A Beginners Guide to Choosing the Right Inpatient Treatment Center
Deciding to get help for a drug addiction through an inpatient drug rehab program can be an exciting time in your life. Treatment helps you get to the bottom of the issues that led to your drug abuse and restore function to all areas of your life so that you can find peace and authentic happiness.
According to the National Institute on Drug Abuse, good intentions and willpower are rarely enough to end an addiction for the long-term. Professional help is almost always needed. If attending rehab seems a little scary, that’s okay. Ending an addiction isn’t easy, but a professional treatment program helps you through every step of recovery.
An inpatient drug rehab program provides the time and resources you need to develop new skills and healthy habits.
What is Inpatient Drug Rehab?
Outpatient rehab and inpatient drug rehab are the two main types of drug treatment programs.
Outpatient rehab involves living at home and continuing to attend school, work or care for the family during treatment. Programs take place at an outpatient center during the week.
Inpatient drug rehab involves living at a residential treatment center while undergoing treatment.
Who Should Opt for Inpatient Treatment?
Whether inpatient or outpatient drug rehab is right for you depends on a number of factors. In general, inpatient rehab is essential for people who have:
- A long history of addiction
- A severe addiction
- Little intrinsic motivation to change
- Been through rehab before
- A co-occurring mental illness
- An unsafe or unstable living environment at home
- Little support at home and in the community
A thorough pre-treatment drug assessment helps providers place you in the right program for your unique needs and issues.
Benefits of Inpatient Rehab
Inpatient drug rehab has a number of benefits over outpatient rehab:
- Allows you to focus solely on recovery without external stressors and triggers getting in the way.
- Ensures your sobriety during treatment.
- Provides a high level of support from peers, providers and staff.
- Offers a high level of supervision, structure and routine, which are essential in early recovery.
- Fosters healthy lifestyle habits and healthy relationships with others.
- Gives you the time you need to develop the skills required for successful recovery once you’re on your own.
- Fosters a strong sense of community and belonging.
- Provides intensive therapy each day to help you address a variety of issues.
The Duration of Inpatient Treatment
According to the National Institute on Drug Abuse, a rehab program that lasts less than 90 days is of limited effectiveness. Just as it takes time to develop an addiction and the unhealthy thought and behavior patterns that come with it, it takes time to develop new, healthier ways of thinking and behaving. This provides the time needed to learn essential coping skills that will help you recover for the long-term.
The Continuum of Care
According to the Substance Abuse and Mental Health Services Administration, the most important consideration when choosing a treatment program is finding a good treatment setting suited to your needs. Choosing the least restrictive environment that will meet your needs is the gold standard for addiction treatment.
Four Levels of Care
The American Society of Addiction Medicine has identified four levels of care for treating addiction. The higher the level, the more intense the services. The first two levels are outpatient treatment and intensive outpatient treatment, and these are the least restrictive treatment settings.
Level three is Clinically Managed Residential Services and Medically Monitored Inpatient Services. This level is subdivided into four levels. The first three are 3.1, 3.3, and 3.5, which are clinically managed inpatient programs. The last level is 3.7, which is a medically monitored program that provides high-intensity treatment for people who have significant problems that require medical supervision and, in many cases, medication. This may include the need for medical detox, which helps manage drug withdrawal.
Level four is Medically Managed Intensive Inpatient Services, which is the most intense level of care. It involves around-the-clock nursing care and physician-guided care during the day. This level is for individuals who have severe problems, including those with a serious mental illness or who require intensive care during withdrawal.
Clients move through the continuum of care as they develop essential skills and their needs change.
Four Stages of Recovery in Treatment
Over the course of treatment, regardless of the level of care where treatment starts, clients move through four stages:
- Engagement in treatment: The more engaged you are in your treatment program, the better the outcome of treatment. The first stage is becoming engaged with your treatment plan and developing the motivation you need to see treatment through to its conclusion. This stage often begins in detox.
- Early recovery: In early recovery, you’ll benefit from a high level of support and healthy daily routines that promote abstinence. Once you demonstrate an ability to sustain behavioral and lifestyle changes and begin to resolve personal issues, you’ll move on to the next stage.
- Maintenance: The third stage is the maintenance stage, where you’re given more space to practice the skills and strategies you’re learning in treatment. During this stage, you’ll develop a sober network, continue working on personal issues during therapy and improve your level of emotional functioning.
- Community support: The last stage is community support, where your goals are to maintain abstinence, develop more independence from the treatment program and develop healthy hobbies and new interests.
The continuum of care is a step-down model that ensures adequate support is provided at every stage of recovery. As you step down through the continuum of care, your treatment environment becomes less and less restrictive until treatment ends, and an aftercare plan is put into place to guide you through the early weeks and months of solo recovery.
Types of Inpatient Programs
Depending on your unique needs and issues, you may recover better in a special environment. Treatment programs aren’t all the same. Some cater to specific demographics to help individuals address issues unique to that group. Specialized treatment can help increase comfort and well-being during treatment. These are some of the most common specialized treatment programs:
For some people, co-ed groups are perfectly suited to their needs and preferences. Others do well in a gender-specific group. Men-only groups are often preferred by men who have a history of sexual abuse or who may feel more comfortable exploring or expressing difficult emotions among people of the same gender.
Women-only groups are often preferred by -and more effective for- women who have a history of sexual abuse, who have low self-esteem or who may feel powerless or intimidated in a co-ed setting.
Some people in the LGBTQ+ community prefer a treatment setting with others in that demographic who will understand and relate to the issues common to that group, such as discrimination or being disowned by family members. They may be more likely to open up in a setting where they won’t face further discrimination.
Religious vs. Secular
Someone who is very religious may prefer a treatment program that follows the tenets of their religion. Likewise, someone who is non-religious may prefer a secular treatment program that doesn’t subscribe to any particular dogma.
A history of trauma is a common underlying cause of addiction. People who have suffered trauma, such as physical or sexual abuse or witnessing death or violence, will likely thrive in a trauma-informed treatment program. These programs specialize in helping trauma survivors develop coping skills for dealing with disturbing memories and symptoms of post-traumatic stress disorder.
People who have a mental illness that co-occurs with the addiction require dual diagnosis treatment. Dual diagnosis treatment involves addressing the mental illness in the context of the addiction and vice-versa. Integrated treatment for addiction and mental illnesses offers better treatment outcomes for people with co-occurring disorders.
The First Step of Inpatient Drug Rehab: Detox
For those who are dependent on drugs, the first step of inpatient drug rehab will be medical detox.
A Quick Primer on Dependence vs Addiction
Dependence is not the same thing as addiction, although these terms are used interchangeably. Addiction is characterized by compulsive drug abuse despite the negative consequences it causes. It’s the result of brain changes in the memory, reward, and learning centers of the brain that lead to intense cravings and dysfunctional thought and behavior patterns.
Dependence is characterized by withdrawal symptoms that set in when you stop using drugs. It occurs as the result of changes in the chemical functions of the brain as the brain tries to compensate for the presence of the abused substances.
Different drugs act on different brain chemicals, known as neurotransmitters. They increase the activity of some and decrease the activity of others. This effect on neurotransmitters is what creates the psychoactive effects of the drug. With heavy drug abuse, the brain alters its neurotransmitter activity in an attempt to normalize brain function. For example, if a drug increases the activity of the neurotransmitter GABA, responsible for feelings of calm, the brain will reduce GABA activity to compensate. It does this by producing less of the chemical or reducing the number of receptors that are activated by it.
This compensation by the brain leads to tolerance, which means that you need larger and larger doses of the drug to get the same effects a smaller dose once produced. As dosage is increased, the brain continues to change its chemical function to compensate. At some point, neurotransmitter activity may shift so that the brain now functions more comfortably when the drug is present.
When you suddenly stop using the drug, normal neurotransmitter function rebounds. Those that were suppressed now flood the brain and those that were increased are now reduced. This causes physical withdrawal symptoms, which can range from mild to severe.
How Medical Detox Helps
Withdrawal symptoms associated with alcohol, opiates, and benzodiazepines like Valium and Xanax can be dangerous or even fatal. Medical detox is supervised by medical and mental health professionals who administer medications as needed to reduce the severity of withdrawal, prevent or treat medical complications of withdrawal and shorten the duration of detox.
During medical detox, care providers help engage the client in treatment. An individualized treatment plan is developed based on individual unique needs. Therapies like motivational interviewing help the client identify his or her own intrinsic reasons for wanting to recover. After detox is complete, the client is placed in the appropriate level of care to address the addiction, which is far more complex than dependence.
What to Expect During Treatment
Addiction almost always has underlying causes, resulting in a number of problems in your life, such as relationship, financial, legal, or health problems. It leads to dysfunctional thought and behavior patterns that further perpetuate the addiction.
High-quality treatment addresses all of these issues through a holistic approach that encompasses body, mind and spirit for whole-person healing.
During inpatient drug rehab, you’ll engage in a wealth of programming that helps you:
• Address underlying issues, such as trauma, stress or family dysfunction.
• Develop essential coping skills for dealing with stress, cravings and other relapse triggers.
• Evaluate thought and behavior patterns and learn healthier ways of thinking and behaving.
• Identify outdated ideas and beliefs and replace them with those that are aligned with your inherent values.
• Repair damaged relationships and restore function to the family system.
• Find purpose and meaning in a drug-free life.
• Learn to relax and have fun without drugs.
• Set goals for the future and work to achieve them.
These changes occur through a variety of therapies and interventions. Since no single treatment therapy is right for every individual, a variety of therapies are offered through high-quality inpatient programs. An individualized treatment plan will include the therapies and interventions that are most relevant to your needs.
Group and Individual Therapy
During inpatient drug rehab, therapies will take place in both individual and group settings.
Individual therapy is one-on-one counseling between you and your therapist. It helps address unique underlying issues and problems and develop the coping skills you’re missing.
Group therapy takes place in a group setting with your peers in recovery. Group therapy is highly effective for treating addiction. According to the National Institutes of Health, 11 therapeutic factors facilitate real and meaningful change. These factors include:
• Instilling hope for recovery.
• The relief and benefit that comes from knowing you’re not alone.
• Sharing valuable information and resources.
• Higher self-esteem that comes from helping others.
• The relief and growth that comes from expressing painful emotions and synthesizing difficult experiences within a supportive group.
• A sense of belonging in a group where all voices are heard, and all members have value.
Traditional “Talk” Therapies
Psychotherapy, or “talk” therapy, takes place in both group and individual sessions. Traditional therapies are those that have been shown through research to be effective for treating addiction. A number of talk therapies are used in addiction treatment:
Cognitive-behavioral therapy, or CBT, helps individuals address underlying issues and identify and change destructive thought and behavior patterns. CBT is the most common and effective therapy used in treatment.
Dialectical behavior therapy, or DBT, is a type of cognitive-behavioral therapy that helps people learn skills related to interpersonal effectiveness, distress tolerance, emotional regulation and mindfulness. It helps to improve self-awareness, self-esteem, and relationships.
Acceptance and commitment therapy, or ACT, helps individuals develop psychological flexibility and accept negative emotions without judgment to overcome psychological pain. It helps people set goals and engage in behaviors that are consistent with their values.
Motivational Enhancement Therapy, or MET, helps to spark motivation for change in people who are ambivalent about recovery or don’t feel ready to give up drugs just yet. MET increases engagement in treatment and leads the client to identify his or her own reasons for wanting to recover.
Family therapy helps improve communication among family members and restore function to the household. Family members identify their own dysfunctional behaviors, including enabling or codependency, and learn how to best support their loved one in recovery. Family members work on restoring trust and repairing relationships damaged by the addiction.
Complementary therapies are those that have been shown through research to be effective for treating addiction when they’re used along with traditional “talk” therapies. A holistic treatment program will offer a range of complementary therapies to promote healing of body, mind and spirit.
Art therapy and music therapy help people communicate their experiences and express difficult emotions through viewing, talking about, and making art or music. Art and music therapy help reduce stress and change self-destructive thought and behavior patterns.
Equine therapy involves working with horses and using the lessons learned to improve self-confidence, communication skills and impulse control. Equine therapy helps you set boundaries, develop trust and hone social skills.
Nutritional therapy educates clients about the importance of good nutrition in recovery. It teaches how a healthy diet improves physical and mental health and helps reduce stress and improve mood. You’ll develop a personalized eating plan that takes into account any nutritional deficits, medical conditions and health goals you have.
Biofeedback helps you learn to reduce stress on the spot. During biofeedback, sensors attached to your body record functions like heart rate, body temperature and blood pressure. As you watch on a screen in real time, you practice a variety of techniques to see how they reduce your body’s stress response. Biofeedback improves psychological confidence and can help reduce cravings.
Yoga brings you into the present moment, where you can evaluate your state of mind and how your body feels. This can go a long way toward preventing relapse by helping you address issues before they lead to a slip-up. Regular yoga practice improves mindfulness throughout the day. It also reduces stress and improves physical and mental strength, flexibility and endurance.
Meditation puts your brain in the alpha wave state, which occurs when you’re relaxed and focused. During meditation, your brain is open to creative ideas. Meditation helps your body learn to respond better to stress, and it can help reduce anxiety and depression. Mindfulness-Based Stress Reduction, or MBSR, is a meditation practice that’s commonly used in treatment settings and is effective for helping to treat addiction, according to an article in the journal Substance Abuse.
BioSound Healing Therapy combines biofeedback, music therapy, sound frequency massage and guided imagery to reduce stress and anxiety. Participants enjoy a calm, healing meditative state that brings them into the present moment and improves mood and concentration.
Psychoeducational groups in treatment are designed to educate clients about substance abuse, addiction, mental illness and related issues so that they can better understand how these develop and how they’re successfully treated. Psychoeducational groups combine short lectures, hands-on activities and group discussion to ensure participants are actively involved in learning. The information you learn in these groups can be actively applied to your life, such as recognizing roadblocks to recovery and increasing your level of self-reflection.
Successful recovery requires developing the life skills you need to navigate day-to-day sobriety. These skills may include coping skills like handling cravings, stress or negative emotions; practical skills like cooking and budgeting; and relationship skills including communication and listening skills.
Twelve-step programs are based in spirituality, but they don’t subscribe to a particular religious belief. As you move through the twelve steps, you gain mental clarity, practice forgiveness of yourself and others and develop a higher awareness of your thoughts, emotions, behaviors and attitudes. According to a study cited in the journal Alcoholism Treatment Quarterly, people who engaged with a 12-step program in recovery were twice as likely to enjoy long-term abstinence compared with those who did not. Another study, published in the Journal of Substance Abuse Treatment, found that people who attended 12-step groups stayed in treatment longer and were more engaged in their treatment plan than those who didn’t attend.
Relaxation, recreation and enjoyment are important during treatment and are central to successful recovery. Recreational time in treatment gives you time and space to decompress, relax, and enjoy hobbies or hang out with peers. Re-defining fun is an important task in early recovery, according to an article published in the Yale Journal of Biology and Medicine. Recreational time helps you develop the ability to have fun and enjoy yourself without the need for drugs or alcohol.
The Last Step: Aftercare
After treatment is complete, an individualized aftercare plan is put in place to help you navigate the early weeks and months of solo recovery. The aftercare plan will include a variety of components based on your needs. These include:
- Ongoing therapy to help you continue to address issues and develop skills.
- Ongoing psychiatric or medical care to help you keep a mental or medical illness under control.
- Support group participation to ensure you have a high level of community and peer support in the early months after treatment.
- Housing assistance to help you find safe, stable housing, which may include spending time in a sober living residence.
- Vocational assistance to help you develop the job skills you need to find and maintain employment.
- Educational assistance, such as help enrolling in school or finding financial aid, to help you achieve your educational goals.
A case manager periodically reviews the aftercare plan to ensure it’s meeting your changing and emerging needs.
Choosing the Right Inpatient Rehab Program
Not all treatment programs are created equal, and in fact, unhelpful programs can make things worse for people with an addiction. Here’s what to look for in a quality inpatient drug rehab program.
An accredited treatment program has undergone intensive evaluation by a third-party accreditation body. A treatment program that’s accredited will adhere to strict industry standards, including using research-based therapies and best-practices protocol. The biggest and most trusted accrediting organizations are CARF International and Joint Commission.
A Proven Track Record
A high-quality treatment program will be able to make claims about its effectiveness and back up those claims with numbers. It should be happy to provide you with documentation that highlights its success rate.
Qualified, Licensed Providers
A high-quality inpatient drug rehab program will hire qualified and licensed providers, including medical and mental health professionals. Staff members will be trained and skilled and will adhere to professional standards of conduct.
Evidence-Based Treatment Therapies
A reputable treatment program will utilize evidence-based treatment therapies, including both traditional and complementary therapies. It will follow the industry’s standards for best practices and won’t utilize controversial, emotionally harmful or potentially dangerous treatment therapies.
A Holistic Approach to Treatment
A holistic approach to treatment involves both traditional and complementary therapies and promotes whole-person healing. A holistic program will develop individualized treatment plans based on clients’ unique needs and issues.
Family involvement in treatment is an important predictor of positive outcomes. A high-quality treatment program will offer family programming, including family therapy and psychoeducational groups that help family members learn how to best support their loved one once treatment is complete.
An inpatient drug rehab facility should be homey and welcoming rather than drab and institutional. You should feel welcome, comfortable and at home at the facility. It should be clean and well-managed, with clear rules and behavior guidelines. You can schedule a visit to the program you’re considering to get an idea of what it will be like to live there.
Alignment with Personal Needs and Values
It’s important to choose an inpatient drug rehab program that aligns with your personal needs, including dietary, mental health and medical needs. The program you choose should align with your personal values. It should be culturally appropriate and non-discriminatory.
How to Pay for Inpatient Rehab
Under the Affordable Care Act, insurance companies are prohibited from denying benefits for essential services, including mental health treatment and substance abuse rehab. Additionally, the Mental Health Parity and Addiction Equity Act of 2008 requires health insurance plans to provide the same level of benefits or mental, behavioral and substance abuse services as they provide for primary medical services.
A treatment program will help you determine whether it accepts your insurance, whether the program is considered in-network or out-of-network and what, exactly, the insurance will cover. The insurance company or treatment program will help you determine whether you need a referral from your primary care physician.
If you have no insurance and don’t qualify for Medicaid, a high-quality treatment program will help you seek out sources of funding. In many cases, payment plans are available for treatment, and some treatment programs offer sliding-scale fees based on your income.
Inpatient Drug Rehab Works
Treatment works for most people who stay in treatment for an adequate period of time and fully engage with their treatment plan. Inpatient drug rehab helps you make a clean break from your old, using lifestyle. Once treatment is complete, you’ll have all the skills and tools you need to enjoy a substance-free lifestyle and find purpose and enjoyment in a life without drugs. You’ll enjoy a higher quality of life and a greater sense of well-being.
Treatment works, and it can work for you or someone you love, no matter how long you’ve been addicted or how severe your addiction is. Hope is the foundation of recovery, according to the Substance Abuse and Mental Health Services Administration. Hope is the belief that a better future is possible -and it is possible, with the help of a high-quality inpatient drug rehab program.