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Levels of Care For Addiction Treatment

Alcoholic drinks & alcohol poisoning.

When it comes to addiction treatment, sometimes it takes a village to get us to where we need to be, no one does this alone.

But where do you start? What does the first step look like?

It can be somewhat difficult to navigate the different levels of addiction treatment and care. Here is a breakdown starting with the highest level of care, detailing each and what you should consider if you are ready to get into treatment for alcohol or substance abuse.

Levels of Treatment

The American Society of Addiction Medicine sets the guidelines for a continuum of care, a flexible treatment system in which individuals can enter the level most suitable for their needs, and if necessary, step up or down in the treatment intensity.

  • Medical Detox

  • Inpatient Treatment

  • PHP - Partial Hospitalization Program

  • IOP - Intensive Outpatient Program

  • OP - Outpatient Program

  • Sober Living

  • Individual Counseling or Aftercare Program

Medical Detox

Traditionally medical detox is done outside of a hospital at a treatment center that offers detox. Typically it takes about seven days to get through a medical detox, however the length of time will depend on the individual, what substances were used, over what duration, and if there are any ongoing medical issues.

There is also an ambulatory detox. If an individual isn’t able to go into detox for a week or five days, some doctors will allow an ambulatory detox at home. Individuals work with a doctor and licensed medical professional to be able to get through some of the withdrawal symptoms comfortably at home.

Stopping cold turkey alone isn’t recommended. It’s important to know the withdrawals from a few substances like alcohol and some benzodiazepines can be fatal in their withdrawal. Speaking to a medical professional or at least the treatment center can give individuals guidance on how to detox safely.

“I've done some assessments in the past. I can think of two off the top of my head where we were in the assessment and the individual, both of them were experiencing shakes, having a lot of difficulty concentrating, difficulty answering questions. I will stop the assessment immediately and transport them or have them transported to a medical detox,” says Matt Goff, Clinical Director of Care Addiction Center. “A lot of times, folks think, hey, I don't have to get into detox yet. Let me do this on my own. And it's not always a safe way to go.”

Biopsychosocial Assessment

Detox is only addressing the physical side of addiction, not the psychological side of addiction which is the next step in treatment.

Once healthy, an individual can move into one of the next steps with an inpatient or day program. Right on the heels of detox with a baseline of sobriety is the time to re-address what's going on psychologically with a biopsychosocial assessment.

The biopsychosocial assessment, as the American Society of Addiction Medicine calls it, is the biological, the sociological and the psychological aspects of what's going on with a patient.

Biological perspective:

  • How is the physical health?

  • Any medications?

  • Are there genetic vulnerabilities?

Sociological perspective:

  • What peer support is there?

  • What family circumstances are going on,interpersonal relationships, any past trauma, legal concerns?

  • Is there any community support?

  • Are they already connected?

  • Do they have any type of support system?

Psychological perspective:

  • What coping skills are in place now?

  • What does the individual utilize to manage cravings or triggers?

  • What is the self concept?

  • What is the self esteem gate?

  • Are there any mental health concerns?

From the biopsychosocial assessment, a trained medical professional is able to make a recommendation of what level of care would be most effective and appropriate for the patient.

When someone comes in to do an assessment, they are not second guessed. So when coming in, there is no point in minimizing what substances are being used, the frequency or how much. Hopefully the individual is at a point in their life where they are ready for change and are sick and tired of being sick and tired.

Inpatient Treatment

Inpatient treatment is the next step below detox - detox is the highest level of care, and inpatient is the next. Inpatient, sometimes referred to as residential, are facilities that are set up to live in full-time. That's the major difference between an inpatient or outpatient program - whether someone is living in the treatment facility, or coming to the facility for treatment then leaving.

Typically, inpatient programs last around 28 days. Based on progress, they can be extended. Most of the time it's highly structured with activities scheduled from as early as 7:00 am until 10:00 pm with different lectures, groups, outings and learning new support systems in individual therapy. The nice benefit of an inpatient program is the day is planned - there is not much time to do much else.

Another benefit of an inpatient program is the 24 hour medical care staff on site. Some individuals enjoy that, some individuals need that.

However, there are barriers that take some planning prior to treatment:

  • Most of the time individuals will need to figure out what to do with their employer. Are they allowed or able to get some time off?

  • If the individual has children, how is that going to work as far as child care?

  • Are there other responsibilities or accountability that needs to be fulfilled while away?

When addressing these barriers, it can be important to remember that a change of perspective and different outlets are needed. Most of the time though, the reason individuals don’t want to go is fear. But knowing what inpatient treatment really looks like reduces some of that fear.

Outpatient Treatment

The next step below inpatient treatment is outpatient treatment. In an outpatient rehab program, the individual lives at home and comes to the addiction center for treatment. This environment allows flexibility to stay connected with family and hold a job while receiving help.

Outpatient treatment varies from several hours per day to a few hours per week with group settings or individual counseling. Here are the different types of outpatient treatment.

PHP - Partial Hospitalization Program

The highest level of outpatient treatment is PHP, a highly structured program focused on rehabilitation and getting skills and counseling supports in place. PHP is a day program. Individuals go in in the morning, there will be group therapy, a break for lunch, and then another long group in the afternoon. Typically it's 8:00 am to 3:00 pm, individuals return home, sleep in their own bed - but again, they are gone for most of the day.

IOP - Intensive Outpatient Program

IOP is a program that meets between 9 and 18 hours per week, at least in the state of Illinois, because that’s the regulations for IOP. It's determined by the hours per week. Some programs may be three days a week, other programs maybe five days a week.

IOP allows for 3 hours per day of treatment. Typically it's in the evening, some individuals have it in the very early morning. Individuals are still able to work a full time job and sleep in their own bed at home.

One of the biggest positives of IOP is that individuals are able to use the skills and strategies they learn in real time. In inpatient or residential, individuals are in an extremely structured, safe environment but the stress levels and the day to day agitations aren't as present. In an IOP program, individuals are able to participate in a normal life and see what coping skills work for and what don't - and readjust.

OP - Outpatient Program

A step below IOP is OP, or regular outpatient program. What determines this is state regulations of 6 hours or less per week. This could be two days a week for 3 hours each, or some programs run it one day a week for 6 hours. Individuals still receive counseling, but less supervision.

Outpatient is sometimes referred to as learn-and-live. Individuals participate in OP group settings and they have counselors bringing in new content. Individuals are able to tear it apart, talk about it, and then the next day they are able to go out and live it.

The goal is for patients to come in and walk the continuum of care. If a patient starts off on detox, the ideal path is to get all the way down through OP. The longer the services and the longer the supports are in place, the better the outcomes of sobriety.

Sober Living

Sober living is a structured environment where individuals can live with others in recovery as a transition from rehab to mainstream society. Most of the time, sober living homes are privately owned - they're not owned by corporations or treatment centers.

The unique thing with sober living homes is there aren't normally time restrictions on them. When individuals go into a halfway house, there's a time restriction on how long you're able to remain in the house whereas in a sober living house, individuals can continue for long periods of time.

Both sober living and halfway houses are centered around helping individuals figure out the next stage of “I got out of treatment, now I need that sober living piece to further my accountability”. Some may require you to have employment, whether that's looking for a job or volunteering.

Another distinction between sober living and a halfway house is that a halfway house almost always requires that individuals are recently discharged from a treatment center or actively involved in a treatment center. With a sober living home, individuals don't have to come from a treatment center. They could go in and just say, “hey, I want to work on this sobriety thing. I can't be at home,” and move in and receive some support services and probably some counseling services as well.

Individual Counseling or Aftercare Program

Aftercare Programs are ongoing, follow up services for individuals who have completed an addiction recovery program and have 30 days or more of sobriety. Patients remain connected and accountable in a lower, less intensive level of care while continuing to learn skills and discuss how to remain sober.

Aftercare is a welcoming group that promotes healthy discussions while continuing to support recovery. Led by recovering individuals with more than 25 years’ sobriety, aftercare groups are involved in the community through activities like picnics, golf outings, and sporting events in the area.

There are different recovery paths for each individual. Addiction counseling can work for those with issues difficult to face alone in recovery. A joint process between individuals and their counselor, some common goals can be handling difficult situations, making healthy decisions or inspiring change. It can also increase positive feelings, like compassion and self esteem.

Things To Consider

Are you or a loved one at the point in life where you want change and are considering addiction treatment? Here are three things you should consider:

1. Talk to a loved one

Whether that's a spouse, parent, a close friend, someone at church, whoever that may be, talk to them. Get the conversation started with, “you know what, I've been drinking more than I should, and I'm getting concerned of what that's going to look like when I stop.”

Let somebody outside of yourself, outside of your head, know that you are concerned that maybe you do have a problem. That's the starting line - that's where we got to begin. We can't go anywhere if we're not at the starting line.

2. Call a professional

Make the call and talk to a trained professional. There are a lot of different resources online to find professionals like Psychology Today and others. If you are ready to talk to a treatment center, Care Addiction has caring, compassionate staff ready to help any time of the day.

Outpatient Treatment at Care Addiction

At Care Addiction Center, we take calls 24 hours a day, seven days a week. There's never an answering machine. It can take a lot of courage to make that first call. Once you do it, it gets easier.

We are a small private practice and offer all outpatient levels of care serving individuals in Geneva, Batavia, Sycamore, St. Charles, and Kane County, with online addiction treatment available anywhere in Illinois. .

We work with some different providers that offer higher levels of care and have linkage agreements with them that we've worked with for decades, so we're able to assist folks whatever need they have.

To get started on the road to recovery, or if you have questions about helping yourself or a loved one, call us today or schedule a confidential assessment online and begin treatment.

This information was first released on Sober.Coffee podcast with hosts Mike & Glenn interviewing Matt Goff, Clinical Director of Care Addiction Center. Listen to the original podcast.


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