A GUIDE FOR FAMILIES, FRIENDS AND PARTNERS OF INDIVIDUALS WITH SUBSTANCE USE DISORDER
In 2014, an estimated 20 million people aged 12 and older suffered from a substance use disorder. Among that group, 14.4 million people were alcoholics, 4.5 million had problems with drugs only and 2.6 million abused both alcohol and drugs.
The problem is widespread. Luckily, so are the available options for treatment.
When you discover that your loved one is struggling with substance use, emotions can overwhelm you. You may feel guilty because you couldn’t prevent the addiction or didn’t uncover it sooner. You may feel a sense of panic to do something about the addiction as soon as possible. You may feel confused about the options for treatment.
This guide will help you find the right treatment facility for your child, your friend or your partner. You’ll learn which criteria are the most important, how facilities may approach treatment differently and how insurance can help your loved one find success in sobriety.
Often, finding the right rehabilitation center is the key to effective treatment.
Real relief from the stresses of addiction can be found by discovering a rehab center where trust-building between clients and staff is a priority, where approaches to treatment are based in science and research, and where your loved one can escape the triggers that led to substance abuse and start the path to recovery.
That’s where success begins.
Tyler’s Story: Why Rehab Matters
When Tyler Dale was 11 years old, he was sexually abused by his baseball coach. It took several months before another child, on the same team, reported the abuse.
Tyler started experimenting with drugs shortly after. His mother, Lynn, reflected on the traumatic experience: “This man got 10 years in jail, but my son ended up with a lifetime of addiction.”
Always a top-notch student with a winning personality, Tyler started to withdraw, and his grades suffered. Over the next several years, Tyler became addicted to Adderall, which he sourced from older kids at school to focus in class.
From Adderall, he started taking painkillers such as oxycodone and tranquilizers such as Xanax and diazepam — known as “blues.” Once he ran out of money for pills, he turned to heroin. He sold almost every valuable object in the family’s home, from televisions and tools to Lynn’s wedding bands.
Lynn has spent the last 12 years trying to help her son free himself from his heroin addiction. Today, Tyler is in his sixth rehabilitation center. Hopes are high; she has faith that this time he’ll stay sober.
Lynn’s experience with rehabilitation centers is extensive, and she’s seen options from luxury rehabs to stark sober living apartments. She’d been through a recovery journey before with her husband, who struggled with an alcohol addiction until he was 40 years old.
“Any family who finds out their loved one has an addiction should get help immediately,” she said. “I wish we had sent Tyler to a rehab when I first heard about his drug use. But I didn’t, and it’s just gotten worse. Don’t hesitate.”
A Facility that Fits: Criteria to Consider
U.S. Surgeon General Vivek Murthy describes the costs associated with addiction as staggering. Drug and alcohol addiction costs the United States upward of $420 billion annually in health care costs, criminal justice system costs and economic productivity losses.
Addiction comes at a steep price, and shifting the way we discuss it and treat it can go a long way toward stemming the tide for future generations. Brett Watson, intake manager for Advanced Recovery Systems, an integrated behavioral health administration company, believes the challenge is in “wrapping our minds around the efficacy of addiction treatment.”
“Addiction treatment should mimic treatment for cancer and other long-term chronic diseases,” he said.
Watson, who is in recovery himself, also believes that finding the right program for a client is critical. But what does the right program look like?
At the very least, an addiction treatment program must address each client’s unique needs at every stage of care — from intake to treatment to aftercare.
It is important to consider a variety of criteria when deciding on a treatment facility.
“If you were diagnosed with cancer, you wouldn’t just head to the nearest, cheapest hospital; you’d go to the hospital with the best doctors and best care,” Watson said.
Here are some of the major factors to consider when deciding on a rehabilitation center for your loved one.
According to the National Institute on Drug Abuse, people in the United States can choose from more than 14,500 drug and alcohol treatment centers. Location will likely influence your choice of facility.
This aspect continues to be a deciding factor for Lynn, who has sent Tyler to rehab centers both in state and out of state, both in urban and rural areas. According to Lynn, her son has found success in rural areas far from a major city.
“Get [your loved ones] out of their everyday environment,” she said. “Tyler has been to rehabs from the quiet desert of Texas to frigid Michigan to ranches in California. Most recently, he’s thrived at a rehab center at a ranch in Mississippi, where rolling hills and bonfires are the norm.”
Lynn believes solitude and peace are necessary while focusing on the hard work of recovery.
“Addicted individuals need to be in a place where they can let it all go and relax. An addict’s life is very stressful. You need time alone to take a walk and process what’s going on.”
Lynn also says that it’s important to remove your loved one from people and situations that might trigger a relapse. When Tyler went to Michigan, “it was winter, and there were feet of snow on the ground. Tyler is a Florida boy, and he wasn’t going to go too far if he left the center.”
SINGLE GENDER VS. CO-ED
After clients go through detox, they often feel emotions and urges they may not have felt in quite some time. Drugs and alcohol can numb feelings of desire or intimacy, and when they return, they can sometimes interfere with treatment.
Several times in Tyler’s treatment, romance complicated his recovery. At one point, he met a woman at the rehab where he was staying. She graduated out of the rehab and settled in a town nearby. A few days later, she picked Tyler up and had beer in her car. Tyler left rehab and went to live with her. Only weeks later, on a Friday, he left her. The following Tuesday, he overdosed at home. Lynn and her husband were able to save his life again.
“Find a place that’s single-gender, especially when looking for a rehab for young adults,” Lynn said. “They can focus better. When [addicted individuals] get clean, their hormones are raging.”
LENGTH OF STAY
Research has shown adequate treatment length to be a primary predictor of treatment success. However, treatment duration is variable. A doctor specializing in addiction medicine can assess a client and then recommend an appropriate length of treatment for maximum effectiveness.
Tyler’s heroin addiction had gone on so long that his needs for detox required him to stay much longer than the typical duration.
“For him, it’s a long detox process,” said Lynn. “He needs a controlled environment, and I believe part of the reason he’s relapsing is because he’s not staying in that highly regulated environment long enough.”
Families should consider a rehab facility that offers variable treatment lengths based on each client’s needs rather than a single duration for all clients.
QUANTITY & QUALITY OF STAFF
While you’re deciding between multiple options for treatment, the level of trust that staff members build with your loved one can be just as important a differentiator as the staff’s credentials and accreditations.
“Developing trust starts at the beginning, even with the intake case manager you talk to when you call the rehab’s number,” said Lynn. “There has to be some empathy from the start. Individuals with addictions sometimes have major trust issues. Tyler feels much more trusting with women than he does with men, most likely related to the abuse he suffered as a child.”
Each case manager should listen intently to your story and offer individualized support. Every substance use disorder is different, and knowing that treatment staff sees your loved one as more than a number can make all the difference.
This relatability between client and doctor breaks down perceived barriers between them and helps forge real connections. Once these barriers fall, conversations shift from talking to a stranger to connecting with someone who understands exactly what your family is going through.
TREATMENT FOR CO-OCCURRING DISORDERS
According to the 2015 National Survey on Drug Use and Health, about 40 percent of all adults who suffer from substance use disorders were also diagnosed with a co-occurring mental health disorder, such as depression, anxiety or bipolar disorder, in the past year. Those affected by two or more mental health disorders should find a facility that specializes in treating these conditions simultaneously.
Lynn’s son, Tyler, has been working through his post-traumatic stress disorder from child abuse at the same time he’s been on the road to recovery. The trick, as Lynn puts it, is trying to get your insurance company to accept a co-occurring disorder diagnosis. This opens many doors to extended and more in-depth treatment.
Just like educational institutions, rehab facilities should be accredited.
“When browsing facilities, look for Joint Commission Behavioral Health accreditation, which is the highest accreditation level for mental health and addiction service organizations,” Watson said.
Accreditation by the Joint Commission is like a rating from the Better Business Bureau. It signals that a rehab center has opened its doors in transparency to a panel of outside experts for review. The panel will validate the care, treatment and services provided at the center.
This certification also creates a culture of excellence in the center and assists the center’s staff and administration in developing programs that will provide clients long-term value and increased recovery success.
With thorough research, it’s possible to find the right kind of help for addiction. No one-size-fits-all formula exists for choosing a program, and no single facility will work for everyone. However, when families understand the factors that make a rehab facility right for their loved ones, they can find a solution that works.
Approaches to Addiction Treatment
Not every rehab facility approaches addiction treatment in the same way. Some provide a spiritual focus on mind and body connection. Others center therapy around medication-assisted treatment. The connection between people and nature is yet another common focus of treatment facilities.
Discovering the treatment focus of each rehab center you investigate will help you determine whether your loved one will be a good fit for that facility.
CONTINUUM OF CARE
The continuum of care describes the levels of intensity of treatment offered to clients. Usually, doctors will determine where on the continuum the client should begin treatment based on a series of evaluations.
Levels of care start with highly regulated, medically supervised detox and continue through aftercare, which continues throughout an individual’s life.
The continuum of care includes:
- Residential inpatient treatment
- Intensive outpatient program
- Partial hospitalization program
- Outpatient services
Families should inquire about the detox process to ensure that medical doctors will be watching over their loved one and taking measures to reduce the discomfort of detox.
Though detox is often a necessary step in the rehabilitation process, detox alone cannot provide adequate healing. A holistically based facility will often offer services both before and after formal treatment — possibly including intervention guidance and aftercare planning.
In fact, aftercare participation is one of the most influential factors in sustained recovery.
A quality rehab facility helps clients plan for life after discharge by helping them find local aftercare providers, such as a therapist, a general physician and a psychiatrist. Facility staff should set up the first appointments before a client’s discharge.
When Tyler’s parents were looking for a rehab facility for him, initially they weren’t aware that some facilities specialize in specific addictions. Some treatment centers specialize in alcohol addiction, some specialize in drug addiction and some specialize in other types of behavioral health disorders such as eating disorders.
At one point, Tyler was sent to a rehab center in Texas that treated not only drug and alcohol abuse but also eating disorders and sex addiction.
“That was not ideal for a young man dealing with sexual abuse issues,” Lynn said.
Finding a facility that has staff who are trained in assisting patients with these challenges is essential when looking for a treatment center for someone with a co-occurring mental health disorder.
Lynn says that some of the best information she’s received about heroin addiction has been from the rehab centers Tyler has attended. In March 2017, she traveled to the rehab center in Mississippi where Tyler received treatment and spent the weekend being educated about her son’s addiction.
“If it’s possible,” she said, “be as involved as you can. There’s family counseling, and that’s very important.”
Often, individuals with substance use disorders can feel alone and isolated from their friends and family.
While this is beneficial to some extent, especially when the family environment is unstable, it’s important for a person with a substance use disorder to feel supported and understood. Education programs and family therapy sessions can assist with those feelings.
It’s also important to account for various lifestyle considerations when choosing a rehab as well. Some facilities have special accommodations for:
- LGBTQ+ individuals
- Mentally or physically disabled people
- Certain religious observances
- Specific age groups (adolescent, middle-aged, elderly)
Treatment centers that specialize in these areas can make a positive difference in the recovery of each individual. For example, to avoid perceived discrimination or bullying, LGBTQ+ individuals may feel much more comfortable among other individuals in the LGBTQ+ community. Likewise, adolescents should be in a single-gender residential space with other adolescents. To treat adolescents in the same facility as adults would be inappropriate.
Evidence-Based Addiction Treatment
Evidence-based approaches to addiction treatment are scientifically proven to produce positive outcomes, and the surgeon general is their strongest proponent. Specifically, Murthy highlights these methods as effective early intervention strategies backed by many studies conducted on children, adolescents and young adults.
A popular example of this approach is cognitive behavioral therapy, an evidence-based practice that helps a client identify and alter the negative thought processes that feed addiction. Cognitive behavioral therapy is administered through both individual and group therapies.
Jolene Feeney, clinical director at The Recovery Village Ridgefield in Washington, calls evidence-based therapies tried and true.
“They offer tremendous value,” she said. “They teach skills in a direct way, and most of our clients need those tangible steps.”
Still, many treatment facilities have been slow to adopt these proven 21st-century methods. Families should look for organizations that approach addiction treatment from a research-backed standpoint.
In 2014, after a battle with heroin addiction, Academy Award-winning actor Philip Seymour Hoffman died tragically from an overdose. Some believe Hoffman’s death could have been prevented with the right evidence-based treatment. In 2015, only about 10 percent of Americans diagnosed with a substance use disorder received some form of treatment.
Certain medications may be used to help curb cravings and change the biological reward pathways in the brain that were altered by drug use. For example, people suffering from alcohol addiction might be prescribed the abuse-deterrent drug naltrexone, administered as the monthly injection Vivitrol, which causes a highly unpleasant physical reaction if alcohol is consumed.
Medicine-based approaches work best for people who suffer from severe addiction. Though anti-addiction medicines may sound like an easy solution, pharmaceuticals alone cannot ensure long-term recovery. After all, even if a person with addiction stops using drugs or alcohol, the disease’s origins cannot be treated without therapy. When considering a medicine-based treatment program, families should ensure that other therapies will continue after detox.
Dr. Richard Rawson, associate director of the UCLA Integrated Substance Abuse Programs, advocates for medicine-based approaches. He told Time, “Failure to encourage patients to use these medications is unconscionable. It’s comparable to conducting coronary bypass surgery and failing to prescribe aspirin, lipid and blood-pressure medications as part of a discharge plan.”
The Role of Insurance Coverage
The method of payment for rehab is another important decision for clients and their families. The average cost of a 30-day rehab program varies greatly. In New York, the estimated cost of treatment ranges from $18,000 to $25,000 per year for residential models and from $4,000 to $10,000 per year for outpatient models.
The right treatment program must be financially feasible. In fact, the 2015 National Survey on Drug Use and Health found that 30.6 percent of people who said they needed addiction treatment but didn’t seek it said they didn’t go to rehab because they didn’t have insurance or they didn’t believe they could afford it.
A few options for payment include:
- Reduced cash pay rate
- Payment plan
Lynn’s experience with rehab centers has been dictated by her insurance coverage.
“They determine the level of care in many cases,” she said. “Initially, we felt such desperation to find a place that would take our insurance. Once we realized that insurance would cover much of the costs, we felt more at ease.”
Under the Affordable Care Act, all health insurance marketplace plans must cover substance abuse and mental health treatment services. However, insurance companies may work with certain facilities only. Families that do not have insurance coverage should consider facilities that offer a cash rate, which is a reduced out-of-pocket rate for people who pay for treatment with cash.
Although a loved one’s addiction may be obvious to family and friends, insurance companies require a formal diagnosis of dependency from a doctor. The initial assessment — which refers to the doctor’s report from a diagnostic meeting with the patient — is a foundational factor in choosing the right drug rehab center.
Not only do these results help an insurance company determine the level of treatment it will cover, but they also provide insight into the severity of the substance use disorder and whether any co-occurring disorders are present. Using the doctor’s findings, a family can narrow its list of prospective centers based on each facility’s specialization and the client’s insurance plan.
Questions to Ask When Choosing a Rehab Facility
When visiting a facility, staff should do more than hand you a leaflet and send you on your way. A facility’s staff may or may not sit down with visitors, listen to each family’s situation and thoughtfully answer any questions.
If the staff does take time to do these things, it may indicate that clients receive the same individualized attention.
Consider asking these questions when visiting a facility or chatting with a provider on the phone:
- Can you provide me with a sample treatment plan?
- How long is the program?
- How much one-on-one therapy will you provide?
- What federal, state and local licenses and accreditation do you hold?
- May I view the credentials of your key staff members?
- How many clients does the facility treat on-site at one time?
- How many hours of group therapy occur daily?
- Do you offer evidence-based treatment that is rooted in proven research? If so, what specific options do you offer?
- Do you offer any traditional treatments, such as recreational therapy? If so, what are those like?
- Do you require clients to enter rehab voluntarily?
- Is effective treatment available for clients with co-occurring disorders?
- Do you have certified addiction physicians, nurses and therapists?
- Can you describe and provide photos of the living arrangements?
- What are your visitation policies?
- Does your facility have an active alumni program?
- Are there relapse prevention groups available to clients?
- Do you offer a family program or family therapy?
- What is your success rate?
- Do you have a waiting list?
- Do you have a formal aftercare program? If so, tell me about it. If not, do you help clients arrange for aftercare before discharge?
- Do you discharge clients who relapse during treatment?
Whether inpatient or outpatient, in the mountains or in the city, co-ed or gender-specific, each treatment facility is different.
The most important part of choosing a rehab center is selecting one that fits your loved one’s unique recovery needs. Finding the right fit between a client and the professionals and service components provided by the selected treatment center is essential for a successful long-term recovery.
Lynn offers some advice to families seeking help for addiction: “As a parent who has a child who when they go to the bathroom you don’t know if they’re going to come out alive, we were told that we needed to find God.”
Instead of letting anger, shame or confusion take over, she says to take it one day at a time.