpatient Treatment

Inpatient treatment, more commonly known as rehab, involves 24 hour treatment with the client living at the treatment facility. It includes individual and group counseling as well as recreational activities and recovery meetings.

Rehabs generally last from two weeks to 90 days, depending on the individual program and insurance coverage. However, there are some long term inpatient treatment programs that can last much longer.

The pros

• This is intensive treatment, addicts can work on co-occurring disorders (in some rehabs)
• Addicts are removed from their home environment and they can learn about addiction and learn healthy coping behaviors
  

The cons

• Time commitment and restriction of freedom
  
• Addicts must follow the rules of the program and are usually engaged in treatment from waking to sleep

Halfway House

Addicts live in a house together in the community, do chores and food preparation, learn life skills and participate in recovery treatment.  It is generally used as aftercare from inpatient treatment. Clients are required to have completed prior drug and alcohol treatment.

The pros

• The addict begins to reintegrate with society while still having peer support and monitoring of staff
  
• Clients can have access to services such as vocational training, GED training, housing assistance, medical and dental assistance and recreational activities
  
• The addict is removed from an unhealthy home environment and can learn how to function again in society and develop support in the community 
  

The cons

• Time and commitment from the addict.  Halfway houses are less restrictive than inpatient treatment. You have to report in to staff but can earn permission to go places

Three Quarter House

Three quarter houses are also called recovery houses, sober houses or sober living. They are homes where addicts can live while continuing to develop their recovery program and practice coping skills.

The pros

Addicts are removed from unhealthy environments, can work, develop support, practice coping skills, learn daily living skills, show responsibility and reintegrate into society

The cons

• Time and commitment from the addict.  Three quarter houses are less restrictive than halfway houses or inpatient treatment
  

Treatment - Recommendations

Addiction is a lifelong disease which requires lifelong treatment. Addicts who commit themselves to longer, more intensive treatment programs have the best outcomes. It is recommended that addicts who have not succeeded at short term or outpatient treatment make a commitment to inpatient treatment.³

In my experience:

• Addicts who are physically addicted to substances such as opiates, alcohol or benzodiazepines need medically supervised detox which should be followed by inpatient treatment and then a halfway house and/or three quarter house living
  
• Addicts who have tried inpatient treatment repeatedly and have continued to relapse should commit to long term residential care
  
• 12 Step recovery meetings should be a part of any treatment program and can be continued throughout the lifetime of the addict
  
• In my opinion, medication assisted treatment is only recommended for addicts who have been to numerous other treatments and chronically relapse
  
• Addicts may need to periodically return to individual and/or group counseling during stressful periods of their life to prevent relapse