5 Key Factors to Consider When Selecting a Substance Abuse Treatment Center
Trying to overcome a crippling relationship with drugs through sheer force of will, a strict regimen, and wellness practices is not a sign of naivety but rather an understandable approach. Journaling, restriction, dry spells, meditation – all these healthy activities provide comfort or support to millions but eventually prove insufficient for many of them, and that is a fact that needs to be normalized much more.
Discussing the transition
Self-care practices are an excellent complement to any wellness, stress relief, sleep, behavior modification, or even light substance reduction program. But they are, quite literally, an inadequate response to a physical dependency. The DSM-V criteria for tolerance and dependence serve as an excellent guide to delineate between a problem that is solved by better life habits and one that requires professional intervention.
The tell-tale sign that you may have crossed that threshold is experiencing withdrawal symptoms upon reduction. If missing your daily dose makes you twitchy, nauseous, anxious, unable to sleep or otherwise miserable, your body has already adjusted to the foreign substance and turned it into a necessity. Your return to full control is now contingent on successfully navigating the first stage of withdrawal, which can potentially be fatal, depending on the substance. Detox is necessary, but it is not something you want to undertake alone, especially not for alcohol or benzos. The next consideration is which reputable facility you should choose.
Factor 1: accreditation & licensing
The simplest thing to research when on the hunt for a trustworthy addiction treatment facility is whether it has independent accreditation. The CARF (Commission on Accreditation of Rehabilitation Facilities) and The Joint Commission are the two most prestigious bodies in the field, each with its own criteria for evaluation. An official accreditation signifies that a facility has demonstrated a level of competence in terms of staff qualifications, treatment protocols, safety, patient outcomes, and ongoing internal audits, among other things. It is also important that the facility possesses a valid license from the relevant state health and social service department, which is often easily verifiable online. This is the absolute minimum to ask for, and if a prospective facility is not forthcoming about those details, it is best to cross it off your list.
The bottom line is that accreditation and state license are what differentiate the actual medical professionals from unqualified operators posing as treatment facilities. The former have objective proof of providing adequate, ethical care while the latter may prey on desperation to make unrealistic promises and deliver little. The presence of either accreditation or state license is an absolute must. It should be noted, however, that those two things, while important, will only get you so far. They vouch for a facility’s commitment to baseline standards of care, but beyond that, there is little they can do. There are many variables to consider when selecting an addiction treatment facility, and the next one is about treatment methodologies.
Factor 2: evidence-based treatment
A competent facility will be upfront about their clinical approaches, which are generally centered around psychotherapeutic interventions. Cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are two of the most popular and effective forms of psychotherapy used in addiction treatment. Both have been scientifically proven to be instrumental in managing substance use disorders. Another crucial evidence-based approach is motivational interviewing, a type of counseling that helps patients identify and work toward their desired future. There are many other therapeutic methodologies, some of which may be right for you or your loved one. Beware of facilities that advertise unproven or proprietary treatment approaches or make unsubstantiated claims about their program being uniquely beneficial. Detox, i.e., the process of withdrawal management, is a separate part of treatment that should not be confused with rehab. Similarly, a balanced diet and regular exercise are important but should be seen as supplements to an otherwise adequate substance abuse treatment regimen. Beware of treatment facilities that promise miracle substances to cure addiction.
An important consideration in this regard is medication-assisted treatment. The use of FDA-approved medications in combination with psychotherapy is an integral part of treatment for many types of substance use disorders and is fully supported by scientific literature. Unfortunately, many facilities do not offer MAT, and many families are reluctant to pursue it due to lingering negative attitudes toward medications in general and the perceived stigma surrounding their use in healthcare. If a rehab facility has an adverse stance toward MAT and cannot substantiate it clinically, it may be an indicator of their overall quality of care.
Factor 3: dually licensed staff
The frequent co-occurrence of substance use disorders and mental health disorders is not a coincidence. In fact, it is so common that it has its own term – dual diagnosis. Many people with mental health disorders turn to substances as a form of self-medication to manage their symptoms. At the same time, prolonged substance abuse can also lead to the development of mental health disorders. Therefore, it is crucial that a treatment facility has appropriately trained staff, such as licensed professional counselors, who can provide integrated treatment for both substance use and mental health disorders.
Another related consideration is trauma-informed care. Many, if not most, individuals with substance use disorders have a history of trauma, which often goes untreated despite playing a significant role in fueling their substance use. It is essential that a treatment facility is equipped to handle the unique needs of trauma survivors and address their trauma in conjunction with their substance use disorder. Ideally, both dual diagnosis and trauma-informed care should be available from the beginning of the treatment process.
Factor 4: individualized treatment plans
When it comes to substance use treatment, there is no one-size-fits-all solution. The ASAM (American Society of Addiction Medicine) has created a comprehensive set of criteria that treatment facilities can use as a reference to develop individualized treatment plans for patients. These criteria take into account a patient’s medical and mental health history, current level of substance use, home environment, social support network, and other relevant factors, rather than basing treatment on assumptions about the patient’s commitment to recovery.
The ASAM criteria outline various levels of care, ranging from medically managed inpatient treatment to outpatient treatment. Patients who have a supportive home environment and do not require 24-hour medical supervision may benefit from a less intensive level of care. It is also important to note that moving from a higher level of care to a lower one (e.g., from inpatient to outpatient) is an appropriate step when a patient is ready for it. Treatment facilities, such as Legacy Healing NJ, that take a holistic approach to substance use treatment can create truly individualized treatment plans by taking into account the patient’s family dynamics, length of stay, and preferred modes of therapy, among other things.
Factor 5: aftercare & long-term management
According to NIDA (National Institute on Drug Abuse), relapse rates for substance use disorders are on par with chronic illnesses such as hypertension and type 2 diabetes, ranging from 40 to 60%. This is an important reminder that treatment for substance use disorders is typically a long-term process that requires a comprehensive approach. Most patients find that a 60-day inpatient stay is insufficient on its own to address their needs, but it is also not an indicator of treatment quality if it is followed by appropriate aftercare planning.
The best treatment facilities encourage long-term recovery and have aftercare planning in place for patients to continue their healing process following discharge. Ideally, patients should have a relapse prevention plan in place from day one of their treatment, and the right treatment facility will help them establish one. If a patient is unable to secure suitable aftercare housing, the facility should be able to assist them in doing so. It is also crucial that the treatment facility follows up with the patient periodically, ideally every month, to monitor their progress. The most important thing is to ask about post-treatment services before enrolling in any program, and if they are not discussed openly, it is best to find a facility that is more transparent about them.
The practical considerations
In addition to the clinical aspects of treatment selection, there are a number of practical considerations that are often overlooked but can be incredibly important to the treatment process.
For one, insurance is a crucial consideration that should be discussed well in advance of admission to a treatment facility. In most cases, it is the provider who facilitates the verification of benefits rather than the patient, and it is always advisable to confirm that the treatment facility is indeed in-network for the patient’s insurance plan. If the facility is not in-network, the patient should request an out-of-network benefits summary so that appropriate measures can be taken to cover the cost of treatment.
Location is another practical consideration, as patients are much more likely to succeed at a facility that is conveniently located relative to where they reside. If the patient is, say, a 12-hour flight from home and the family is flying in, it is the treatment facility’s responsibility to help arrange the patient’s return home. After all, family participation is known to bolster long-term recovery, and there should be options for family meetings and involvement with the patient’s treatment in order to facilitate it. The same goes for aftercare – it is important that the patient has a proper sober living environment to return to, which may be difficult to identify and secure without the guidance of the treatment facility. The family may benefit from discussing recovery expectations and general outlook with the medical staff once the treatment facility has been shortlisted.
Other practical considerations include asking the facility’s staff about their credentials and years in practice, asking for references, discussing what the patient can expect from the treatment process, and any specific questions the patient, their family or legal guardian may have. The point is, an open and transparent conversation is always the best way to determine the suitability of a particular facility. Reputable centers will not hesitate to field questions regarding staffing and other general concerns, such as how they would proceed if the patient had a relapse while in their care.
Conclusion
The decision to transition from self-care to professional intervention is not one that should be taken lightly. Selecting the right addiction treatment facility is an intensely personal process that requires both careful research and due diligence on the part of the patient or their guardian. It bears repeating that recovery is not the same thing as abstinence. If the ultimate goal is to live a more fulfilling and enjoyable life, it is important to understand that recovery will be a lifelong process. If there is even a possibility of achieving that goal, no matter how remote, research should continue until one feels completely confident in one’s decision.
Clear evidence is often the best guide when making that decision.
