Levels of Care for Alcohol Addiction Treatment
According to Dr. Casey Green at Greenhouse Treatment Center (an American Addiction Centers facility), multiple levels of care allow you to remain in a familiar environment and benefit from the continuity of staff as you progress through treatment. It also allows you to more easily move up or down in terms of level of care based on your changing needs and progress.
American Addiction Centers provides multiple levels of care throughout our facilities including medical detox, residential treatment, partial hospitalization program (PHP), intensive outpatient program (IOP), standard outpatient, sober living, and aftercare planning.
After chronic and/or heavy alcohol use leads to the development of significant physical dependence, when a person decides to quit drinking, symptoms of alcohol withdrawal may occur.1 Because of the associated risks of severe withdrawal, medical detox is commonly an important element of early alcohol recovery. Medical detox and withdrawal management allows the body to rid itself of the toxic influence of alcohol resulting from excessive, long-term drinking while keeping the individual as safe and comfortable as possible.
Withdrawal symptoms may arise as early as 8 hours after the last alcoholic beverage is consumed.1 Symptoms may continue for weeks but usually peak between 24-72 hours.1 In some cases of significantly severe physical dependence, alcohol withdrawal can be life-threatening.
In such instances, it is recommended that you go through a medically-monitored detox that can manage symptoms and address any issues that may arise in the process.2 While each detox facility has their own set of specialized plans and protocols, many will follow a similar set of steps to help clients. Inpatient detox begins with evaluations to determine the answers to the following questions:
- When was the last time alcohol was consumed?
- Have you consumed any other substances? If so, when was the last time?
- How long have you been abusing alcohol?
- How many times have you tried to get sober in the past?
- What happened during those prior sobriety attempts?
- Have you ever experienced a severe withdrawal syndrome before?
After this, we’ll create a medical detox protocol that may include medications, emotional support, nutrition, and complementary therapeutic approaches. You’ll be asked to accept or decline all aspects of your plan before the process begins. As you move through detox, you’ll have the benefit of having both your mental and physical health being monitored to ensure comprehensive treatment attention and more comfortable recovery progress. If there are any signs of discomfort or if any medications need adjusting, there is always someone nearby to provide modifications to your plan.
Residential rehab provides 24-hour care within a treatment facility, giving patients access to on-call medical and psychiatric services throughout the entirety of their stay. Most residential treatment facilities offer a longer length of treatment such as 30- to 90-day programs, which allow patients the opportunity to focus solely on their recovery without the distractions of their everyday life.
Though the most appropriate duration of treatment depends on addiction severity and other individual needs, research indicates that remaining in treatment for longer periods of time—and more specifically, 90 days—allows for better outcomes.3
All residential facilities vary in amenities and services, but all incorporate a variety of recovery programming such as individual and group counseling, coping skills education, and relapse prevention classes. Within each facility, there is a day-to-day schedule which may help to create structure and routine in an individual’s life. This can also counter the highs and lows of addiction and feelings of being out of control.
At our facility in Mississippi, Oxford Treatment Center, a typical day may look like the following:
- 6:30 a.m. – Wake Up
- 7:30 a.m. – Breakfast
- 8:15 a.m. – Morning Assembly
- 8:45 a.m. – Group Therapy
- 10:30 a.m. – Alternative Therapies
- 11:50 a.m. – Lunch
- 12:30 p.m. to 3p.m. – Group Therapy
- 5 p.m. – Dinner
- 6 p.m. – Personal Time
- 10:30 p.m. – Lights Out
Partial Hospitalization Program (PHP)
Partial hospitalization program (PHP), also known as day programming, is a level of care which allows patients to attend treatment during the day before heading back home at the end of the day. PHP still provides a relatively intensive level of care but in a somewhat more flexible environment than inpatient/residential. It is typically only offered to individuals with a stable living environment and based on a physician’s assessment of their needed level of care.
In PHP, you’ll have to check in for 5 days a week and will receive 4 hours of group therapy each day. Typically, at our facilities, the day begins at 9 a.m. with sign-in and finishes at 2 p.m. The first 2 hours consist of process groups which help individuals resolve problems relating to other people and issues that may have led to their drinking in the first place.4
Afterwards, you’ll head into psychoeducation classes at 11 a.m. which are made up of four components: treatment of the condition; management of it; compliance with the medical and psychological regimen; and prevention of relapse, progression, or exacerbation.5 You’ll then be served lunch followed by another hour of programming before going home for the day.
Intensive Outpatient Program (IOP)
Intensive outpatient programs (IOPs) focus on disorders or other dependencies that do not necessarily require detoxification or 24-hour supervision. These types of programs require less time weekly in therapies than PHPs and still allow patients to continue with their normal lives off site. IOPs are designed to establish support mechanisms, provide coping strategies, and help with relapse management.
Although those suffering from alcohol use disorders initially go through a detoxification phase, they could still move into this level of treatment during the course of their recovery programming. This treatment option would also require that a person’s home environment be alcohol/drug-free and filled with a safe support system. IOPs are also sometimes utilized after completion of an inpatient program as a way of easing the transition back an individual’s families and communities.
During your time in our IOP, you’ll learn how to embrace a new, healthier, sober lifestyle and will work on finalizing aftercare plans. Activities and requirements vary between different treatment facilities, but within our facilities, many IOP patients undergo 10-12 hours of therapy over the course of 3-4 days each week. Participants are also encouraged to attend 12-step meetings during this time.
This type of program, however, may not be ideal for those with co-occurring disorders or relatively severe cases of addiction.
Outpatient treatment can take place in a variety of settings, including hospitals, counselor’s offices, community mental health clinics, or inpatient/residential rehab facilities.6 Many meet for a limited number of hours during the week and often occur in the evenings and on weekends so participants can go to school or work.6 Attendance requirements vary by program, with some requiring daily sessions and others only meeting 1 to 3 times per week.6
Patients are able to live at home while in treatment, allowing for a level of flexibility that many individuals need to fulfill family or work obligations. Those participating in outpatient treatment would need to have a stable home environment that is alcohol and drug-free.
Outpatient treatment programs include access to the full range of treatment services as those found in residential treatment facilities. These include:
- Medically-assisted treatments and pharmacotherapies.
- Psychosocial interventions (i.e., group participation, complementary and alternative treatments).
- Support services (i.e., transportation services to treatment, occupational support, mentoring services).
- Case management services.
While this option may seem universally preferable, there are several situations where this may not be the ideal form of initial care. For instance, this level of care might be a good fit for those who’ve already gone through a more intensive program first, such as a residential, PHP or IOP and can then transition into an outpatient setting. In some cases, lower-intensity outpatient programs may be somewhat limited in terms of the scope of their treatment offerings, such as those that offer little more than addiction education.7
Recovery isn’t a one-and-done deal once treatment is complete. For many, it is a lifelong process that requires commitment, self-compassion, patience, and ongoing support. Aftercare is an important aspect in maintaining your sobriety and avoiding relapse.
Some of the more commonly utilized aftercare services include:
- 12-step meetings, like Alcoholics Anonymous.
- Non-12-step groups, like SMART Recovery.
- Individual counseling.
- Group therapy.
- Sober living homes (group homes that provide structure, offer support, and require a promise to remain sober).
According to the Substance Abuse and Mental Health Services (SAMHSA), 84% of treatment facilities offer aftercare planning services.8 Thankfully, AAC facilities offer this kind of assistance once you complete treatment within our centers. Our therapists or case managers will work with you to create a specific plan tailored to your circumstances, goals, and needs.
Sober living housing gives individuals the opportunity to live in a healthy and safe environment surrounded by a community of like-minded people. Sober living provides a nourishing alternative that allows individuals to transition back into society gradually.9
Typically, sober living housing will outline a set of guidelines for residents including participation with 12-step or other peer-supported help groups and adherence to house rules such as completing your chores, attending house meetings, and paying rent. Those who abide by these guidelines can remain within the house as long as they desire.10
If you complete treatment within an AAC facility, we offer a number of sober living options to choose from either close to the facility or within another state. Or we’ll help you make arrangements with one in the city of your choosing.
Additionally, we offer aftercare recovery groups that consist of sessions led by our therapists. Some of topics of discussion include Relapse Prevention Skills, Family Intervention & Education, and Addiction & Brain Chemistry.
According to the National Institute on Drug Abuse (NIDA), relapse rates for substance abuse range between 40-60%.11 Because of this, AAC also offers a 90-Day Promise that allows patients who have successfully completed our 90-day programs within our facilities to return for an complimentary 30 days of treatment if they relapse.*