Introduction
Selecting a treatment program for a substance use disorder (SUD) can be a challenge. Decisions are often made with the best of intentions, but without considering the most important criteria. What are the right questions to ask when considering which program is best for you, or your loved one? What criteria are “musts”, and which are “nice to have”? How do you rank criteria in order of importance?
Levels of Care and Types of Facilities
What is most important to one person is not always what’s most important to another. Experts agree that getting the right level of care should be the number one criterion.
Alcoholism and drug addiction (now referred to as substance use disorders and abbreviated as “SUD”) are killers and should be treated as seriously as cancer or any other serious and deadly disease. One often has only one shot at picking the right treatment center and the right level of care. So how does one make the best choice?
There are multiple levels of care for SUD’s that range from hospital emergency room to unstructured sober living houses.
Hospital Emergency Rooms – Life threatening
- An overdose that makes one unconscious, stop breathing or appear unresponsive.
- A related accident (auto, fall, ) that requires immediate emergency medical care.
- Severe intoxication that is life threatening.
The primary objectives of emergency departments are to save a life and to get the patient medically stable so that he/she may be transferred to an appropriate facility for treatment.
Medical Detox Center – Non life-threatening, but not medically stable
If the individual with the SUD (referred to as “client” from here forward) is not in a threatening condition but is not necessarily medically stable for treatment due to alcohol or drug inebriation, a medical detox facility is appropriate.
- What are the protocols are for alcohol and drug withdrawal?
- What are the medical and psychiatric staff-to-‐client ratios?
- Do they have one or multiple “wards” for clients?
- Who pays?
- Is insurance accepted? How is insurance verified?
- Is payment in full required upon admittance?
Inpatient or Residential Primary Care – Medically stable
Once the client is medically stable and has detoxed, it is time to move to the next level of care, which is often a residential primary care program.
- The first question should be: “Are you a licensed facility? If so, what is your license number?” You can also look up the license information of the facility by going on the state’s department of health website.
- Are you accredited by The Joint Commission or CARF?
- What programs are offered and what are the lengths of stay for each?
Most insurance companies only authorize 10-20 days of inpatient and residential treatment. To extend the length of stay, some treatment centers offer partial hospitalization (PHP) and intensive outpatient (IOP) levels of care. You should call your insurance company BEFORE you call a treatment center.
- Is the treatment center in-network or out-of-network with your insurance?
- What are the costs?
- Program fees
- Additional fees
- What does insurance cover?
- What doesn’t insurance cover?
- Will I get a balance bill at the end of treatment?
- Does the client have access to personal funds?
- When do the fees need to be paid?
- Before admittance?
- Upon arrival?
- Within “x” days after admittance?
- Ask about the overall program. Is it:
- Based upon twelve-steps?
- Faith based?
- Based upon some other philosophy related to recovery?
- Ask about their services:
- Individual counseling? How many times a week?
- Group counseling? How many times a day?
- Psychoeducation? How many times a week?
- Medical care?
- What are the education and licenses of the therapists?
- Is any therapy provided by non-licensed staff?
- Is case management Provided?
- Is there an MD on-site or on-call?
- Is there a clinical psychologist on-site, or on-call?
- Are clinicians in recovery?
- Are program staffs in recovery?
- What is the client-to-staff ratio?
- Is there an aftercare program?
- Who does it?
- What is it?
- Is it: phone-based, on-line or on-site?
- Is there a family program?
- What are its components?
- When is the program offered?
- At which stage of the process?
- Is the facility coed or gender specific?
- Is staff bi-lingual, if required
- Is the facility equipped to handle handicapped clients?
- What is the visitor policy?
- How does staff ensure there are no illegal drugs at the facility?
- What arrangements are there for transportation, if required?
- What makes this program unique?
- Are their published outcomes?
- Is there an alumni organization?
- What are the grounds for discharge, other than completion of the program?
Extended Care/Sober Living Following Primary Treatment, the next levels include Extended Care and Sober Living.
The purpose of Extended Care is to help the client achieve long-term sobriety by offering additional clinical services but on a less frequent basis. The questions for inpatient and residential levels of care also apply to Extended Care. Extended Care may be from 90 days to six months in length.
Sober living facilities typically do no include clinical services. They are designed to be safe-supportive living homes where clients reside post treatment. Many sober living facilities require the client to have a job while they live there.
Outpatient
For those with a mild SUD and for those who have completed inpatient or residential or even extended care treatment, outpatient treatment centers provide clinical services by licensed therapists.
Most outpatient treatment centers offer Partial Hospitalization, Intensive Outpatient (IOP), Relapse Prevention, therapy for co-occurring disorders and in-depth substance abuse classes and/or intensive Twelve Step work. The questions for inpatient and residential treatment can be asked of an outpatient treatment center.
Other considerations:
- Before you consider treatment, seek advice from a professional who specializes in substance use disorders.
- Has the client accepted his/her situation and therefore willing to seek treatment?
- Are they motivated to do “whatever it takes?”
- Is alcohol/drug addiction the only problem?
- Are there co-occurring disorders such as: Clinical Depression? Bipolar Disorder? Anxiety Disorder?
- Do they treat co-occurring disorders and what are the qualifications of the staff who do?
- Is there a history of family trauma? If so, is the treatment center equipped to address it?
- What medical conditions does the client have in addition to a SUD?
- Is the client so intoxicated that a medical detox is required?
- Is the client incarcerated, or have serious legal issues?
- Is the client medically/mentally stable?
- What is the ability to pay for services?
- Does the client have insurance to cover medical and behavioral health problems?
- Is the family able to pay?
- Is the employer able to help out?
Summary
There are many other things to discuss as each situation is different; however, the above is a great start to help you understand where to look and what questions to ask. What you want is to find the right level of care for yourself or your loved one. At the end of the day, everyone needs to feel that the provider and client are a good match.
About the Author: Ken Chance, D. Div. is the former owner of three behavioral health agencies and a sober living home. His company offers behavioral health consulting services to individuals, families and treatment centers. Dr. Ken may be reached at 1.928.288.2004, or email at ken@kennethchance.com, or visit www.kennethchance.com for more information.