Step-Down Approach to Addiction Treatment

Joseph B. Devlin: Hello, and welcome to the show. I am your host, Joseph Devlin. And on today's episode, we're going to read some more excerpts from my book chapter for treatment options. And it's just a reminder, I've been reading some of the book and then expanding upon the ideas that we're reading about today. So let's get at it.

Two men looked out for prison bars, one saw the mud, the other saw the stars Dale Carnegie. In this chapter, we will discuss levels of treatment. Let's say that our loved one is in need of an inpatient treatment facility. I would like to remind you that your loved ones entry into an inpatient treatment facility does not mean that they are cured. The goal of therapy during a 3060 90 day rehab program is to prepare an individual in recovery for the life after intensive treatment. Therefore, many individuals require continued therapy for many months or years after rehab. With that said, I want to give you an idea of what treatment may look like. Let us take the all too common example of a loved one who needs to enter an inpatient detox unit. The best course of long term treatment in the ideal world would be a detox, stay seven days, a step down to inpatient rehab 28 days, a step down to a partial hospitalization program. PHP for six weeks, a step down to an intensive outpatient program IOP, eight weeks, and I stepped down to general outpatient GOP continued at least six months. The above is an ideal world treatment scenario. This is not meant to be a cookie cutter approach, I just really want you to understand that treatment is not a quick fix is not a one and done. I understand the realistic obstacles to committing to this ideal world length of treatment. The two major concerns expressed about this level of commitment are that your loved one will point out the financial difficulty, a legitimate concerns and time constraints. When addressing time constraints, I would want to know how much time they spent using and compare it to the amount of time they're being asked to be in treatment. The good news is that they do not have to make a long term commitment up front. They are not taking on a mortgage, but they may be more touching their future.

I'm going to stop reading right now because the book now goes in and starts describing a detox program. And in short, I just want you to know I know many of you are aware of this, that the detox it provides a safe environment for somebody to experience withdrawal. It's really the physical withdrawal but also expect mental withdrawal, emotional withdrawal, spiritual withdraw safe environment where they can do this and they'll have access for support from the individuals working at the facility. Okay, now I'm going to begin going to go back and read some of the book about inpatient.

Inpatient treatment may last 30 days, but insurance will typically fund for about two weeks. This is not enough time to get everything back on track. While an inpatient rehab a patient's environment becomes more structured for the time they wake up in the morning until the time they go to bed at night, their day is mapped out. Individuals are assigned a primary counselor, whom they should meet with at least twice a week and attend a scheduled groups throughout the day. Normal inpatient stays used to be a straight 28 days. To date, most insurance providers will only cover about two to three weeks for inpatient treatment. During this time, the individual's thought process may become less cloudy, and they learn to follow treatment center rules, develop a normal routine for waking up and going to sleep, learn about treatment and addiction and set treatment goals during their stay in an inpatient treatment, I recommend you have at least one family session a week. These family sessions are in addition to the family session you should have upon their discharge from inpatient treatment. These sessions will allow you to review the treatment plan goals and see what they're working on. A good tool to evaluate your loved ones mindset is to evaluate their treatment goals. The book goes on when we start talking about outpatient. The first one that the bookstore is talking about is the partial hospitalization program. And I'll pick up readings upon completion of inpatient treatment A person should step down to partial hospitalization program or sometimes referred to as partial care. This is a five day a week outpatient treatment normally scheduled from 9am to 3pm. It has slightly less structure than inpatient treatment. And at the end of each day, the individual has the benefit of returning to home life. in their community, your level will meet individually with their counselors a minimum of twice a week. And again, I suggest attending a family session a minimum of once a month. Now the book moves on to the intensive outpatient program the IOP. A typical IOP has group sessions three days or nights a week with one individual slash family session per week. Total time for IOP is a minimum of nine hours a week. I continue to recommend attending a family session a minimum of once a month. Right I'll stop there. And then I'll say you know the book kind of goes on to we call general outpatient or GOP and I'll pick up reading here. General outpatient GOP Okay, GOP should consist of one group session and one individual family session a week. Overtime the individual stop attending the group and continue to engage in just the individual and family session a week. Follow through is key. Just as with any other treatments, please remember to schedule follow up appointments, you've invested a lot of time and your loved ones treatment and want to capitalize on the momentum. The number one misconception about drug and alcohol treatment is that the addict becomes cured. What a cancer or diabetes patient not have a follow up appointment. Even if you agree to a six month checkup, I believe this can only help set you up on a path of successful long term recovery. One of the main reasons why I see relapse occur is that after someone completes a level of treatment, they stop engaging with their support networks, or treatment, thus causing them to lose accountability and connectedness after the treatment. This is one of the reasons why the 12 step community is so helpful. They maintain a level of connectedness follow up and accountability. A common reason for resistance to treatment you will hear from someone in addiction is that they don't want to go to treatment because everyone else there is an addict, and they are not one of them. And very few instances this is an actual legitimate concern. The addict wants to stay different, they want to separate and say I'm better than the person who can blame the individual. Our society has trained us to compare ourselves to one another who has what meant who was most successful. For our current concerns, those who are most successful, will be the ones who stay sober. I've only provided a brief overview of the levels of treatment, my goal was to give you a basic insight to the most common levels of services so that you can be familiar with them. When you take your loved one in for an evaluation. There are longer term treatment programs sent that can last 18 months. There are also sober living facilities, as well as medically managed communities, just to name a few other options. You can explore these different levels of services with your counselor as your loved one is in treatment.

Okay, and then we'll stop there are as you see these readings were it was an overview of the different levels of services. One of the main points I really wanted to get across was that somebody goes to treatment once doesn't mean that they're cured. Also, somebody may need to go to different levels of treatment. Some folks will just go to the GOP, that general outpatient and that's all they will need. Others will need to go to the detox to the inpatient, to the PHP to the IOP to the GOP. But just to remember, one size doesn't fit all. And one time through doesn't mean that you're cured. The statistics are showing that folks are going to treatment eight times before they're getting sober. That's an astounding number. And but I want to say is that there's hope because I know plenty of people have gone to treatment for their first time and remain sober. So as we looking at the the overview of all of these different levels of treatment, one another common theme I want you to see was the fact that look, there's family sessions designed. So insert yourself and say hey, I want to be part of I know you're going to your, your counseling session. So let's make one of them a family session. And then on any one of them. You know, I strongly encourage you to say hey, listen, let's Can we look at the treatment plan. And the treatment plan is going to really map out where the individual wants to go. Because again, not every treatment, it's not all one size fits all. Everybody has different goals and different aspirations of where they want to move in treatment and where they want to go in life. So just saying hey, listen, can we just Take a look at and review the treatment plan. And then you'll know how you can support your loved one because you can say, Okay, this is your goal, you know, you want to go back to school or you want to go to meetings or you want to get your, you know, you want to begin working out again. Okay, how can we come around you and support you in that. One of the things I didn't really say in here is like, even in the that intensive outpatient program that IOP, it's about nine hours a week. But technically, you don't even need to do an individual session a week, you could just sit in groups. And I would say it's make sure that you go into a program, that's going to give you an individual session once a week, because this is also where, you know, once a month, come in there and do a family session. And you're going to have a better gauge of how you can support your loved one by looking at the treatment plan. But also just knowing Hey, listen, I'm somebody here, I love them, I'm supporting them. What can we do? What can we do better? Alright, so I want us to look at that IOP, the intensive outpatient program. This is this is a great program. And if you remember how I mentioned the levels of care, really, when you come out of the inpatient facility, you know, just step down to the PHP, but many people when they're coming out of the inpatient program, they come into the IOP. And one of the main reasons why folks do that, as they say, Hey, listen, I've already spent a whole bunch of time into an inpatient facility, I don't want to spend five days a week, coming to treatment, so I'll do it three days. For some folks, that's a legitimate concern, like they've got to get back to work.

So they have IOP, at night, very convenient. For other folks who aren't really doing anything, I would challenge you to say, Listen, let's let's do the PHP maybe until you get a job. This is why it's great to have a professional counselor to be able to speak with somebody to really devise a game plan on how you're going to do them, what's going to be the best course of action for you. I'm going to share our story with you. I know for many people listening, it's a hard act to say, Wow, somebody's got to go to treatment eight times before they get sober. Again, remember, I know plenty of people who went there first time and they got sober. And I believe a lot of that had to do with proper planning and proper preparation and proper direction of where they were going, what they were going to do. And of course, I firmly believe it's what's the community that was surrounding them, and what was the community they plugged into. However, there was a gentleman when I was working at a treatment facility, and he had been in treatment, at least 15 times. He had been in my groups and my IOP, my PHP groups that I ran and, and my team, you know, we've all had experiences with this individual. Because they'd all been in everybody else's groups as we shared the IOP. And we shared the PHP groups and and, you know, we heard he was coming back, we were like, really, like, it's just one of those things, hey, I'm a human being. And I'm kind of like, wow, you know, like, Is this really necessary? And like, is he going to come back, because he was also one of those guys who was causing problems and in group and, you know, it's okay to have a dissenting opinion. But it's also, it's also very good to allow others to speak when you have a dissenting opinion. So it was kind of a struggle, we knew they were coming in. And he was, you know, he was put on my caseload, and I just flipped the switch in my brain and said, Hey, listen, everybody gets his fresh shot, everybody's got a fresh start with me, you're coming in through that door. He came in, and he sat down on my office, and we were talking for a little bit and we're discussing, like his his course of action, and it was going to be an IOP come out of the inpatient facility. And I was like, okay, and mapped out the reasons why he was trying, you know, trying to get a job. He knew he could work one day a week, and he had been through it before, and I was like, Okay, I'm willing to work with you where you're at. But I was also willing to just believe that he was going to get sober this time. And, lo and behold, like, he started coming around this time, he was acting a little bit differently. He was getting a little bit more engaged in treatment, and he would be sharing with me in individual sessions, like, Man, this is something I really, you know, I appreciate this time, you know, this is something that, you know, I'm going to really stick with 12 step this time. Okay. All right, man, I'm with you. unbelieving in Yeah, you know, like, we set up his treatment goals that way. You know, he even looked at us like, he's like, you know, me. He's like, he, you know, you don't really mess like I absolutely believe in you. I believe that you're going to do this. You know, he just he just kept coming and we were working together. We're building up his community. He didn't really have family anymore. You still trying to get in contact with his daughter. But I mean, think about it. You've been in treatment 15 times your daughter's probably waiting to see if you're going to do something differently. And, you know, I'm a firm believer that it was the fact that not only just myself but some other people that I worked with, you know, who run in some of the groups that he was in, I was like, Listen, man, we gotta believe in this guy, we got to, you know, we got to give him the opportunity that we give everybody and really speak life into him, we know him. He's like, that gives us an advantage. We knew things that were successful for him in the past. And he started, you know, grabbing on to a 12 step community, he was working with a sponsor, he'd bring in his sponsor, sometimes for family sessions. And, and lo and behold, this guy, you know, he stays sober. And I will tell you, nobody was more shocked than me. But I knew that I gave him my all every time that I was with him. And to this day, he still sober and, you know, me and the folks, you know, who I worked in a treatment center, we, we still stay in touch. And, you know, we often talk about this guy, like, Hey, man, you know, just remember, you know, eight times is the average, but this guy was 15. And so there's always that possibility, there's always that hope.

So listen, I challenge you out there, if there's a level of treatment that you're wanting to explore a little bit more at ease, as I touched on at the end was like, you know, sober living communities. They're out there. Definitely look into them. And be prepared for you know, if your loved ones in treatment, so you have a place for them to go following treatment. Also, if you are thinking that they need to go to a treatment center, again, explore the those options. What is it a partial hospitalization program isn't an IOP isn't an inpatient, what's most appropriate, and just be ready to know where you're going to go to next. I appreciate you being here with me today. And please, if you liked this episode, please subscribe and like it. It increases the algorithm so that this information gets to more people. If you share it, it increases the algorithm that much more. Because my mission and my goal is to be able to share this information with as many people as possible so that we can begin changing lives begin saving lives, and begin having a positive influence on families for generations to come. So thank you in advance for helping me out with my mission. And until our next episode. Remember, sobriety is a family affair.