There is no right treatment, only what is right for you.
The abundance of treatment options is ultimately a positive, but it can make selecting the right one for you an arduous process. Although there is a lot to consider about what makes an approach right for you, several key things to consider are:
1. Setting: what kind of setting are you looking for?
2. Intensity: what level and frequency of support do you need?
3. Approach: what approach are you most comfortable with?
4. Financial: what will insurance cover and/or what can you reasonably afford?
This article is here to help you understand the options, what they mean, and ultimately guide you to getting the support you need.
12-step meetings
What they are:
12-step meetings (alcoholics anonymous, narcotics anonymous, etc.) are widely available and accessible with both in person and remote options. They are free to attend and can be a way to connect with others with similar issues and concerns.
What to consider:
12-step meetings are not run by professionals, and therefore cannot provide support in other areas such as mental health concerns. Groups can vary widely in size, structure, participant make-up, etc., so it can take some trial and error to find the right fit for you. While many people find the step work and structure helpful, others find it does not meet their need.
Counseling Services
What they are:
Counseling services are outpatient and typically offered once per week, though a little more or less often can usually be accommodated. All counseling services should be provided by licensed professionals (LPC, LMFT, LCSW, PhD, or PsyD). Counseling for substance use is easily combined with other supports such as psychiatry, IOP, etc. Some counselors accept insurance and many work on a sliding scale option.
What to consider:
When selecting a counselor for any concern, you want to make sure the person has experience that matches your need and feels like a good fit for you. You want to ensure they can provide support for all of your areas of concern, i.e., anxiety, relationship issues, etc.
Look for counselors that offer a no charge consultation so that you can ask questions and determine if it feels like a good fit. Most importantly, you should feel free to establish your own goals, not feel judged and feel safe with your counselor.
Intensive Outpatient Program (IOP)
What they are:
IOPs are time limited programs that offer structured programming 3-5 days per week from typically 3-6 hours per day. In person and remote options are often available. IOPs are sometimes a starting point for treatment and sometimes a step down from more intensive treatment settings. They tend to be structured and take place in a group setting. Some programs have dual diagnosis options or have different versions based on gender, age, etc. Some IOPs are in network with insurance companies.
What to consider:
There are lots of different versions of IOP programs. Many are 12-step based, while others are more clinically oriented. Some IOPs have requirements for sobriety and will perform drug screening, while others are more open and accessible to a range of needs. If you decide an IOP is right for you, it is worth doing the research to find the program that best meets your unique needs.
Medications for Substance Use Disorders
What they are:
For opioid use disorder (OUD), buprenorphine and methadone are considered evidence-based treatment options. Both are medications that assist in the reduction of cravings, the minimization of withdrawal symptoms, thereby providing stability and increased safety.
Naltrexone is also prescribed for OUD but is not considered evidence based. Naltrexone for alcohol use disorder (AUD) has shown promising results.
Ideally your prescriber can address other mental health needs, if applicable, in addition to your substance use needs.
What to consider:
As with all medications, there can be side effects and no medication is right for everyone. Only you and a medical professional can determine if a medication is right for you. Medications for substance use are most effective when combined with counseling and other supports.
Unfortunately, there are not medications available that help with addiction to stimulants.
Detoxification (Detox) Programs
What they are:
Detox programs are short term, usually 3-10 days based on medical need. They provide safe and medically supervised detoxification from psychoactive substances. Detox centers are sometimes stand-alone facilities and other times part of a longer term program. In some cases, medically supervised detoxifications can be done on an outpatient basis and some programs offer at home detox services. Substances like alcohol and benzodiazepines can be dangerous to withdraw from outside of medical supervision.
What to consider:
The physical aspects of a substance use disorder are only a piece of the puzzle. Many people find continued abstinence or other types of changes difficult to sustain after a detox program without being connected to other types of care and support. Detox is often covered by insurance.
Inpatient Treatment Programs
What they are:
Inpatient treatment programs are often what we think of when people say ‘rehab’. Patients typically stay for anywhere from 2 weeks to 90 days, with 30 days being the average (and often the maximum that insurance companies will cover). They range drastically in their amenities and therapeutic approaches. Many offer dual diagnosis programs when there are also mental health concerns.
What to consider:
With so many versions, it is important to do some research and find one that meets your needs. The majority are rooted in 12-step principles and programming, however programs more rooted in other approaches (i.e., SMART) and clinically informed approaches (i.e. CBT, DBT, psychodynamic) are becoming more available.
Some treatment programs will initiate medications such as buprenorphine or Naltrexone, but many are still opposed to medications being used to address substance use disorders. Costs vary widely, with some programs costing upwards of $100,000.
Due to the cost and time commitment, devoting time to researching the best options for you is worth it.
Sober Living Homes
What they are:
Sober living homes are residential environments where people live while working on maintaining abstinence. They are often a step down from inpatient programs. They are often located in residential areas and generally house 5-10 residents at any given time. They provide structure and tend to have strict house rules and maintain requirements for attending 12- step meetings.
What to consider:
Sober living homes are not cheap and generally rooms are shared. The number of personal items that can be brought in is limited. There is a wide variation in the expertise, training, and professionalism of the owners/staff, so definitely do your research. Random drug screens are common in these residences and often being on methadone or buprenorphine is a disqualifier. Failure to comply with abstinence and other house rules can result in loss of residence.
Support if you need it.
Substance Use Therapy is here for you. We provide counseling services wherever you are on the continuum of use. We are also happy to help assist in locating additional treatment programs and provide referrals as needed. Whatever you are facing, you don’t have to face it alone.
Sources:
Foote, J., et al. (2014) Beyond Addiction: How Science and Kindness Help People Change. Scriber, NY.
About the Author:
Kimberly May, LPC-S, LMFT is the founder of Substance Use Therapy in Austin, TX. Kimberly works with individuals, couples, and families whose lives have been affected by substance use. By utilizing a harm reduction framework, Kimberly works effectively with people in any stage of use. In addition to substance use, she works with other issues such as anger, burn-out, anxiety and grief. Contact today to schedule a no-charge, 30 minute consultation.