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No More Square Pegs in Round Holes: Picking the Best Treatment Option for You or a Loved One

Rick Baumgartle
No More Square Pegs in Round Holes Treating addiction is just like anything else when it comes to treating any disease, what works for one person doesn't work for another. Families and loved ones often get frustrated, especially when they have spent thousands of dollars, often more than once on various treatment programs, and the person in their life continues in active addiction. It's enough to want to throw up your hands, believe that the whole treatment thing is just a big money-making scam, or believe that their loved one just doesn't have what it takes to make it in recovery.

Let me let you in on a secret...treatment doesn't always work, at least not the first time. Addiction is a disease and like most diseases it behooves you to do the research and talk with professionals in the field of treating that disease about what the best way to do it is. Here are the important things to consider. There are different modalities of treatment and what may seem like the best, might not be.

Throughout the history of the United States there have been hundreds of programs that have sprung up, both profit, and nonprofit who have all worked to help and in some cases claimed to “cure” the person with addiction. From asylums, to fancy hotels that provided room service and treatments while their patient got better, to the rooms of AA and later NA, and hundreds of other 12 step programs that have been around since 1935. Many have come and gone. They weren't all identical, and they still aren't. Remember that with a disease there is rarely a one size fits all approach. Now let's talk about some of those modalities.

Inpatient Treatment
Inpatient treatment centers are generally the ones you see advertised on television. The time people spend there can vary from a few days to several months. The costs run from the hundreds, well into the thousands and even hundreds of thousands of dollars. Betty Ford Centers have been popular for years, Hazelden has also been around for decades and has helped thousands of people.Most inpatient treatment centers include a medical staff. They often have detoxification services (those are usually extra) for people who need to be medically supervised after quitting certain substances. Patients are required to attend group counseling, see counselors, both addiction and mental health counselors. The medical staff in most facilities are available to provide medications (usually only for the duration of the stay) to help with withdrawals or possibly mental health issues (anxiety and depression often become apparent shortly after quitting alcohol and other substances).

Detoxification Centers
Detoxification centers can run the gamut from more expensive options that generally only take private insurance to centers that accept low income patients and state-run health insurances. Hooper Detox in Portland, Oregon has been running their program and helping people for years. At a detox center, a person's stay is usually much shorter. The idea is to help people get over the difficult first few days of being abstinent from drugs and alcohol, which is usually done under medical monitoring. Most detox centers require patients to attend group sessions, see a counselor, and encourage people to have follow up or after care with another agency, perhaps one attached to the detox center itself. Some detox centers are walk in. At some it may take a person going in several days in a row in order to get in, as they take the most severe cases first, and work in those who show motivation by showing up every morning in the order they get them. Other centers may take appointments and can schedule those for you over the phone.

There are different levels of outpatient. Intensive outpatient, which is usually court ordered through drug courts, or even DUII diversion programs, are programs in which a patient is required to attend group, usually several times weekly at first and where the groups themselves are usually longer. Level one (1) outpatient is one where people are required to see counselors, go to group sessions, but generally not as frequently and the groups generally are not as long. Some provide medication and others do not.

Daily Dispense
Often incorrectly referred to as “methadone clinics.” Daily dispense programs are set up to help people specifically with opiate issues (i.e. heroin or pain pills). They provide medication in the form of not only methadone, but also Suboxone or one of its equivalents. Patients initially are required to go 6 days a week, during the clinics regular operating hours, which are almost always early morning until around noon or so. They receive their medication at the clinic and take it there as well. Clients are eligible to receive take home medication after time in treatment and following through with the program expectations. Daily dispense programs require their patients to see counselors as well as go to group counseling. Access to the medical staff aside from the nurses who dispense the medication is often limited as one medical director will oversee the entire clinic and are there in the capacity to write prescriptions, and usually do not have time to see the clients on an individual basis.

Office Based Medication Assisted Treatment
Office based treatment is one in which people come to regular medical appointments, see a doctor, and are prescribed medications, if called for, to treat their condition (usually opiates). The medication most commonly prescribed is Suboxone/Burprenorphine or one of the alternatives. They also can prescribe and administer Vivitrol, a time released, non-narcotic, monthly injection for treating opiate dependence as well as alcohol issues. Doctors at office-based practices cannot prescribe methadone for opiate issues. That currently is only available at daily dispense programs. Most office-based settings require that clients attend group sessions and see a counselor. Even if they don't have those facilities on site, they may require that clients seek that care elsewhere as part of receiving care.

Which One is Best for Me or My Loved One and What should I Look For?
No one size fits all. In looking for a treatment program it's not only important to evaluate what a person needs but what the programs have to offer. I highly recommend that anyone considering treatment, who isn't sure what type or intensity of treatment is best, go and talk to a professional in the field, doctor or counselor, and get an opinion before proceeding. Here are some things to look for.

Success Ratings
Watch out for programs that tout their “success rating,” or offer some percentage of success. Some programs tell you they have a 99% success rating. Rarely do programs follow people more than 30 to 90 days after they leave and have limited data available on the long-term success. The people they do get a hold of for follow up are inevitably doing well and are happy to talk about their success. The ones who aren't often don't want to admit they slipped or returned to addiction and so aren't included in their data. That percentage is not the only indicator of the real success or effectiveness of their program.

Touting a Cure
Addiction is a CHRONIC disease that does not go away. I have said many times, “Once you become a pickle, you can't go back to being a cucumber.” Addiction, like a lot of other chronic diseases (e.g. Diabetes) can be put in remission and kept there through ongoing efforts. Any program that tells you they have a cure or that they can teach you to drink or use in moderation like a “normal person,” is misinformed and any examples they offer in the form of client testimonials are the exception rather than the rule, and what's more likely the people writing those testimonials almost assuredly were having problems with abuse (a different condition than addiction) and not actual a true substance or alcohol use disorder.

After Care
Find a program that has after care. I recently attended a lecture and listened to a doctor who talked about an “Acute” model of care vs a “Chronic” model of care. Acute care is what you receive from your doctor when you have a cold or the flu. You see them, they treat you, you may have a follow up and then if you are better, case closed. Addiction is not acute. Addiction, like many other diseases, requires follow up care even after the symptoms have been brought under control. Many people with addiction themselves are misinformed and try and treat their disease like it's acute. They just want to get better and move on with their lives. People with addiction, even after completing a program should be having medical and therapeutic follow ups for months and even years after. Graduation or completion of a program does not equal cured.

Medical Supervision + Counseling
Find a program that requires counseling along with medical supervision. This isn't to say everyone needs medication. Addiction affects people in all areas of their lives. It does biological, psychological, and social damage to the people it effects directly and to the people in the lives of the person with the addiction. A person's rate of success goes up if they address all the aforementioned areas and not just one. Often people who begin to feel better physically develop the attitude that everything is “fine.” Those people are the ones who leave treatment, only to return again and again until they finally get that it's more than just feeling better. Or just “quitting.”

Inpatient Treatment
Not everyone needs inpatient treatment. Due to the marketing done by most inpatient programs, as well as the viewpoint of the media on what treatment looks like, many people believe inpatient is the only way to go. There are thousands of people who spent a good deal of time in inpatient programs and weren't successful. It's not always the best option.

Some people do need medication for them to be successful. This is not a weakness. It is not trading one addiction for another such as in the case of Suboxone/Burprenorphine or methadone. Some people may require a medication to help treat a chronic disease. Starting medication does not mean a person is on it for life. It means that some people benefit from having medication along with counseling or therapy to help them move forward. Some people who are pre-diabetic or diabetic can manage their diseases through diet and exercise. Others, for a variety of reasons are not and require medication. Those people aren't weak, they don't lack willpower or motivation. They are different. Different isn't bad, it's just not the same as others.

This is a lot of information to consume in a short amount of time and it just scratches the surface of some of the considerations when it comes to treating a disease as complex as addiction. Talk to a trained professional and get their opinion. Often a drug and alcohol assessment, by a competent, licensed professional can give enough information to recommend a direction to begin treatment.