Levels of Treatment Providers
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There are different levels of care for substance problems. Here are the main categories of treatment and help listed by levels of care.
(A note about “medical necessity”: Insurance providers reimburse for what they determine to be medically necessary, in their eyes justifiable “as reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care.” This means that the line between what is paid for and what isn’t, isn’t always clear. Some providers can be encouraged to build a case for payment for their services and families can request that a provider do so.)
Illustration © Eleanor DavisInpatient Detoxification
This is medical treatment for safe withdrawals of substances (usually paid for by insurance or state Medicaid plans for an average of 3-7 days).
Note: Withdrawals from alcohol and benzodiazepines can be life threatening and must be handled by a medical doctor in an inpatient detoxification unit; opiate withdrawals create very uncomfortable physical and emotional symptoms that are not, in themselves, life threatening, such as flu-like symptoms, a restless and twitchy body, vomiting, diarrhea, and deep sadness. Stimulant withdrawals are primarily psychological, with deep sadness or depression and a flat outlook. Stopping marijuana can cause anxiety and irritability.
These are brief hospitalizations (7-14 days) to observe, assess, and stabilize individuals typically suffering from just mental illness and sometimes also substance problems (called dual diagnosis). Programs in these hospitals are different than the usual stay in a psychiatric ward and are usually paid for through insurance. Often requires referral from a professional and evidence of past mental illness and treatment.
Rehabilitation or "Rehab"
These are longer stay housed programs (14 days and up) and may include medical detoxification and psychiatry, but are primarily designed to provide substance abuse and mental health therapy and recovery skill training. In our experience, almost never paid for by insurance. Insurance can sometimes be pressured to pay for several days at a time based on medical necessity. Rehab can provide a family with a reimbursable treatment invoice, such as therapy provided by licensed provider or laboratory tests, which can be claimed for through insurance.
Residential Program/Therapeutic Communities
These are long-term housing programs, usually 90 days or more, providing a highly structured alcohol- and drug-free environment. Residential programs typically do not allow residents to work outside the residence. These are publicly funded residences that contract with the state. They can have long waitlists for admission and require 30 days or more sobriety upon admission. Typically low cost.
Sober Housing "Recovery Homes"
These are group residences that offer an alcohol- and drug-free living, low-structured environment. Typically, residents work or do community volunteer work part-time, are drug tested, must abide by house rules, and attend house and 12 step meetings. Usually low cost. Stays can be up to a year or more. For a list of questions to ask when you're picking a Sober Home, click here.
Intensive Outpatient Programs/ Partial Day Programs
These are outpatient programs lasting 3-4 hours a day, 3-5 days a week, for 3-4 weeks. Insurance and state Medicaid plans will reimburse for these programs. Treatment is similar to inpatient rehabs: psychotherapy and recovery skill training and perhaps psychiatry.
Outpatient therapy is sometimes paid for by insurance and State Medicaid plans for varying lengths of time. Therapist approaches vary widely. Use our system described below for identifying treatment to help narrow the field. The supplement provides evidence-based approaches. SAMHSA.gov lists other approaches reviewed and recommended by the government.
Note: some therapists are willing to work by phone.
Recovery coaching is typically not paid for by insurance or state Medicaid plans. This is a relatively new modality made up of individuals who have been trained to work with people in recovery. They do so in person, by email, and the phone. See this article for more information and training requirements of coaches.
Note: recovery often entails a certain length of sobriety (often 30 days) and a desire to stay in recovery.
Sober Companions are similar to recovery coaches but can provide round the clock care. See this article for more information.
These are medications that support the reduction or elimination of a problem substance through lowering cravings or reducing withdrawal symptoms, for example, campral for alcohol or cocaine, suboxone for opiates. They can be given for the brief period of withdrawals or for longer periods, as a medication substitute for the problem drug. For a description, click here. For the AiR supplement page on MAT, click here.
Note: protocols for successful treatment with one of these medications includes psychotherapy and other supports. In researching providers, make sure other supports are offered.
These are peer-run groups (12 steps and not) that provide community support for problem substance use. Some individuals motivated to do something about their use may receive sufficient benefit from these peer-run style groups that they decide to quit or cut down without treatment.
Note: See “Self-Help Resources for Your Loved One” in the Supplement for more information.
Helping Your Loved One Find Treatment
Experts believe that problem substance use comes in a range of severity and that treatment should match up and be proportional to that severity. As a family member, however, you can’t be the one figuring out this equation for two reasons:
You are not qualified to assess your Loved One’s use and any professional you consult with, even us, can only guess at what may be needed without an evaluation of your Loved One
Accessing different types of treatment may be difficult (wait list, costs, etc.), especially if you’re depending on the public treatment system.
In creating your list of options to present your Loved One, two things should drive the selection:
What you think your Loved One will say YES to, and
What you can quickly get your Loved One admitted to, with the least amount of trouble. If the level of care is wrong, let the professionals make that determination and then insist on referrals and support by those professionals to get your Loved One into the correct program.