Inpatient, or residential, treatment programs are designed to treat substance use disorders that require a high level of supervision and 24-hour access to medical and clinical care. Clients in residential programs would likely run into challenges with living independently, whether it would threaten their health or sobriety. Residential treatment programs, also called inpatient services, are one of the four main levels of care in formal addiction treatment.
Residential treatment is the second-highest level of care after medically managed treatment or drug detox. Multiple levels of residential treatment may be used, depending on a client’s needs. This kind of treatment program offers a highly structured environment for people with a range of needs.
Learn more about residential treatment programs in the context of treating substance use disorders.
The difference between medically monitored services and medical detox is the difference between management and monitoring. Medical management involves actively treating medical conditions and complications. In medically managed treatment, a client will have stabilized or less urgent medical needs.
Still, medical monitoring is for patients who need continued care and could experience complications. For instance, someone who spends a week in detox for alcoholism could experience a sudden seizure after medical detox is over.
The highest level of care in residential treatment involves 24-hour nursing care with access to a physician when needed. If a client is in this level of care, they likely need medication and have recently gone through drug or alcohol withdrawal. This level may also be appropriate for clients with severe emotional, behavioral, or cognitive problems.
Clinically managed services involve multidimensional treatment from clinicians and therapists. People at this level of care don’t have high-level medical needs that would require medical management or monitoring.
The lowest sub-level of residential treatment is called clinically managed low-intensity residential services. At this level of care, a client will receive 24-hour living support, which means they will have access to housing and other support and structure. They will also attend five hours of clinical services each week.
The low-intensity clinical schedule with residential services is for people who don’t have high-level medical or psychological needs but do have other factors that would make independent living risky.
For instance, if a person is medically and psychologically stable but has a significant relapse risk, they may need low-intensity residential services. Other factors could be their home environment. If they live with someone who uses drugs, a sober living environment or residential program might be ideal.
There are also higher levels of care in clinically managed treatment that fall within the residential category. For instance, clinically managed residential services that are high-intensity and population-specific involve 24-hour clinical care with access to group therapy programs. This level of care is for people with high-level cognitive or psychological needs.
The National Institute on Drug Abuse recommends 90 days in addiction recovery as the most effective minimum amount of time to spend in treatment, including all levels of care. However, some people enroll in long-term residential programs that can last from six to 12 months.
Long-term programs involve 24-hour access to care in a non-hospital setting. This could be an ideal level of care for people who have experienced chronic relapse. Highly structured environments can help remove a person from a lifestyle of active addiction and teach them to develop coping mechanisms to deal with stress and triggers without drug use.
Long-term residential programs may also involve therapeutic communities.
Therapeutic communities (TC) is a form of treatment that focuses on social needs, which is important in long-term residential treatment. Making meaningful connections with others is vital in safeguarding long-term sobriety. Therapeutic communities use the total treatment community, including other clients and staff, to help socialize an individual. The idea behind the therapeutic community model is to combat isolation and loneliness, which can contribute to a substance use disorder. TCs can help develop personal accountability, community involvement, and a sense of responsibility. TCs may also involve practical life skills like job training and other services that can help a person succeed.
In residential treatment, you may participate in several therapy options depending on your needs. However, addiction treatment often involves several widely used therapies, including individual and group therapy options.
Still, your treatment plan should be tailored to your specific needs, and you shouldn’t be placed into a standard one-size-fits-all plan. Though your plan will be unique, you will likely experience a few common treatment approaches that are appropriate for your needs. Some of the most common therapy options used in residential addiction treatment are:
One-on-one sessions with a therapist can help you process the treatment objectives you’ve been through or accomplished. Individual therapy is also important in assessing your current treatment plan, which can be changed if it’s not effective.
Addiction can lead to isolation, which can worsen a substance use disorder. For that reason, group therapy is an important part of addiction treatment for many people. Group therapy helps clients make personal connections, strengthen social skills, and learn to step outside of their own worries and concerns.
Addiction is called a family disease because of how it can grow out of a dysfunctional family relationship. It can also affect the friends and loved ones around the addicted person. Family therapy involves family members in addiction treatment. It can begin the healing process to mend relationships between family members. It can also show the addicted person how their substance use issues have affected their loved ones. However, family therapy isn’t for everyone. It can hurt people with abusive or enabling family members.
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Behavioral therapy examines motivations and thoughts that influence behaviors. Cognitive behavioral therapy is commonly used in relapse prevention strategies. It examines common triggers and coping responses to these triggers.
When you enter an addiction treatment program, you’ll complete a process of intake and assessment with medical and clinical professionals. This process is designed to determine the best level of care for your needs and start to formulate a personalized treatment plan.
To place you in an appropriate level of care, clinicians will use the ASAM Criteria, a list of important treatment factors put together by the American Society of Addiction Medicine. The criteria involve a six-dimensional assessment that looks at multiple areas of need in a client’s life.
The first three dimensions usually indicate the highest levels of need, including withdrawal potential, biomedical conditions, and psychological conditions. If you have high-level needs in any of these areas, you might require a high level of care like residential treatment or even medically managed detox.
However, you may also need residential treatment if you have significant needs in the last three dimensions, including readiness to change, relapse potential, and your recovery environment. For instance, if you’ve struggled with chronic relapse, or if you live with someone who still uses drugs, you might need a more structured living environment.
American Psychiatric Association. (2017, January). What Is Addiction? Retrieved from https://www.psychiatry.org/patients-families/addiction/what-is-addiction
ASAM. (n.d.). What is the ASAM Criteria? Retrieved from https://www.asam.org/resources/the-asam-criteria/about
National Institute on Drug Abuse. (2018, January). Types of Treatment Programs. Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states/types-treatment-programs
National Institute on Drug Abuse. (2018, July). Treatment and Recovery. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
Weiss, R., Ph.D. (2015, September 30). The Opposite of Addiction is Connection. Retrieved from https://www.psychologytoday.com/us/blog/love-and-sex-in-the-digital-age/201509/the-opposite-addiction-is-connection