The main premise of this type of drug and alcohol addiction treatment is that the patient (or client) resides full-time, 24/7 within the treatment center itself – hence, they are an inpatient at the facility. Inpatient drug rehab programs are normally for an extended period of time, usually for a minimum of 28 days.
Because of the professional day-to-day nature and therapy-based structure of inpatient drug rehab, this level of addiction treatment is ideal for those with severe substance use disorders or alcohol use disorder (AUD), and for those who also suffer with a comorbid (or co-occurring) mental health disorder, such as depression, post-traumatic stress disorder (PTSD) or bipolar disorder. The comorbidity (or simultaneous presence) of substance addiction and a mental health disorder is medically known as dual diagnosis or co-occurring disorder.
Even though recovering from drug addiction can be challenging, it is possible, and there are millions and millions of people worldwide who have achieved their own recovery following inpatient treatment. Beginning your recovery in an inpatient drug rehab gives you the best and most effective opportunity to address your substance use disorder, as well as any other co-occurring issues, and to help you to move on to the life of sobriety you deserve.
Drug Addiction Treatment in the U.S. in 2021
Although over 20 million people are estimated to be suffering from at least one SUD in the U.S., the actual national percentage of those who seek and find the appropriate substance addiction treatment is very low – around 10%. This figure is primarily affected by treatment access, the cost of treatment, and the perceived stigma surrounding drug and alcohol addiction.
In the U.S., addiction treatment is delivered in many types of settings, and uses a variety of behavioral and pharmacological (or medication-based) approaches. There are currently estimated to be around 14,500 specialized drug treatment facilities who provide counseling, behavioral therapy, medication, case management, and other types of services to people suffering with SUDs.
Record Numbers of Fatal Drug Overdoses in 2020
Even though the treatment take-up figure of 10% is low, there has never been a more critical time to find treatment and to begin recovery. The record numbers of fatal drug overdoses (93,331, to be exact) during 2020 is clear evidence that the illicit drug supply is now as risky and dangerous as ever, with virtually every substance now being mixed with the powerful synthetic opioid fentanyl or a derivative of fentanyl.
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The Principles of Effective Substance Addiction Treatment
According to the National Institute on Drug Abuse (NIDA), there are a number of key principles that need to be met for any substance addiction treatment program to be as effective as possible. These are:
- Addiction is a chronic and complex disease, primarily affecting brain function and an individual’s behavior, but it is TREATABLE
- No single treatment is the correct treatment for everyone
- People require quick and obstacle-free access to treatment – otherwise, they may reconsider their decision to go to drug rehab
- Effective treatment addresses 100% of the patient’s health needs, including their mental health – not just their drug use
- Staying in treatment for long enough is critical to recovery
- Counseling and other behavioral therapies are the most commonly used forms of treatment
- Medications are an important part of treatment (known as medically-assisted therapy or MAT), especially when used in conjunction with behavioral therapies
- Treatment plans should be individualized, and must be reviewed and modified on a regular basis to address the patient’s changing needs
- Treatment should address other possible mental disorders if diagnosed or present (known as dual diagnosis or co-occurring disorder)
- Medically-assisted detoxification is only the first stage of treatment
- Treatment doesn’t have to be on a voluntary basis to prove effective
- Any drug use during treatment must be monitored rigorously and continuously, because of the risk of addiction relapse
- Treatment programs should always test patients for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases, as part of their standard clinical practice. In addition, treatment programs should educate patients about steps they can be taken to reduce the high risk of these illnesses
What is Dual Diagnosis / Co-Occurring Disorder?
Dual diagnosis (or co-occurring disorder, as it is also known) is the simultaneous presence of a substance use disorder (SUD) and a diagnosed mental health disorder in the same patient. The mental health disorder can be anything from a depressive or anxiety disorder to bipolar disorder or post-traumatic stress disorder (PTSD).
An undiagnosed mental health disorder has been shown to be the starting point of excessive drug or alcohol use, as the individual tries to self-medicate the way they are feeling. It is quite common for teenagers and adolescents to attempt to “self-medicate” in this way. However, for those with the appropriate genetics and / or the appropriate family history, such substance abuse can quickly lead straight to an addiction.
Sometimes, dual diagnosis can occur in reverse, where it is the excessive substance use that is the reason for the development of a mental health disorder, and this can be particularly true for teenagers and adolescents. Substance abuse at a young age when the brain is not fully mature (the human brain doesn’t mature until around 25 years old) can lead to the development of a mental health disorder.
The result, sadly, is the same – dual diagnosis or co-occurring disorder.
Dual diagnosis requires a more complex form of treatment than normal, as both disorders need to be treated simultaneously. Failure to do so often leads to the untreated condition to cause the return of the other disorder. Dual diagnosis treatment, as with any form of clinical treatment, works best and more successfully the sooner it is begun.
Dual Diagnosis in the U.S.: Facts & Statistics
According to U.S. national survey data from the Substance Abuse & Mental Health Services Administration (SAMHSA):
- Approximately 1 in 10 Americans ages 12 or older are or will at some point in their lives suffer from either a SUD or an AUD
- Of those, 72% of those with SUD and 45% of people with AUD will also have at least one comorbid mental health disorder
- Only about 40% receive any treatment for either disorder, and
- Less than 5% receive treatment for both disorders
Source: National Alliance on Mental Illness (NAMI) [downloadable graphic]
Mental health disorders are becoming increasingly more common, too. According to the National Alliance on Mental Illness (NAMI):
- 20.6% of American adults have a mental health disorder
- 1 in 20 U.S. adults experience serious mental illness each year
- 1 in 6 U.S. youth aged 6-17 experience a mental health disorder each year
- 50% of all lifetime mental illness begins by age 14, and 75% by age 24
- Suicide is the 2nd leading cause of death among people aged 10-34
NAMI also lists the following most common mental health disorders in order of prevalence:
- Anxiety Disorders – 19%
- Depression – 8%
- Dual Diagnosis – 4%
- Post Traumatic Stress Disorder (PTSD) – 4%
- Bipolar Disorder – 3%
Dual Diagnosis: Treatment & Recovery
Recovering from dual diagnosis, where a severe illness such as PTSD is the mental health disorder, requires simultaneous professional treatments. An integrated dual diagnosis rehab program, therefore, should incorporate:
- Expert professional counseling
- Peer support
- Education
- Medication (if required), and
- Relapse prevention strategies for both PTSD and substance abuse
Specific clinical therapies for the successful treatment of dual diagnosis include:
- Cognitive Behavioral Therapies (CBT)
- Dialectical Behavior Therapy (DBT)
- Interpersonal Therapy
- Family Therapy
The Main Advantages of Inpatient Drug Rehab
- High-Level Care for Long-Term Substance Use Disorders: Inpatient programs are specifically designed for those people who have a chronic history of substance use over an extended period of time, as they provide the ultimate level of professional support and medical care.
- On-Site Detox / Referrals: Many inpatient rehabs offer an on-site professional, medically-assisted detox as a part of their treatment programs. Those that do not have detox facilities normally provide their patients with a referral.
- Daily Evidence-Based Therapy: By undergoing treatment for their SUD in this way, individuals receive round-the-clock individualized medical care, which can involve detoxification and always involves evidence-based therapeutic treatments on a daily basis.
- No Access to Drugs or Alcohol: The rehab facility is safe and secure, meaning there is no access to addictive substances for the patient, and so no chance of them relapsing into their previous substance use.
- Away from the Environment of Substance Use: Additionally, by residing as an inpatient, they are removed from every aspect of their own usual environment – along with the accompanying stresses, personal issues, temptations and triggers which led to their substance use originally.
- Peer-Based Community: Individuals basically “live” with other people who are suffering from either a SUD or an AUD, encouraging a “sense of belonging” and fraternity.
- Highest Rates of a Successful Recovery: Furthermore, according to research, inpatient drug rehab programs (or IPs) offer the best opportunity for a successful long-term and sustainable recovery, as it allows the patient to fully engage with their treatment and their improving health. Patients learn how to enjoy their free time in a way that does not involve the use of addictive substances.
Inside a Typical Inpatient Drug Rehab
Inpatient drug rehabs can vary widely in the type of environment they offer – from a 5-star hotel-type setting, with all the customary luxury facilities and amenities, to the rather sterile surroundings of a typical hospital ward.
However, the vast majority of drug rehabs are positioned halfway between these extremes, providing a warm and friendly environment, so patients feel comfortable and relaxed while receiving their treatment. It is important for people to find what will work for them. The program they choose may be based on their insurance, their lifestyle, or any preferences they may have for addiction treatment.
What’s Inside a Typical Inpatient Drug Rehab?
Professional inpatient drug addiction treatment centers are usually comprised of the following areas, many of which are for the provision of patient treatment:
Entrance / Admissions
On arrival at the drug rehab for your residential stay, you will undergo the admissions process, which can include a clinical physical and mental assessment. This assessment (if it has not been carried out on an initial visit pre-treatment) is designed for the facility to create your individualized treatment plan.
Source: © SpringBoard Recovery
Clinical / Medical Areas
For assessing patients, check-ups, and for dispensing medication
Source: © SpringBoard Recovery
Counselling Rooms
Private meeting areas where qualified counselors and therapists provided one-to-one counseling or other specialized therapies, such as Cognitive Behavior Therapy (CBT) or Motivational Enhancement Therapy (MET).
Source: © SpringBoard Recovery
Please note: Specialized therapies, including CBT and MET are described in detail later in this article.
Group Support / Meeting Rooms
For group support meetings, 12-Step meetings, and other community meetings or therapy.
Source: © SpringBoard Recovery
Communal Areas:
Dining Area: For normal meal-times
Source: © SpringBoard Recovery
Exercise / Free-time Facilities: Examples include a gym, tv lounge, swimming pool, and an outside area for sport or other activities
Source: © SpringBoard Recovery
Accommodation: Bedrooms can either be single occupancy, double occupancy or multiple occupancy, and with or without a bathroom
Source: © SpringBoard Recovery
Administration Areas / Staff Rooms / Other: Additional areas required for the day-to-day operation of the inpatient drug rehab.
Source: © SpringBoard Recovery
What is a Typical Day at an Inpatient Drug Rehab?
Regardless of the setting, most inpatient drug rehabs follow a similar daily structure for their patients, which will normally include individual and group therapy, and scheduled meal times and free-time. Here’s an example of how that works out in practice:
Mornings
After an early breakfast, you can expect either individual counseling, group support meetings, or exercise / relaxation sessions, such as yoga or meditation. The specialized therapies [described later in this article] normally begin later in the day.
Afternoons
Source: © SpringBoard Recovery
After lunch, you can expect one of the specialized therapies, which can include CBT, MET or any others used by the rehab center, and supplemental therapies (depending on the rehab), such as art or music therapy. Additionally, there will be free time at some point during the afternoon, with the option of using the rehab’s facilities.
Evenings
Source: © SpringBoard Recovery
After dinner, there is often a group support meeting, which can involve a program such as the 12-Steps of Alcoholics Anonymous or Narcotics Anonymous, and additional free time. Residents are normally requested to be in their bedrooms no later than 10pm, as establishing a healthy sleep pattern is highly beneficial to treatment.
The Importance of Individualized Addiction Treatment Plans
Although there are millions of Americans suffering with a SUD, and will perhaps have their “substance of choice” in common, no person or their personal story is the same as another. Simply put, a standard addiction treatment plan for all just doesn’t work. Therefore, individual treatment plans need to be personalized during the appropriate assessments, and adjusted throughout the program.
There are many general factors that differentiate each case of SUD – for example, the drug used, the length of time that use has occurred, the amount used each time, any other important factors, such as experiences of trauma and mental health disorders, plus family circumstances and history, genetics, other social factors, and so on. Because of all these differentiating factors, it’s impossible to have a single course of treatment that meets the direct needs of every single client.
The aim of individualized treatment plans is to ensure that each treatment is ultimately successful. Furthermore, individualized addiction treatment for each patient has been shown to reduce the risk of future relapses, and to contribute to a recovery’s long-term success.
What are the Main Elements of an Inpatient Addiction Treatment Plan?
Treatment plans should address how a SUD affects the different aspects of the patient’s life, including their mental, physical, social, and financial health. The plan needs to be periodically adjusted to reflect changing needs over time. These are the main elements of a professional substance addiction treatment plan:
- Diagnostic Summary: A review of the patient’s substance use patterns, medical history, and mental health conditions.
- Issues to Address: A list of specific issues that need to be addressed during the treatment program, with a short summary of each, and any signs and symptoms that illustrate the issue; for example:
- Inability to reduce or stop drug use
- Evidenced by: Divorce; loss of employment
- Evidenced by: Daily use of heroin
- Goals: A list of solutions for each issue outlined above. They should be:
- Based on their list of issues (at least one should directly relate to the SUD)
- Broad (instead of focusing on eliminating a behavior, focus on how to replace a harmful behavior with a healthy one)
- Achievable during the treatment program
- Examples can include:
- Learn anger management skills
- Learn to communicate negative emotions to others
- Objectives: Goals are the issues the patient wants to change, whereas objectives are the actual behavioral steps that need to be taken to achieve each of those goals. Additionally, a patient’s objectives should be “SMART”:
- Specific
- Measurable (actions that can be observed)
- Attainable (achievable during the treatment program)
- Relevant (related to the issues previously given)
- Time-limited (have a target date for completion)
- Examples:
- Attend weekly counseling sessions with therapist
- Practice the 12 Steps
- Interventions: These are the methods the clinician will use to help the patient complete each of their objectives.
- Tracking & Progress Evaluation: Regular comprehensive notes, including recommendations and changes, to track progress and evaluate whether a treatment is working. This typically includes details such as response to treatment, changes in the condition, and adjustments to the plan.
- Long-Term Care Planning: During treatment planning, the clinician will discuss long-term maintenance care and relapse prevention. The aftercare plan can include:
- Attending regular 12-step meetings or support groups
- Continuing therapy sessions with a counselor
- Taking prescription medications, eg. medication-assisted treatment for an opioid use disorder (OUD)
Detox: The Safe Removal of Drug-Based Toxins
“Detox” (short for detoxification) allows for the safe elimination of all the toxins within the patient’s body that are a direct result of the substance use, including the remaining remnants of the substance itself. Those toxins significantly contribute to the severity of the withdrawal.
Detoxification Defined:
The process of removing toxic substances
- medical treatment of an alcoholic or drug addict involving abstention from drink or drugs until the bloodstream is free of toxins.
Depending upon the substance used, the period of time the substance was used, and the amount used each time, a complete detox usually takes about 7-10 days, depending on the patient’s progress. Many inpatient drug rehab programs offer detox services in-house. If this is not the case, most professional drug rehabs will provide the detox via another nearby drug rehab.
A professional medically-assisted detox ensures the detox is as comfortable and as safe as possible, as it both helps with the severity of the withdrawal symptoms, and reduces the risk of a medical emergency due to complications.
The Importance of Drug Detox at the Beginning of Recovery
Detox is the vital first step of any recovery from substance addiction. Before any recovery can fully begin, it is imperative that the individual being treated is 100%-free from the drugs they have abused, as well as any toxins in the body that have been produced by their drug use.
When people use addictive drugs, they build up a “tolerance” to the substance over time, which invariably leads them to keep increasing the amount they use, and how often they use it just to get a similar effect. When they stop using, the result is drug withdrawal. Some of the symptoms that can appear during the process can range from uncomfortable to severe, and even life-threatening. Therefore, detox is always the first step for anyone withdrawing from moderate to severe forms of drug addiction.
Depending on the drug, detox can require the use of specific medications in order to reduce the intensity or severity of the withdrawal symptoms. A process of “tapering” can also be used where the medicating drug is itself addictive, meaning the medication is slowly reduced in dosage until the patient is no longer physically dependent.
Common Drug Withdrawal Symptoms
Some of the most common signs of drug withdrawal include:
- Sweating
- Fatigue
- Irritability
- Headaches
- Loss of appetite
- Nausea and vomiting
- Tremors
- Anxiety
- Depression
- Mood swings
- Cognitive problems
- Sleep disruption
- Nightmares
- Rapid heart rate
During detox (and possibly during post-detox treatment), patients can be prescribed specific medications to assist with their recovery process. This is known as “medically-assisted treatment” (MAT), and these medications are used for:
- Managing withdrawal symptoms during detox
- Reducing drug cravings
- Treating a co-occurring mental health disorder
In no way does MAT [which is described in more detail later in this article] replace evidence-based drug addiction treatment; it is only effective when used as part of a comprehensive treatment program.
What is Medically-Assisted Treatment (MAT)?
Drug addiction treatment programs, whether inpatient or outpatient, can use prescription medications during detox and /or as part of the patient’s therapeutic treatment, if required, and this is known clinically as pharmacotherapeutics, as well as medically-assisted treatment or medication assisted treatment (either is abbreviated to MAT).
The clinical use of these medications is normally dependent upon the drug that the patient is addicted to, and any other existing medical conditions affecting the patient – for example, a heroin addict with a co-occurring disorder, such as major depressive disorder, may require medication during the detox to help with withdrawal symptoms and to control cravings, as well as further medications to treat the depression throughout their treatment.
How Do Addictive Substances Affect the Brain & Lead to Addiction?
To understand how the medications provided by MAT actually work, and why they can be essential to a patient’s recovery from drug addiction, we firstly need to look at how addictive substances affect the brain when a drug user uses them.
Addictive substances produce the feeling of euphoria, as well as other side effects, by manipulating the brain’s pleasure and reward centers through the release of high levels of dopamine, the brain’s “feel good” chemical. Although different MAT medications work in different ways, the majority of these pharmacotherapeutics are designed to restore the brains’ natural balance in both of these centers, and to stabilize the patient’s neurochemical processes, such as the natural release of dopamine which has been previously disrupted by a patient’s substance abuse.
Pharmacotherapeutics are only used as part of the drug addiction treatment for specific addictions, and they can continue to be prescribed after treatment has finished. They are prescribed because they offer a particular benefit, such as:
- To diminish cravings and withdrawal symptoms
- To counter the intoxicating effects of a drug
- To provide “off-label” benefits that can support a patient’s recovery, or
- To replace the drug with a less powerful drug; this is known as “opioid replacement therapy,” which uses medications, such as methadone, to replace the abused opioid
The most common medications prescribed for use within an addiction treatment program, offering one or more of these benefits, include:
- Naltrexone (Vivitrol): Naltrexone, known as an opioid agonist, is highly effective when used in opioid addiction treatment, as it completely blocks other drugs from binding to and so activating the brain’s opioid receptors – necessary for achieving the euphoric effect. It is used in post-detox treatment. If it was used during the detox, when opioids are still present in the body, it will significantly increase the severity of withdrawal symptoms.
- Buprenorphine (Suboxone, Zubsolv): Buprenorphine, a partial opioid agonist, works in a similar way to naltrexone, but only partially blocks the opioid receptors – this means that the receptors are activated after the drug is administered, but not to the full extent that, say, heroin can activate them. It can be used to wean patients off their use of opioid substances.
- Methadone (Dolophine, Methadose): Methadone is a synthetic opioid agonist, and it is used in opioid replacement therapy.
- Naloxone (Narcan): Naloxone is a competitive antagonist, which means it blocks the effects of opioids, and even reverses them. It is commonly used to reverse opioid overdoses.
- Other medications include mirtazapine (Remeron) and bupropion (Wellbutrin, Zyban), which are antidepressants, and modafinil (Provigil), used to treat sleep disturbance.
Therapies: The Core Elements of Addiction Treatment
The majority of inpatient drug rehab treatment normally consists of various therapies (also referred to as modalities). The type of therapy used during the treatment program is determined by the SUD concerned, eg. opioid use disorder (OUD) or alcohol use disorder (AUD) and the goals and objectives stated in the patient’s individualized treatment plan [as discussed earlier].
1. Counseling / “Talk” Therapy
A critical part of treatment is for the addiction counselors and therapists to learn a patient’s motivations, thoughts, feelings, history, and so on – in other words, their personal story of addiction. From this information, the counselor or therapist can determine how best to help their patient. Counseling or “talk” therapy normally takes the following forms during an inpatient drug rehab program:
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One-to-One Counseling / Therapy
Individual (or one-to-one) counseling sessions are extremely critical and valuable during addiction treatment and recovery. A qualified counselor or therapist meets with the patient on a regular basis, usually every day, and they are also available to provide support in between sessions, if needed.
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Group Support / Therapy
Group therapy sessions are used during addiction recovery, as people tend to learn valuable and new lessons or viewpoints from a group of their peers. A group support session provides the opportunity for patients to discuss differing personal situations, to offer support to one another, and build a sense of community within the program.
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Family Therapy
Family therapy sessions can be vital to a constructive treatment. The family should be the patient’s number one source of support during this time, but because of the powerful nature of addiction, these family relationships can become damaged over time.
The goal of family therapy, therefore, is to help repair those damaged relationships, and restore the support system. Lastly, it is also beneficial for educating the family about the nature of substance addiction, so they can understand, and possibly empathize with what the patient (their family member) is going through.
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Twelve-Step Facilitation (TSF)
Many inpatient drug rehabs offer optional 12-Step fellowship programs and regular meetings, but some go one step further and actively use Twelve-Step Facilitation (TSF), a therapeutic engagement strategy that directly links individuals in recovery to 12-step mutual-help organizations, like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), and encourages the active participation of those individuals.
According to the NIDA, Twelve-Step Facilitation (TSF) is classified as an “evidence-based” therapy, along with other more science-based therapies such as Cognitive-Behavioral Therapy (CBT). The strategy is designed to increase the likelihood of an individual becoming affiliated with and actively involved in 12-step groups (in no way is it viewed as a condition of treatment), and so promoting abstinence as a treatment goal, and a vital way forward during long-term recovery.
The central principles of TSF are as follows:
- Addiction is a multi-faceted illness influenced by various factors: medical, social, emotional, and spiritual
- Consistent with the 12-step philosophy, abstinence is the most vital (though not the only) facet of recovery from substance use disorder; emotional and, in some cases, spiritual growth is also a critical recovery process
- AA participation will help patients achieve and sustain recovery over the long-term
- Facilitation is effective only when the treatment provider actively helps to engage the patient with AA and other 12-step mutual-help organizations
- A professional clinical provider can also assist the patient to address any practical and attitudinal obstacles to AA attendance
2. Commonly Used Specialized Therapies & Modalities
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (or CBT) is a widely used and specialized form of talk therapy or psychotherapy. It is commonly used in inpatient drug rehabs as it is an effective way for patients to change their thought patterns and behaviors. CBT usually involves the following 4 steps:
- Identifying difficult situations and issues: This may involve recognizing trauma, grief, anger or a specific medical condition, such as a mental health disorder. The qualified therapist assists the patient in selecting the issues that should be focused on.
- Identifying the patient’s relevant thoughts and beliefs: The patient is encouraged to share their thoughts about each issue (keeping a journal is an effective tool for this).
- Identifying the negative thought patterns: The therapist encourages the patient to become aware of any responses which are negative and which lead to addictive behavior.
- Changing these negative thought patterns: The therapist discusses the issues and actively challenges the patient’s perceptions of these. This can be a difficult step for the patient as they need to change their view of different aspects of their lives.
CBT can help drug rehab inpatients effectively manage the symptoms of their mental health disorders, resolve trauma, prevent a relapse of their substance use, learn new techniques for dealing with stress, resolve conflicts in their relationships, and learn better forms of communication.
Eye Movement Desensitization & Reprocessing Therapy (EMDR)
Eye Movement Desensitization & Reprocessing Therapy (or EMDR), originally designed to treat those with post-traumatic stress disorder (PTSD), is now commonly used in drug and alcohol addiction treatment. Like CBT, EMDR therapy concentrates on the reasons behind the substance use, such as trauma, or a mental health disorder, such as depression or anxiety..
A course of EMDR therapy normally involves around 6-12 sessions, provided once or twice a week. It works by using “bilateral stimulation,” a continuing series of left-to-right, back-and-forth eye movements, audio tones, or physical taps. This repetitive practice helps to activate, and then to reduce the intensity of a patient’s traumatic memories. Unresolved trauma can stem from a range of different experiences, such as:
- Natural disasters, such as earthquakes or flooding
- Military combat experiences, either a soldier or civilian
- Terrorist acts
- Sexual assault or abuse
- Domestic violence
- Childhood neglect
- Violent criminal assaults
Accelerated Resolution Therapy (ART)
Accelerated Resolution Therapy (or ART) is a form of psychotherapy that is similar to CBT and EMDR in approach, but has been shown in studies to produce equally effective results much quicker (usually within 1-5 sessions). ART, used here at SpringBoard Recovery, helps those suffering with substance use, mental health disorders, and complex issues, such as family problems, codependency, grief, pain management, and chronic stress.
Always in control of the entire ART session, the patient is guided through the process by the qualified therapist. Many traumatic experiences, particularly sexual assault, combat experiences, or the loss of a loved one, can be very diificult for the patient to think about or visualize. The aim of the therapy is to move the patient beyond the place where they are stuck in these experiences. This then allows positive growth and the necessary changes.
The ART process uses relaxing eye movements and a technique called Voluntary Memory / Image Replacement to change how negative images are stored in the brain. Importantly, the patient does not need to talk about their trauma to achieve recovery – the recall and visualization is sufficient.
Dialectical Behavioral Therapy (DBT)
Initally introduced to help those with suicide thoughts, and now primarily used in the treatment of severe personality disorders, particularly borderline personality disorder, Dialectical Behavioral Therapy (DBT) has been adapted for use within drug addiction treatment.
Its aim in a drug rehab environment is to reduce cravings, to help patients avoid the situations, and even opportunities, to relapse, and to learn healthy coping skills. It is actually a form of CBT, as it effectively addresses a person’s thinking (their cognitions) that form their belief systems, personal assumptions, and assumptions about the world they live in.
Motivational Enhancement Therapy (MET)
Motivational Enhancement Therapy (MET) is a therapy approach to help patients become or regain their motivation for stopping their substance use and for participating fully in substance addiction treatment. The approach aims to evoke rapid and internally motivated change, rather than simply guiding the patient.
MET consists of an initial assessment session, followed by 2-4 individual treatment sessions with a qualified therapist. In the first treatment session, the therapist stimulates the discussion of personal substance use, to elicit self-motivational statements from the patient. Additionally, coping strategies and tools for high-risk situations are discussed with the patient.
In the following sessions, the therapist monitors changes, reviews the substance cessation strategies being used, and continues to encourage a direct commitment to sustained abstinence from the patient. Often, it is considered beneficial for the patient to bring a loved one to sessions.
Biofeedback Therapy
Biofeedback is a therapy designed to help patients understand the normal, yet involuntary processes that our bodies go through. During the therapy, electronic sensors are positioned on the patient’s skin to monitor their brain activity. Once the resulting brain patterns have been reviewed by the qualified therapist, they can recommend a number of psychological techniques that the patient can use to help overcome aspects of their addiction.
3. Additional / Complementary Therapies
Like SpringBoard Recovery, many other professionally accredited inpatient drug rehabs adopt a “holistic approach” to treatment programs, meaning their aim is to treat the “entire” person – their mental wellbeing, their physical wellbeing, and their spiritual wellbeing.
To achieve this, inpatient drug rehabs with a holistic approach to treatment provide additional or complementary therapies in addition to those specialized ones which are primarily directed at the substance use and any mental health issues, such as disorders and trauma.
Holism: The philosophy of “holism” is defined as “the theory that parts of a whole are in intimate interconnection, such that they cannot exist independently of the whole, or cannot be understood without reference to the whole, which is thus regarded as greater than the sum of its parts.” In terms of medical treatment, such as an inpatient substance use rehab program, it can be defined as “the treating of the whole person, taking into account mental and social factors, rather than just the symptoms of a disease.”
Often called “complementary treatment,” common alternative therapies used in holistic treatment programs include equine therapy, mindfulness and meditation, yoga, art therapy (as described below), and many more.
Equine Therapy
Equine therapy, also known as Equine-Assisted Therapy (EAT), is an effective therapeutic treatment involving horse-based activities and/or a horse-based environment, used to promote physical, occupational, and emotional growth in people suffering from a range of medical conditions, including substance use disorder (SUD), anxiety and depressive disorders, autism, cerebral palsy, dementia, genetic syndromes, such as Down Syndrome, traumatic brain injury (TBI), behavioral issues, and other mental health problems. Equine therapy is used here at SpringBoard Recovery.
Equine therapy helps patients build confidence, self- efficiency, communication, trust, perspective, social skills, impulse control, and learn boundaries. Since horses exhibit similar behaviors with humans, patients can create a connection or bond with the horse. EAT is now recognized as an effective therapy in both medical and mental health fields.
Horses became a popular animal to use in animal-based therapies because they provide immediate feedback to the actions of the handler or the rider. Horses will also mirror the feelings of the handler or rider. Lastly, the horses’ large size and imposing appearance forces the patient to gain confidence and build trust around them.
Mindfulness & Meditation
Mindfulness, an ancient form of meditation used to manage stress, chronic pain, and other conditions, such as substance use disorder (SUD), is the simple concept of “living in the present moment.” Buddhist monks have used mindfulness exercises as forms of meditation for more than 2,600 years, seeing them as one of the paths to enlightenment.
“Our mind wanders all the time, either reviewing the past or planning for the future. Mindfulness teaches you the skill of paying attention to the present by noticing when your mind wanders off. Come back to your breath. It’s a place where we can rest and settle our minds.”
– Suzanne Westbrook, Mindfulness instructor, Harvard University
More recently, its use has been verified by psychologists and medical researchers, who have consistently found that mindfulness meditation changes the brain and our biology in positive ways, improving both mental and physical health.
Meditation can be defined in numerous ways, but, in essence, mindfulness is “training your attention to achieve a mental state of calm concentration and positive emotions,” according to the American Psychological Association. Now easily one of the most popular meditation techniques, the art of mindfulness has 2 distinct parts – attention and acceptance:
- Attention: Tuning into your experiences to focus on what’s happening right now – in the present moment. It involves directing your awareness to your breath, your thoughts, physical sensations in your body, and feelings you are experiencing.
- Acceptance: Observing those feelings and sensations without judgment. Instead of responding or reacting to those thoughts or feelings, your aim is to simply note them, and then let them go.
Yoga
Yoga is far more than a physical workout, it is considered a full mind and body exercise. Yoga can be defined as “specific exercises, called poses, combined with specific breathing techniques and meditation principles.” Just like substance addiction treatment, there is no “one-size-fits-all” yoga; in fact, it is said that the best yoga workout for you depends solely on your individual needs and goals.
The benefits of regular yoga practice are proven and wide-ranging. Generally speaking, a complete yoga workout can help keep the back and joints healthy, improve posture, stretch and strengthen muscles, and improve balance. In substance addiction treatment, yoga therapy assists the body’s natural processes in rebuilding brain chemistry and circuitry.
Additionally, there is the meditative side to yoga that many people who practice the discipline find deeply relaxing and even rejuvenating. Yoga’s specific focus on the breath calms the individual, and helps them to learn to be more mindful of their body. Numerous research studies into yoga have proven a range of health benefits, including:
- Back pain reduction
- Strengthening bones
- Improved balance
- Later and slower mental decline
- Stress reduction
- Relief from symptoms of depression
Art Therapy
Art therapy is used to improve a patient’s cognitive and sensorimotor functions, to foster self-esteem and self-awareness, to cultivate emotional resilience, to enhance social skills, and to reduce and resolve conflicts. Art therapy works holistically by engaging the mind, body, and spirit in ways that are distinct from simple talking.
Art therapists are qualified master-level clinicians who work with people of all ages across a broad spectrum of practice, and their work is specifically designed to help people who are suffering with medical conditions, substance use disorders, mental health disorders, and behavioral issues. It can also be used for individuals who are simply seeking emotional, creative, and spiritual growth.
Horticultural Therapy
Horticultural therapy is the combination of practical gardening with social services to improve the lives of people with either physical and mental health problems. A horticultural therapist engages patients in various gardening and plant-based activities to achieve specific therapeutic treatment goals and objectives.
Horticultural therapists work in a wide variety of settings, including inpatient drug rehab centers, hospitals, schools, community gardens, retirement homes, and correctional facilities. They collaborate with other specialists to help patients reach their therapeutic and vocational goals.
Today, horticultural therapy is accepted as a beneficial and effective therapeutic modality, which can help to improve memory, cognitive abilities, task initiation, language skills, socialization, and communication skills.
Music Therapy
Music therapy is the clinical use of music interventions by a qualified music therapist to help patients accomplish their individual therapeutic goals. Music therapy interventions can address a number of specific aims, such as:
- Promoting wellbeing
- Managing stress
- Pain management and alleviation
- Emotional expression
- Enhancing memory
- Improving communication skills
Life After Inpatient Drug Rehab
If you believe the notion that when you finally leave the safe and secure confines of the inpatient drug rehab where you have spent the last few weeks that you are now cured of your substance addiction, think again. There is no medical cure for addiction – no new wonder-drug and no new revolutionary therapy that will ensure you never, ever again reach for a hit, a fix, a smoke or a drink.
No, there is no cure for addiction, but there is recovery. There is definitely recovery. Many former drug addicts and chronic alcoholics are alive today because when they left their own respective inpatient drug rehab programs, they understood the recovery process was a journey, and they had only completed its beginning.
They didn’t leave the rehab empty-handed, either. They left with new coping mechanisms, tools and strategies for their new substance-free life, they left mentally and physically stronger, they left with a comprehensive education in their own addiction, they left with a new knowledge of what it will take to remain abstinent, they left with healthy new habits and routines, and, perhaps most important of all, they left with an actual plan – a proven, practical, documented guide to preventing a relapse.
Research states that the majority of relapses occur in the first year after treatment. From then on, the more years of sobriety you get under your belt, the less chance there is a potential relapse. By fully understanding your relapse triggers – the things that you were unable to deal with before without using substances – the more chance you have of remaining 100% abstinent. This is exactly the purpose of a Relapse Prevention Plan, your personal guide to preventing a relapse formulated by the inpatient drug rehab you attended and yourself before your departure.
Relapse Prevention
As those in addiction recovery today know only too well, a future relapse always remains a possibility, regardless of any progress so far achieved. Addiction experts understand this, too, so all professional drug rehab facilities should provide a personalized Relapse Prevention Plan prior to a patient’s departure.
What is a Relapse Prevention Plan (RPP)?
A relapse prevention plan is a vital tool for anyone at the beginning of their recovery. It is a written document created by a patient’s rehab treatment team, and it offers a practical course of action for responding to dangerous triggers and cravings. Additionally, having a plan that lists the personal behaviors and relapse triggers that make you susceptible to a return to substance use allows you to fully prepare for any eventuality.
Normally, an addiction relapse when it occurs is a three-part process, which consists of the following identifiable stages:
- Emotional Relapse: Signs of an emotional relapse can include bottling up emotions, isolating, not going to group support meetings, like AA or NA, going to those meetings but not sharing, focusing on others and not yourself, and poor nutrition and sleeping habits.
- Mental Relapse: Likened to an internal mental battle, the main point of a mental relapse is this: Part of the person wants to use, but part of them doesn’t. As individuals go deeper into mental relapse, their cognitive resistance to relapse diminishes, and their need for escape increases.
Examples of the warning signs of this can include physical and mental cravings for drugs or alcohol, thinking about the people, places, and things associated with past use, minimizing any consequences of past use, lying, looking for relapse opportunities; and actually planning a relapse.
- Physical Relapse: A physical relapse is when the person starts using again. Some addiction experts prefer to divide physical relapse into a “lapse” (the initial alcoholic drink or drug use) and a “relapse” (a return to the uncontrolled use of substances).
With a relapse prevention plan, it is possible for the person in recovery to firstly acknowledge certain feelings and events that have risk, and then, secondly, to act upon them. If the actions taken are sufficient to avoid a physical relapse (which is the stage when the person reverts to substance use). Their sobriety will remain intact.
What’s Inside a Relapse Prevention Plan?
Here are the main, structured elements of a relapse prevention plan:
- Assessment of Personal Substance Use History
- Warning Signs & Relapse Triggers
- Definitive & Comprehensive Action Plan
All relapse prevention plans need to include:
- Definitive list of personal triggers
- Management of cravings
- Preventative tools
- Support groups and programs
- Appropriate lifestyle changes
Continuing Addiction Support in Recovery
For people in recovery, life after inpatient drug rehab should become one of personal progress towards a long-term and sustainable recovery. After any rehab program is completed, there are a number of excellent options available. These include:
- Continuing Substance Addiction Treatment, such as progressing to an outpatient treatment program (less intensity, but with equal accountability), or moving into Sober Housing, accommodation that requires all those who live there remain substance-free.
- Individual Therapy Sessions, where people can continue with one-to-one counseling.
- Mental Health Check-ups, with a mental health professional – to promote accountability, and to ensure progression and staying substance-free.
- Mutual Aid Support Groups, such as 12-Step Narcotics Anonymous (NA) and Alcoholics Anonymous (AA), or Self-Management and Recovery Training (SMART).
SpringBoard Recovery Can Help You
SpringBoard Recovery, located in Scottsdale, Arizona (near Phoenix), provides effective and affordable outpatient treatment programs for individuals struggling with substance use disorders and mental health disorders.
We understand that beginning addiction treatment in an inpatient drug rehab can be highly beneficial. At SpringBoard Recovery, many of our clients started with this level of care, giving them the hope and inspiration that recovery was more than just possible, and providing them with the intensive round-the-clock support and care they so desperately needed at the start of their recovery journey.
Find out more about how to begin your own addiction recovery journey by contacting us today.
External Sources:
- National Institute of Drug Abuse (NIDA): Trends & Statistics. January, 2018. Available at DrugAbuse.gov.
- National Institute of Drug Abuse (NIDA): Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) – “Evidence-Based Approaches to Drug Addiction Treatment.” January, 2018. Available at DrugAbuse.gov.
- Science Direct: Behavior Therapy. 2002. Available at ScienceDirect.com.
- Substance Abuse & Mental Health Services Administration (SAMHSA): “Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health.” 2018. Available at SAMHSA.gov.
- National Alliance on Mental Illness (NAMI): Mental Health By The Numbers. March, 2021. Available at National Alliance on Mental Illness NAMI.org.
- Alcoholics Anonymous (AA): Home webpage. 2021. Available at AA.org.
- Narcotics Anonymous (NA): Home webpage. 2021. Available at NA.org.
- U.S. National Library of Medicine: “Substance Abuse Treatment Planning.” 2005. Available at NLM.NIH.gov.
- American Nurses Association: Nursing World – “Medication-Assisted Treatment (MAT) for Opiate Dependence” (downloadable PDF). 2021. Available at NursingWorld.org.
- Substance Abuse & Mental Health Services Administration (SAMHSA): Resources for Families Coping with Mental and Substance Use Disorders. August, 2021. Available at SAMHSA.gov.
- National Institute of Drug Abuse (NIDA): Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) – “Twelve-Step Facilitation.” January, 2018. Available at DrugAbuse.gov.
- American Psychological Association (APA): What is Cognitive Behavioral Therapy? July, 2017. Available at APA.org.
- American Psychological Association (APA): Eye Movement Desensitization & Reprocessing (EMDR) Therapy July, 2017. Available at APA.org.
- U.S. National Library of Medicine: “Ethical Reflections on Offering Patients Accelerated Resolution Therapy (ART).” August, 2018. Available at NLM.NIH.gov.
- U.S. National Library of Medicine: “Dialectical Behavior Therapy: Current Indications and Unique Elements.” August, 2018. Available at NLM.NIH.gov.
- National Institute of Drug Abuse (NIDA): Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) – “Motivational Enhancement Therapy.” January, 2018. Available at DrugAbuse.gov.
- U.S. National Library of Medicine: “Biofeedback in Medicine: Who, When, Why and How?” August, 2018. Available at NLM.NIH.gov.
- U.S. National Library of Medicine: “Equine‐Assisted Therapies Using Horses as Healers: A Concept Analysis.” September, 2019. Available at NLM.NIH.gov.
- American Psychological Association (APA): Mindfulness Meditation. October, 2019. Available at APA.org.
- U.S. National Library of Medicine: “Treating Major Depression with Yoga.” March, 2017. Available at NLM.NIH.gov.
- American Art Therapy Association (AATA): About Art Therapy. 2017. Available at ArtTherapy.org.
- American Horticultural Therapy Association (AHTA): About Horticultural Therapy. 2021. Available at AHTA.org.
- American Music Therapy Association (AMTA): What is Music Therapy? 2005. Available at MusicTherapy.org.
- U.S. National Library of Medicine: “Relapse Prevention and the Five Rules of Recovery.” September, 2015. Available at NLM.NIH.gov.
