Did you know that substance abuse is a mental health problem? According to the National Survey on Drug Use and Health, 9.2 million U.S. adults experienced both mental illness and a substance use disorder in 2018. The National Alliance on Mental Illness (NAMI) calls this a dual diagnosis and states, “People experiencing a mental health condition may turn to alcohol or other drugs as a form of self-medication to improve the mental health symptoms they experience.” 

The existence of co-occurring psychological disorders helps explain how many people who struggle with substance abuse get to the point of developing a chemical dependency or addiction. In addition to this psychological disorder, once a person’s brain is addicted to alcohol or other drugs, it also has a physical disease that must heal.

For employers, the connections between substance abuse disorder (SUD), mental health, and physical disease matter. That’s because the Substance Abuse and Mental Health Services Administration (SAMHSA) reports that almost 11 million full-time workers in the United States have SUD and American businesses absorb a large portion of those costs through healthcare costs and due to absenteeism and loss of productivity. The impact from the loss of productivity equals $130 billion annually according to the American Journal of Preventive Medicine. 

A dual diagnosis, however, can make treatment difficult. NAMI suggests that the best treatment for dual diagnosis is integrated intervention, “when a person receives care for both their diagnosed mental illness and substance abuse.” 

Effective addiction treatment is highly-structured counseling that draws from several disciplines to help a person struggling with addiction begin healing. Treatment is a combination of education – understanding what addiction is and how recovery works – and the development and practice of new ways of coping and living life that support long term recovery.

Here’s What Treatment & Counseling Process Can Look Like

This is how we approach treatment at Lionrock Recovery:

Before everything is the question of physical health.

  • Does the client need help with detoxing from substance use?
  • Is the client medically stable?
  • Does the client need other health care services?

Next, through an assessment process, a counselor will uncover deficits that have developed in the client’s life as a result of substance use disorder. To start, the counselor will ask questions about physical health factors like exercise, proper nutrition, and sleep habits which are important factors to consider in the recovery process. As the assessment goes deeper, the counselor looks to uncover aspects of a client’s social life and spiritual connections which may need strengthening in order to support a sustainable recovery.

The assessment process will also uncover the possibility that co-occurring disorders are contributing to the addiction. If so, and when appropriate, the substance abuse counselor will bring in a professional who specializes in the type of co-occurring disorder that is burdening the client.

Once the assessment process is complete, the counselor and client collaborate on the creation of a substance abuse treatment plan that breaks down the areas of improvement into achievable goals, and puts them on a timeline. Using this plan, both the client and counselor can plan and measure the client’s work toward building a life in recovery.

With assessment and treatment plan complete, the client is ready to join a substance abuse therapy group. At most levels of inpatient and outpatient care, therapy is a mix of group and individual sessions. Group sessions form the backbone of drug addiction counseling because through the interaction with others in early recovery, clients gain perspective on their own recovery, and benefit from helping their peers gain similar perspective. Individual sessions provide time to discuss topics better explored in private as well as time for family therapy and case management.

Types of Treatment

The “continuum of care” in drug addiction treatment spans the most intense levels of care through post-treatment recovery support. Ideally, clients progress from higher levels of care to lower levels, however, depending on a client’s success at a particular level, the counselor might recommend a higher level of care.

Medical Stabilization (Detox)

A person who drinks heavily every day may need supervised medical stabilization, also known as “detox”, for a period of 5-7 days. Withdrawal from any addictive substance can be unpleasant, but alcohol withdrawal in severe cases can result in delirium tremens (the DTs), which in the worst cases, if not medically supervised, can result in severe complications and even death.

Residential (Inpatient) Treatment

Just like it sounds, a “residential” drug and alcohol rehab center requires that you live at the center during your treatment. The terms “inpatient” and “residential” are often used to mean the same thing, but an inpatient facility might be more likely to be located in a hospital, rather than a separate treatment center. Hospital-based inpatient programs offer around-the-clock medical care, compared to inpatient/residential facilities located outside of a hospital, which may not.

A residential program can provide more of the continuum of care, beginning with medial stabilization and then stepping down through lower levels of care. A residential program is more likely to offer physical services, like nutrition and exercise, as well as alternative therapies, like equine and art therapies.

Extended Care

An extended care program is a residential program that offers a multi-month program, often 90 days.

Outpatient Treatment

Outpatient care refers to any level of care which does not include a medically/professionally supervised residential component. Partial Hospitalization (often called “PHP” or “Day Treatment”), Intensive Outpatient, and Outpatient are the three most common levels of Outpatient Treatment.

Partial Hospitalization

Partial Hospitalization is generally a 6-8 hour program five days weekly. Clients attend during daytime hours. PHP consists of the same kind of structured care provided in residential programs, but at the end of the day, clients go home. It’s common for clients in early sobriety to reside in a Sober Living Home (also know as a Sober Living Environment or Recovery Residence) while enrolled in Day Treatment.

Intensive Outpatient (IOP)

Intensive Outpatient Programs, often called IOP, are the next step down from Partial Hospitalization. Typically, IOP meets three times weekly for three-hour sessions, although clients may start with four or five sessions weekly and step down to three. IOP is approximately 80% group therapy, with the remaining 20% consisting of individual sessions.

Outpatient Treatment

Outpatient Treatment is the lowest level of professional substance abuse treatment. The frequency and mix of group and individual sessions depends on the counselor’s assessment of the client’s treatment needs. An Outpatient program can be an equal mix of weekly group sessions, usually 60-90 minutes, and hour-long individual sessions, or a different mix, that also can change flexibly as a client’s needs evolve.

Mutual Support Groups

Mutual support groups, like Alcoholics Anonymous (AA), play a critical role in recovery, but they themselves are not substance abuse treatment as it is currently defined. Treatment is provided by healthcare professionals, is “evidence-based” psychological therapy (like Cognitive Behavioral Therapy – CBT), and focuses on the individual with in-depth assessments and treatment plans that are customized each individual client. Treatment is “inside-out”, focused first on changing thinking patterns, so that changed behavior can follow.

Mutual support groups are led by peers – people in recovery from all walks of life. They are typically (but not always) spiritually-based, and they focus on the group, the community. AA calls it a “design for living”, and it is a philosophy of how to live in recovery. In sum, it is “outside-in”, implicitly putting behavioral change first, with the idea that understanding will flow from these changes, in turn changing thinking patterns generally.

It’s important to note, the brain disease caused by long term drug and alcohol abuse can take up to a year of sobriety to heal, and if a dual diagnosis exists,  these must be addressed over time, often with both behavioral and medication-based treatments. So, while treatment itself may be relatively brief, success in recovery requires a long term commitment.