If you think you have a problem with alcohol or drug use, you may have considered seeking professional support and treatment.
We commend your bravery. Recognizing you have a problem and seeking help to make positive change in your life takes courage and strength.
We understand it may be difficult to decide what kind of treatment you need, or if you need professional treatment at all. If you search the internet, you’ll find various treatment options: inpatient treatment for addiction, residential treatment for addiction, inpatient drug rehab – the list is long.
This article will help you narrow down your choices and understand your options with regards to treatment for alcohol and/or substance use disorder. The first thing we want to tell you is that the phrases you read when you search online – if you did already – refer to levels of care.
The two levels of care we’ll focus on here are inpatient/residential treatment and outpatient treatment.
Before we continue, you should know something else that’s important: inpatient psychiatric hospitalization is not the same thing as inpatient treatment for AUD or SUD. Inpatient psychiatric hospitalization is appropriate if you’re in crisis right now and are at imminent risk or harming yourself or others. Inpatient psychiatric hospitalization is on the treatment continuum, but the priorities are safety and stability.
If you enter emergency psychiatric hospitalization for an alcohol or substance use emergency, the medical staff will discharge when they determine you’re safe and stable. That’s when the real treatment for AUD or SUD begins: when you’re psychologically, emotionally, and physically ready.
Which bring us back to the topic at hand, phrased as a question in the title of this article:
How Do You Know if You Need More than Outpatient Drug Rehab?
We can help you answer that question.
NOTE: Call the national mental health hotline at 988 right now if you or someone you love is in crisis or at risk of harming themselves or someone else.
Residential, Inpatient, Outpatient: What’s Right for Me?
There’s a saying among people in treatment for alcohol use disorder (AUD) and substance use disorder (SUD):
If you’ve ever thought about cutting back on your alcohol and or drug use, or stopping use altogether, you should probably give it a try.
We have one serious disclaimer: long-term use of alcohol or drugs changes the body, and if you completely stop, alone, without consulting a physician, you may experience a very uncomfortable phenomenon called withdrawal. For most substances of misuse or disordered use, withdrawal is not life-threatening, but in some cases, it is life-threatening.
Therefore, if you plan to stop completely, we advise you to consult a physician – and we should reword that statement:
If you’ve ever thought about cutting back on your alcohol and or drug use, or stopping use altogether, you should take that thought seriously – and consider seeking professional help and support.
What Are Levels of Care?
A level of care refers to the amount, intensity, and level of immersion of your treatment. Generally speaking, a lower level of care means a less intense, less immersive treatment experience, and a higher level of care means a more intensive more immersive treatment experience. Those levels coincide with your treatment needs: if you have a severe AUD or SUD, more immersive and intensive treatment may be appropriate. On the other hand, if you have a moderate or mild AUD or SUD, less immersive and intensive treatment may be appropriate.
Only a mental health professional can determine clinical severity and recommend a level of care. This article is neither a diagnosis nor a referral.
Keep in mind that when we talk about levels of care and the relative levels of intensity and immersion, those things are not related to the quality of care. A lower level of care is not like a less expensive consumer product in a product line, made with lower quality parts or in made in a factory as opposed to handcrafted in a workshop.
If you receive a diagnosis for AUD and/or SUD, a referral for treatment, and choose a well-regarded, fully licensed treatment center, then you will receive the latest evidence-based treatment at all levels of care. Again, the level refers to the amount, intensity, and level of immersion – not the quality.
The most common levels of care – excluding inpatient psychiatric hospitalization, for the reasons we mention above – are inpatient/residential treatment and outpatient treatment.
Inpatient and/or residential treatment levels of care include:
- Detox is the process by which your body eliminates the toxic byproducts of chronic alcohol or substance misuse. Depending on the substance and frequency and duration of misuse of disordered use, detox may last from 3-4 days to two weeks.
- During detox, you live onsite at the treatment facility
- You receive around-the-clock monitoring from a trained medical staff, including physicians and nurses, who are ready to address any complications related to detox immediately
- When clinicians determine you’re stable physically and psychologically – i.e. past withdrawal – they’ll most likely discharge you to a less immersive level of care, such as residential treatment
Residential/Inpatient Treatment for AUD or SUD
- During residential/inpatient treatment, you live onsite at the treatment facility.
- The typical length of stay in a residential treatment program is 10 days to one month
- You receive 24/7 medical support and care
- Nurses and doctors on call for emergencies
- You participate in a full day of treatment and treatment-related activities (see list below)
- During the evening, you will most likely complete/participate in:
- Group counseling or educational workshops
- Peer support groups, such as:
- Narcotics Anonymous (NA)
- Alcoholics Anonymous (AA)
- Recovery homework: journaling or reading
- Group outings to sober-friendly activities
- These typically happen on weekends
- Residential/inpatient treatment may be appropriate if you have a moderate or severe AUD or SUD.
- Your clinician makes the final determination
The primary thing you need to understand about residential treatment is that you have the time and space to work on yourself and your recovery in a setting designed for your success, among a group of people – recovery peers and clinicians – who are one hundred percent on the same page as you: working toward a life in sustainable recovery. Since you sleep and eat at the treatment center, you don’t have to worry about the details of daily life. You can focus on recovery, and build the skills you need to take your first steps toward independence.
Next, we’ll talk about outpatient levels of care, from the least immersive to the most immersive.
Outpatient levels of care include:
Outpatient Treatment for AUD or SUD
- During outpatient treatment, you live at home and participate in treatment once or twice a week for about an hour per session
- Outpatient treatment typically involves visits with a licensed psychotherapist, psychiatrist, or alcohol/substance use counselor
- Your counselor will likely encourage – or require – you to participate in as many community/peer support group meetings as possible each week
- Many people in outpatient treatment go to a peer support meeting every day
- Some go to two meetings a day
- Your therapist/counselor/psychiatrist will support you with the same evidence-based techniques used in more immersive levels of care (see list below)
Intensive Outpatient Treatment (IOP) for AUD or SUD
- During intensive outpatient treatment, you live at home and participate in treatment for 3-4 hours per day, 3-5 days per week
- IOP schedules enable you to continue with a typical work or school schedule while engaging in immersive treatment
- IOP programs typically include a wide range of treatment activities, including therapy, counseling, and complementary supports
- During an IOP program, you will most likely be required to participate in as many community/peer support meetings as possible per week
- You receive the same evidence-based techniques used in more immersive levels of care (see list below)
Partial Hospitalization Treatment (PHP) for AUD or SUD
- During partial hospitalization treatment, you live at home and participate in treatment for 5-6hours per day, 5 days per week
- PHP schedules enable you to commit to intensive, immersive treatment at almost the same level as residential treatment: the difference is that during a PHP program, you do not live on-site at the treatment facility.
- Many people in PHP programs live in sober homes/sober living facilities
- PHP programs typically include a full range of treatment activities, including therapy, counseling, and complementary supports like educational workshops, stress management, and relapse prevention
- During a PHP program for AUD or SUD, you will most likely be required to participate in as many community/peer support meetings as possible per week
- During a PHP program for AUD or SUD, you receive the same evidence-based techniques used in more immersive levels of care (see list below)
Those are the levels of care you will find when you search online for professional treatment and support for an alcohol or substance use disorder. We can anticipate your next question:
How do I know what level is right for me?
You don’t have to decide alone. In fact, we recommend against deciding alone. Once you decide you want to seek treatment, the most important thing to do is get a comprehensive assessment administered by a mental health professional.
An Accurate Diagnosis Improves Treatment Outcomes
To learn which level of care is best for you – meaning the level of care that increases your likelihood of achieving sustainable, lifelong recovery – the first step is arrange a full biological, psychological, and social evaluation administered by a licensed and qualified mental health professional. In the context of treatment for mental health treatment and treatment for alcohol and/or substance use disorder (AUD/SUD), clinicians call these evaluations biopsychosocial assessments. A professional mental health or addiction treatment professional uses a biopsychosocial assessment to learn about all the factors in your life related to your alcohol or substance use disorder.
Biopsychosocial assessments allow treatment professionals to arrive at an accurate diagnosis, identify the severity of the alcohol or substance use disorder, and offer a referral for a level of care that indicated by the symptoms and severity of your addiction disorder.
During your assessment, a clinician will ask for detailed information in the following areas
- Full individual medical history
- Family medical history
- Current physical problems or medical diagnoses
- Current medication(s)
- Personal psychological/psychiatric history
- Any psychiatric medication
- Any psychiatric treatment
- Experience of trauma
- Recent major life events
- Recent stressful events/trauma
- Family psychological/psychiatric history
- Any mental health disorders in family
- Any alcohol/substance use disorder in family
- Personal psychological/psychiatric history
- Factors that increase risk of escalation of AUD/SUD
- Factors that decrease risk of escalation of AUD/SUD
- Work and school history
- Gender, sexual identity
- Current ability to meet commitments/responsibilities/obligations in your family, school, and/or social life
After you receive a comprehensive biopsychosocial assessment, and you receive a diagnosis for AUD/SUD – if you do – then there’s another step: the clinician needs to determine your level of acuity. In other words, they determine – based on the full biopsychosocial evaluation – how serious and disruptive your AUD/SUD is right now.
The Diagnostic and Statistical Manual of Mental Disorders, Volume 5 (DSM-5) defines three levels of severity for alcohol and substance use disorders: mild, moderate, and severe.
We’ll describe those levels of severity now.
Mild symptoms can be disruptive, uncomfortable, and difficult to manage. Despite the problems they cause, the symptoms of a mild AUD or SUD do not prevent your ability to meet your family, work, school, or social responsibilities. If your symptoms are mild, you probably don’t require an inpatient, residential treatment program.
If you receive a diagnosis for a mild AUD or SUD and your symptoms are not extremely disruptive, outpatient treatment may be appropriate.
Moderate symptoms may be more disruptive, uncomfortable, and difficult to manage compared to mild symptoms. These moderate AUD/SUD symptoms may impair your ability to meet your family, work, school, or social responsibilities. In most cases, they don’t completely prevent you from meeting your commitments – but they make do make meeting them challenging. If your symptoms are moderate, you may or may not need residential treatment: you and the assessing clinician will collaborate on that decision. They will most likely refer you to intensive outpatient treatment (IOP) or partial hospitalization treatment (PHP).
In some cases – based on individual needs – residential treatment may be appropriate if you receive a diagnosis for moderate AUD or SUD.
Severe symptoms of AUD and SUD are more disruptive and difficult to manage than symptoms considered mild or moderate. In fact, severe symptoms may be unmanageable and make your life unmanageable. In other words, if the symptoms of your AUD or SUD are severe, they most likely prevent you from meeting the bare minimum responsibilities and commitments related to your family, work, school, or social life. Severe symptoms of AUD/SUD – as determined in a clinical biopsychosocial assessment – typically trigger a referral for residential/inpatient treatment.
If you receive a diagnosis for severe SUD or SUD and you are not currently in crisis, residential treatment may be appropriate.
Once a treatment professional administers an assessment and arrives at a diagnosis, they will most likely refer you to one of the levels of care we describe above. The levels of care differ in their levels of intensity and immersion, but that all include the same essential components.
We’ll describe those now.
What Happens During Residential/Inpatient Treatment for AUD and SUD?
The most effective treatment for AUD and SUD follows the integrated treatment model. This is a whole person approach to treatment, which means clinicians address any and all the factors in your life that contribute to AUD/SUD. During integrated treatment, clinicians look beyond your symptoms – although treating symptoms is critical, of course – and help you achieve total health and wellness.
We’ll list the most common components of integrated treatment now. When we wrote see list below in the previous section of this article, this is the list we meant.
Integrated, Evidence-Based Treatment for AUD and SUD: Common Elements
- One-on-one psychotherapy:
- Dialectical behavior therapy (DBT)
- Cognitive behavior therapy (CBT))
- Group psychotherapy:
- DBT for groups
- CBT for groups
- Family psychotherapy
- When your family participates in treatment, outcomes can improve
- Complementary supports:
- Stress-reduction techniques
- Experiential/outdoor supports:
- Expressive supports:
- Medication (if needed)
We say it at the beginning of this article.
We’ll repeat it because you need to hear it:
If you think you have an alcohol or drug use problem and have decided to seek professional support, we commend your strength and bravery. That’s a hard realization and a difficult choice to make. You also need to know something else: you are not alone. There are millions of people across the country in treatment right now, working towards a life without alcohol and drugs.
Evidence shows that if you need treatment for AUD or SUD, the sooner you get treatment, the better the outcome.
You can join those millions of people working toward a better tomorrow: we hope this article helps you make an informed decision about seeking support and care. You’re reading this article, so we know you have the insight and awareness it takes to make a positive change in your life. We also know that if you commit to treatment, sustainable recovery is within your reach: we see people move past the cycles of addiction every day, and create new lives based on their personal vision of wellbeing and happiness.
The strength they show is within you, too: believe that.