Residential Treatment

Aspects of Recovery: Residential Treatment

What Are Residential Treatment Programs?

Residential treatment programs are where patients reside for various lengths of time depending on their individual needs as determined through clinical assessments . Short-Term programs average 28 days, but many offer also 7 or 14 day stays.  Long-Term residential programs offer stays from 60 days, 90 days or even longer.

Both programs provide intensive counseling groups, individual counseling, education about the disease of addiction and more.  While these programs are voluntary, there are many restrictions, including wake up and bed time hours, restricted access to the internet, phones and media, and dietary guidelines.  It is common for residential facilites to prohibit leaving the facility-unauthorized absences will usually result in discharge from the program.

Visiting hour restrictions also normally apply; many facilities restrict all outside access for the first week or two.  

How is the Length of Stay Determined?

The length of treatment and the intensity of treatment, depends on several factors, including

  • the severity of the addiction

  • the existence of any co-occurring mental health conditions prior treatment

  • Insurance or the ability to pay

Most inpatient centers offer family programs, where members of the patient’s family participate in family counseling and activities. This provides the opportunity to open communication between family members and significant others, educate on the disease of addiction and its after effects, and identify and repair dysfunctional relationships or dynamics that could trigger a relapse. Families can help encourage and support their loved one by being actively involved in their recovery.

Each inpatient residential facility provides its own unique accommodations. Some are basic, with dormitory style living, others offer apartment style shared rooms, cafeteria-style meals and most offer recreational activities such as walking, running, pool and ping-pong.  Others may offer private luxury suites with gourmet meals and a host of amenities, like a pool, spa and gym.

Inpatient Facilities

Most inpatient facilities are connected with a detox unit on site.  As a patient completes their detox from drugs or alcohol, they transition from the ‘hospital unit’ into semi-private rooms or dormitories.  Most hospitals that have a chemical dependency treatment program are set up in this way.  Patients who are detoxing from benzodiazepines, heroin or opiates and alcohol and will be provided with medications as part of their recovery may be best served in this environment. 

Treatment is intensive and highly structured, with medical monitoring throughout the duration.  There are specific wake up and bed times, meals are generally cafeteria style and private time is limited.  Personal computers(including i-pads) and phones are generally prohibited and television is usually limited to sports.  Books and magazines may also be restricted to recovery materials.  Personal items, as a rule, are limited to one suitcase or backpack, and will be searched upon admittance to ensure no items containing alcohol or other substances that can be used for abuse are brought in.

Mental health professionals may be available, but unless the facility is designated as a co-occurring treatment program, time will be limited.  

Treatment consists of psycho-education, group process and individual sessions.  The curriculum is often based on a 28 day rotation set up as pods; each education piece does not hinge on any particular order.  Meditation or yoga sessions have been implemented into most schedules.  Introduction to AA and  NA groups may be on site or patients may be transported to various meetings.  

Laundry facilities are usually on site. 

It is important to note that most times, patients must enter inpatient treatment through the facilities detox program, regardless if the patient believes they need this; a 24 hour period of observation for any symptoms of intoxication or withdrawal is the general rule, although this may vary.  

Residential Facilities

Residential treatment implies a more home-like atmosphere, with residents having their own space to live in or share with a roommate, with fewer beds, more freedom, and more amenities. Patients in residential rehab essentially move into this new home for a period of time.

Residential facilities differ from inpatient facilities in that they are outside of a hospital setting.  They also are open ended in the time frame for stays.  Most inpatient facilities average 30 days, while a residential facility may last six months or more.  They do not provide intensive medical care, although they may offer access to it via transportation.

Residential facilities are often a ‘step down’ from inpatient services, but continue a structured and monitored agenda of psycho-educational classes, group process and individual sessions.  Patients entering a residential setting are generally more stable than in the inpatient setting, but continue to lack the necessary components to remain sober and in recovery outside of a structured environment.  During this time, they have the benefit of living away from family, friends, stress, and many temptations to use. This allows for better participation in therapy, positive interaction with peers, and a focus on sobriety rather than all the pressures of everyday life.

It is important to note that whether choosing inpatient or residential treatment, or a combination of the two, that this is still treatment.  Sober living houses are not treatment and are discussed in the resource section of this site.

In addition, patients looking to engage with a residential facility must be assessed by a clinician for appropriateness of placement; a referral from an inpatient or detox facility is most common.  Other referrals may be obtained from medical professionals or the court system.  There are also residential programs specifically designed for certain populations, such as court referred or medically managed opiate treatment.

Questions you should ask when choosing a facility:

  • Cost

    • Many facilities dance around this question and it is one of the greatest setbacks a family may experience when trying to get a loved one into treatment .  Insurance may pay for some, but not all of the treatment.  Some insurance companies will pay only for detox and provide no coverage for inpatient services without severe mental health factors.  Many insurance companies request frequent reviews of progress and can deny services midway through a program.

    • Deductibles are often requested by the facility up front, with payment plans attached.  Any missed payments will result in collections, and there may be frequent errors on the part of the company. 

    • Many times, a well meaning intake coordinator may misrepresent  payment estimations.  Get this detailed and in writing, including the nuances if a patient chooses to leave treatment early or if the facility is not qualified to treat a mental health disorder and seeks to discharge.  If uninsured, ask if the treatment center offers scholarships or in-house financing options. 

  • What types of addiction does the program treat and how

    • It’s important to find a center that has experience treating your specific addiction and any co-occurring disorders. Every substance has different physical and psychological effects, so make sure to ask about the treatment center’s familiarity with treating your specific one.  In addition, patients with opiate dependency benefit greatly from medication assisted treatment, but buprenorphine or suboxone may not provide adequate relief from symptoms for IV heroin use. 

  • What types of therapy are offered

    • Most rehabs offer group and individual counseling. Beyond that, there are many different types of traditional and nontraditional therapies. Family therapy, holistic therapies, such as yoga, art, music or equine therapy may be offered-ask how these are facilitated and their frequency.  I learned of one facility that advertised equine therapy, which in reality consisted of going to a horse boarding and cleaning stalls.  One time.  Ask questions.  

  • Discharge Planning and Aftercare

    • It is a federal standard to provide planning and referrals prior to discharge and is essential to maintaining sobriety. Ask if your rehab of choice has an aftercare program and what that looks like-how often is it offered, what are the costs, what is their schedule and what is their agenda.  How will the facility connect the patient to that aftercare, and what is their responsibility to ensure a smooth transition.   

  • Unplanned Discharges

    • One of the most common reasons patients leave treatment early is experiencing symptoms of withdrawal that are overwhelming.  They also report excessive feelings of anxiety, claustrophobia, mood swings and cravings, which are all symptoms of PAWS, or Post Acute Withdrawal Syndrome.  ​​Residing in close quarters with others in times of physical and emotional stress foster behavior issues that  many facilities are ill equipped to cope with. 

    • Ask what the rehab policy is for an unplanned discharge.  Are the monies returned?  Is the party still responsible for payments of any unpaid balances?  What responsibility does the facility accept for patients leaving AMA?  How will they ensure that the patient will be provided transportation home?   

    • Ask what the facilities success rate is, what their discharge AMA ratio is and what their Outcome Improvements Plan is.

  • Credentials and licensing

    • Because you want access to skilled professionals, find out the credentials and accreditation of the clinical staff and the facility itself. This is important, as sub-standard facilities can not only fail to help you, but do so at a high financial cost. 

      • A facility should be accredited- look for a 3-year CARF Accreditation as the highest standard.  The facility should be in excellent standing with the state health authority and the DEA, if medication assisted.  Licenses should be displayed and readily available to view. 

      • Staff should reflect services offered-if a residential facility advertises for treatment of mental health in addition to substance use disorders, a mental health professional should be on staff, not as a contracted outside support.  They will be a vital and contributing member of the treatment team and based from the location of the facility.

  • Peer or Mentor Services

    • While many rehabs adhere to the 12-step program — Alcoholics Anonymous or Narcotics Anonymous, these should not be what their programs are based upon.  Because these programs are provided free of charge in the community, program agendas should be focused on treatment, psycho-educational aspects and individual counseling.  

    • AA and NA, along with SMART Recovery, Celebrate Recovery and others should be introduced and patients should have the opportunity to explore them.   In addition, ask if Certified Peer Mentors are available.  Most hospital inpatient services are now providing these on staff and are a valuable assert based upon drugs of addiction.  If a CPM is not a staff member, ask if the facility connects patients to them as part of their discharge planning.    

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