Do You Need to Go to Rehab?

So you’ve decided you need help because you can’t stop drinking or using drugs on your own. Good for you! Now the next major decision to make is to decide between getting help on an outpatient basis or getting residential care (rehab).

This is an important choice and by getting it right from the start you improve your odds of success. Given this, you probably shouldn't make the decision on your own. It makes good sense to find a professional who can assess you and make a treatment recommendation that’s appropriate to your needs, location and situation.

To find someone who can perform this service:

• Ask your doctor for a referral
• Get in touch with an addiction counselor
• Get in touch with a local addiction treatment provider (they will have assessment professionals on staff or can refer you to a local option).

Though you might think it’s primarily just a decision between getting outpatient treatment or rehab, there are actually many different treatment options, at varying intensities, and you might benefit most from a combination of more than one type of intervention. Different treatment options that an assessment professional might recommend include:

Outpatient Options

• Getting individual addiction counseling
• Getting into an ambulatory detoxification program (where you check-in daily with a doctor and get appropriate medications, but spend most of the detox period at home.)
• Getting substance abuse focused behavioral couples or family counseling
• Joining an outpatient addiction treatment program or an intensive outpatient addiction treatment program. An outpatient program usually provides one or two evening or weekend group or individual therapy sessions per week, and may last for a year or longer. An intensive outpatient program typically provides between 10 and 20 hours of group and individual therapy per week.¹
• Joining an all-day addiction treatment program (this would have a very similar daily schedule to a residential treatment program, but you would go home each night to sleep.)
• Joining a local therapy group
• Community mutual self-help group, like AA/NA or SMART Recovery meetings
  

Residential Treatment Options

• Inpatient medical detoxification program
• Drug or alcohol rehab
• Specialty drug or alcohol rehab (trauma sensitive or trauma focused, dual diagnosis capable, gender specific, age specific – adolescent or senior)
• Inpatient medically monitored treatment (psychiatric hospital care)
• Long term residential care (therapeutic community)
• Halfway housing or sober living housing

Do You Need Rehab?

Unfortunately, this isn’t an easy question to answer.

Professionals rarely make treatment decisions based on a single determining factor, they normally consider a range of mental, physical, emotional, historical and environmental factors and make a placement decision based on this big-picture assessment.

To help you decide whether residential or outpatient treatment makes most sense, consider the following assessment variables.

Detox variables 

• People withdrawing from alcohol or benzodiazepines (benzodiazepines are rarely withdrawn cold-turkey) may need residential care during detox. People withdrawing from opiates who are expected to have complicated withdrawals (for example those with poly-drug dependence or other serious health conditions) may also require residential treatment.
• People withdrawing from drugs like marijuana or cocaine may not require residential detoxification.

Treatment Variables²

• Are you addicted or abusing? People who are substance dependent (addicted) tend to require more intensive treatment than people who abuse drugs or alcohol, but are not yet dependent. In most cases, substance abuse only is best treated on an outpatient basis, while depending on the severity, substance dependence can be treated in an intensive outpatient program, a day treatment program or a residential treatment program.
• Are you addicted to more than one drug? The more substances you are dependent on the more complicated the treatment. Someone who is addicted to cocaine and alcohol is more likely to require residential treatment than someone addicted to only one of those substances.
• Do you have co-occurring mental illness? People with active addiction and symptomatic mental illness are more likely to require residential treatment and more intensive integrated treatment.
• Do you have a serious physical illness that may get worse when you stop using drugs or alcohol? Although reducing your drug or alcohol use will almost certainly improve your long-term health, the short-term process of getting to abstinence can create medical complications - especially for people with diseases like hepatitis C, cirrhosis, HIV and others.
• Have you ever tried outpatient treatment before? You want to find the least intrusive level of care that gets you the results you need. If you haven’t yet tried far less costly and disruptive outpatient treatment, it may make sense to start with this and see if it helps. If you’ve tried outpatient before, especially recently, and not found success, this indicates a need for a higher intensity level of care, like residential.
• Does your home situation help or hinder your recovery efforts? If you’ve got supportive people in your life and a safe, sober and stable home situation, then you’re more likely to have success with outpatient treatment than you would if living without sober support or if living in an unstable environment and exposed to temptation in the home.
• Can you get away from work or school for a month or longer? While it’s rarely easy for anyone to find a ‘free’ month for treatment, in some situations, it’s prohibitively hard. For example, if you’ll lose a good job to go to rehab, then maybe you need to try outpatient first. Remember though, for most people it’s getting insufficient treatment that ultimately leads to job loss.
• Can you get to outpatient sessions? If someone needed intensive outpatient or day-treatment but lacked reliable transportation to sessions or lived too far away for a daily commute, that person might be better off in a residential program – or in a day-treatment program and sober-living environment.
• Will you actually go to outpatient sessions? If you know that on your own you’ll blow off meetings and therapy sessions, then you may need the structure and support of a residential program.
• Do language or cultural concerns preclude residential care? It’s important to think about cultural fit and language accessibility. For example, if a person speaks only Korean and residential services are available only in English or Spanish, that person would need to either travel to a distant language accessible facility or get less intensive counseling from a Korean speaking counselor.
• If residential treatment is possibly indicated, can you afford it or access low-cost care? In an ideal world everyone would get exactly what they need – in this world, things don’t always go so smoothly. If residential treatment is indicated, can you afford the out of pocket costs and or will your insurer fund residential care? If not, are there local public or charitable options worth considering and are their availability issues or waiting lists to consider?

Do your answers to the questions above mostly point you toward rehab, or toward an outpatient option as a best starting point?

Rehab or Outpatient - Which Is Better?

Not which is best – which is best for you!

Although you might feel that more intensive treatment, like rehab, gives you a better chance at success, no legitimate treatment is really ‘better’ than another, it just depends on your needs.

• Rehab provides you with the safety and structure and time you need to get past the really difficult first few weeks of abstinence. Since it’s an intensive all-day program, you can learn a lot about the disease and learn many effective coping strategies within a short period of time.
• Outpatient treatment isn’t nearly as disruptive. You can still go to school or work while in treatment and the costs are generally a fraction of residential treatment. Additionally, by staying at home and in ‘the real world’ you can put all the coping strategies and tools you learn into immediate practice.

A Starting Point Isn’t an Ending Point

Remember – treatment and recovery aren’t things that happen on a neat and tidy 28 day timeline. Recovery lasts a lifetime, the brain changes of addiction are lasting or permanent and you may need different types of interventions at different periods, as your needs change.

Ideally, your treatment experience changes as your needs change. When you start off in an intensive outpatient program and do well, it makes sense, after a while, to step down to a less intrusive form of treatment, such as a weekly counseling session.

On the other hand, if you’re not making sufficient progress at one level, it makes just as much sense to intensify treatment to a level that meets your needs. If an intensive outpatient program does not lead to significant improvements, this doesn’t mean that treatment doesn’t work, it just means you need more intensive care, such as the treatment you’d get in a day treatment program or a residential drug or alcohol rehab.