Treatment providers try to match the appropriate level of care to the particular needs of the patient. The type of care that an alcoholic or addict needs is identified by his or her particular needs. There is a standardized set of criteria for treatment at different levels of care, with levels of care escalating based on intensity and with the different levels of restriction.  

1) Brief intervention. A family physician might intervene briefly by pointing out the negative health consequences of the patient's consumption of alcohol and/or other mood altering drugs. A brief intervention usually involves assessment and often assumes that "the problem" has not progressed to the point that a more in-depth and intensive treatment is warranted. Brief intervention often involves teaching about consequences of drinking or using other drugs and often attempts to motivate people who are not yet addicted to modify their consumption behavior before it becomes addiction. A DUI assessment and ADSAC class might be an example of a brief intervention. A brief educational intervention is usually not considered "treatment".  

2) Outpatient Counseling. Outpatient counseling is one of the least restrictive forms of substance abuse treatment. Patients live at home, continue to go to work, or continue to maintain their normal responsibilities while attending individual or group counseling sessions. They receive an education about alcohol and/or other drugs, identify the impact of their misuse of the chemical on various aspects of their lives, learn abstinence skills, and begin to work through unresolved issues that may sabotage their continued abstinence. They could go to out patient counseling sessions once or twice a week. As an alternative, they could be involved in an intensive outpatient program where they may spend several hours a day, several days a week at the counseling offices. Some of the major advantages of outpatient counseling are that a) the expense tends to be less than inpatient treatment, and b) that they are able to employ the new abstinence skills in the "real world" as they develop those skills.   

3) In-patient Treatment. In-patient treatment is provided in a residential care facility. Inpatient treatment can involve short term detox services, a 28 day (or longer) program, or long-term inpatient treatment program.            

a) Detox programs. Short term inpatient detox facilities provide a supervised detox which includes 24 hour care, 7 days a week, individual and/or group education, brief counseling, and referral for continuing treatment. Patients may be referred to inpatient treatment or outpatient treatment services after being discharged. Detox, by itself, is generally insufficient for sustained abstinence.            

b) Individualized, varying length of stay inpatient programs. Currently the trend and standard of care for inpatient programs involves individualized treatment based on a patient's unique needs. This involves somewhat of a flexible length of stay. The average length of stay at Valley Hope in Cushing, Oklahoma, an inpatient treatment facility is 24-25 days, says Mike Miller, Executive Director. Patients who need inpatient treatment tend to be those who may need assistance with detox, and who require more structure and intensity of services to assist them in maintaining abstinence than outpatient counseling provides. 

Treatment services provided in inpatient programs generally include a multidisciplinary staff with medical care, education about addiction and recovery, individual and group counseling, family counseling, and "aftercare coordination". An inpatient level of care has additional structure and laser-like focus and support that may be necessary for development of early abstinence skills.  Most inpatient treatment facilities also treat some of the more common mental health issues that alcoholics and addicts typically suffer from, such as depression and anxiety. There are also special "co-occurring" inpatient treatment centers that treat more serious mental health problems along with addiction concurrently.             

4) Long term inpatient treatment programs. For those in need of a longer course of inpatient treatment, there are "long term" treatment facilities where the patients continue to live in the facility and do not go to work or go to school. They focus exclusively on their recovery. Jim Schmit, director at Clay Crossing, a long term inpatient treatment program in Maud, Oklahoma, indicated that typical treatment goals for long term treatment include a deeper acceptance of addiction and the development of a relapse prevention plan of action. He pointed out that patients also need to identify and develop a constructive use of leisure time, to develop a spiritual plan that enables them to achieve long term recovery, and to develop or improve their living skills. He indicated that the advantages of long-term care are that patients are assisted with handling post acute withdrawal symptoms, that they have the structure and support necessary over time to become comfortable with using their new recovery tools (including new coping skills), and that with continued focus on reducing the denial that comes with addiction and deepening their acceptance of addiction, that they have an opportunity to fulfill their commitment to recovery. Long term treatment is recommended for people who have been in inpatient treatment on more than one occasion and who have experienced chronic relapse in their efforts to remain clean and sober.   

5. Half-way, three-quarter way houses are also considered long term treatment. They are residential programs where the alcoholic/addicts lives in, attends meetings, participates in counseling and other recovery activities, but also goes to work or to school, while in residence. The designation as a half-way or three quarter way house is based on the level of structure. An Oxford House is similar, but does not have professional counseling as part of the program. Residents attend AA or NA meetings and participate in house governance. Half-way, three-quarter, and Oxford House participation usually happens after inpatient (or outpatient) treatment. These long term supportive environments tend to focus on relapse prevention and development and practice of new living skills.   Most treatment providers encourage active participation in 12 step recoveries, along with counseling or other professional services. Attendance and participation is usually encouraged from the beginning of treatment services and continued involvement at various stages of treatment is expected.  

Like other chronic illnesses, addiction must be viewed and treated within a biological, social, psychological, and family context. Continuing care seeks to meet the needs for chronic illness.    Many people at the beginning of recovery and in search of treatment services prefer to try the least restrictive level of care, outpatient counseling. When alcoholics or other addicts are being treated at one level of care, and they are not able to stay sober, then the next level of care is called for. Just as with diabetes, if your doctor recommends diet and exercise to get your blood sugar under control, and it those efforts are insufficient for the desired outcome, the next level of care or treatment is called for. If you are not able to stay sober in outpatient counseling, it is time to go to inpatient counseling. When you have been to inpatient treatment, followed by outpatient counseling and you keep relapsing, the most appropriate level of care is probably long term inpatient treatment, followed by outpatient counseling.   

Twelve step recovery should be a continuing part of recovery efforts from the beginning. Treatment choices should be based on individual need, driven by continuous assessment. Choosing the most appropriate level of care every step along the way to recovery, will help maximize the effectiveness of your efforts.   

It is generally acknowledged and accepted that addiction is best treated from a continuum of care framework. A continuum of care is a treatment concept that includes a stage of treatment called continuing care. What is treatment for addiction? Many people think of treatment as a place, a pill, a kind of therapy, or a religion. In reality, "treatment" is a set of therapeutic services.

The course of addiction treatment starts with stabilization or "acute care". It is in this stage of addiction treatment that detox occurs. Detox is the process where the body is allowed to remove its toxins through abstaining from ingesting any more mood/mind altering drugs. Sometimes, in order to avoid possible catastrophic physical complications, another similar drug or the original drug of choice is administered in diminishing dosages over a brief period of time.

During the treatment process, the newly sober alcoholic/addict begins to learn the skills necessary to withstand cravings, remain abstinent, and change their behavior. They work on accepting the disease, learning how to stay abstinent in the face of life challenges. They work on learning new living skills, such as managing and communicating feelings appropriately, reducing stress, dealing with conflicts, and improving self confidence.  An overarching goal of the recovery process and the stages of treatment is to return to full functioning in all areas of the person's life.    After a primary treatment experience, inpatient or outpatient, they move in to a next stage. Aftercare has been used to make the transition from a more structured level of care to maintain continuing abstinence in an environment where alcohol and drugs abound, where cues from cravings are ever present. It also usually involves providing support and encouragement for staying in AA/NA. 

It might involve outpatient counseling, AA, or a formal aftercare program. It involves learning, practicing, and reinforcing the skills learned to maintain changes in behavior. The roles that the chemical once played are replaced with new healthy living skills. Continuing care can focus on preventing relapse, and encouraging the alcoholic addict to stay committed to and engaged in ongoing recovery efforts.   

Continuing care for addiction is very important because of the nature of addiction. Addiction is a chronic disease characterized by relapse. Most people leaving acute care settings are precariously perched somewhere between continued recovery and relapse. Recovering addicts not in some form of treatment are at an extremely high risk for relapse. It helps keep the newly sober alcoholic/addict engaged in recovery activities, which reduces probability of relapse. Additionally, continued behavioral change is necessary for sustained benefit.   

Aftercare is very important for a number of reasons. One of the main reasons is that it increases the probability of sustained recovery. While there is no predetermined length of treatment, research has shown that the longer the engagement in some level of continuing care, the better the treatment outcomes. Many people drop out of continuing care prematurely. Statistically only about one in five actually go on to continuing care after inpatient treatment.  Of those who go to inpatient treatment, sixty percent have been to inpatient treatment at least once before. 

The majority of people who complete treatment will relapse within the year, 80% of whom will do so in the first 90 days after discharge.  Fifty percent of those who relapse will do so in the first 30 days after discharge. Of the people who follow up with AA without aftercare, 50 % will stop going to meetings within the first 90 days. People in recovery are not considered to be in sustained recovery until about four or five years of sobriety. The low follow through rate for continuing care is strongly correlated with the high rate of relapse after inpatient treatment.    

I am often asked for referrals for marriage and family therapists that also work with addiction. These requests come from all parts of the country or even from other parts of the world. While I do not have the contact resources to make those recommendations, there are some resources available to help you find an appropriate counselor or therapist--wherever you are.

Although there are a number of therapist referral sites online, I don't know much about them. I would tend to shy away from sites where therapists have to pay to be listed, because your choices will be small. You need to know what kind of therapist you need to best be able to use a therapist finder service. Things to take into consideration are:

1) The type of sessions you need - individual, family, marital, or group,

2) The types of issues that are most important to deal with - marital, mental health, addiction, or a combination (i.e., addicted spouse, marital problems),

3) The qualifications of therapists that would provide the best fit for your situation (i.e., mental health - possibly psychologist or licensed professional counselor, or other licensed professionals according to their state statutes on scope of practice).

A good example of finding the appropriate fit would be to look for a professional who is licensed as a marriage and family therapist and as an alcohol/drug counselor for dealing with addiction in a marriage).

Once you have a good idea about the kind of help you need, follow these steps to use a therapist referral service:

1) Go to your therapist referral service such as the one on Psychology Today's website,

2) Click on "find a therapist" or something similar that will achieve the same results,

3) Search your location,

4) Look for a professional that has the kinds of credentials you are looking for.

There are psychiatrists, psychologists, clinical social workers, licensed professional counselors, licensed marriage and family therapists, licensed alcoholism/drug counselors.

Other ways to find an appropriate referral is to ask friends and colleagues. Ask people at church or at work for a recommendation for a good therapist. If you are attending AA or some other 12 step group, ask the people in the meetings. They know who the best therapists are. You can also call licensing boards or go to their websites and look for professionals according to your location.

Once you have some names and phone numbers, call them. Ask them questions about their services. Such questions might include their specialty, costs, types of insurance they take (if any), typical frequency of sessions according to your issues (i.e. mild depression), what kind of therapeutic approaches they use (i.e. Cognitive behavioral therapy, etc.), specialty population that they work with (i.e., seniors, adolescents, adults, alcoholics/addicts, right-handed artists, etc.). If you get voice mail, leave a message for them to return your call. Make sure that you speak slowly and distinctly when you leave your name and number, so that they can call you back. People often assume that a counselor has simply chosen not to return their call, when in fact, the message left on the machine was not understandable.

Make appointments. Try some out. Make sure that they are interested in your goals for therapy and that you have some level of comfort with them. If they don't seem to fit after a few sessions, try someone else. The number one factor in successful outcomes for therapy is the relationship between the therapist and the patient/client.

8 Really Good Reasons You Need To Be Involved in Your Family Member's Addiction Treatment
By Peggy L. Ferguson, Ph.D.