Addiction is a complex, chronic illness that, in order to ensure sustainable recovery, requires a long-term continuum of care. However, while numerous studies have demonstrated high recovery outcomes are supported by long-term care, monitoring, and community recovery engagement, not every individual’s continuum of care will look the same and that continuum may not always be linear. Not every patient requires the same continuum, and supportive recovery care needs to appropriately take into account not just the clinical needs of the patient, but also the many other biopsychosocial aspects of their individual needs associated with their substance use disorder.
Therefore, one patient’s continuum of care may look very different from another patient’s continuum of care, each one obviously based on their individual and personalized needs.
However, to best understand the addiction treatment continuum of care, it is important to understand the many different pieces that can potentially make up the continuum of care for a patient.
Detox is often the first step for a patient to enter the treatment continuum and start their recovery from addiction. Detox occurs in a highly monitored environment, with 24/7 medical care and addiction supportive care from clinical and recovery support professionals. During detox a patient is safely brought off substances, through medical interventions, and their withdrawal symptoms will be managed and they will be brought to a place of medical stabilization, where they are physically stable to begin the next step in treatment and recovery. Ideally, they will also have enough time to be emotionally and mentally stabilized, so that they will be adequately able and prepared to being their next phase of treatment. Detox and medical stabilization can occur at a stand-alone detox facility, like here at Innovo Detox, or can be a unit within the next step of the continuum, either an inpatient rehab or a residential treatment facility. Detox, depending on the situation and the substances being misused, occurs on average between 5-10 days.
Inpatient Rehab/Residential Treatment
Step 2 in the addiction treatment continuum of care after detox is often a traditional 28-day day inpatient or residential treatment program. This can occur either at a hospital-based inpatient or a residential rehab campus model. Inpatient rehab or residential treatment that occurs for 28 days, and sometimes longer, often includes a detox for the first 5-10 days and once detoxed and stabilized, the patient moves into full treatment.
Extended Care Treatment
Extended care treatment is not a step in the continuum that every patient takes. It is sometimes a suggested aftercare recommendation for patients when they are leaving an inpatient rehab, but it sometimes, depending on clinical need, can replace a residential treatment program. It is a level of care that is also suggested from patients that have gone to multiple detoxes or rehabs and haven’t followed suggested aftercare recommendations, patients with a history of chronic relapsing, or for younger adult patients (between 18-35) that are often considered “failure to thrive.” This level of care often is comprised of either a partial hospitalization (PHP) or intensive outpatient (IOP) clinical level of care that is coupled with a living component, such as a recovery house or sober living environment.
Partial Hospitalization (PHP) Treatment
Many patients that are returning to their home area with a stable living environment after detox or inpatient treatment, and do not need the full structure of an extended care addiction treatment program, may enroll in partial hospitalization treatment, called PHP. PHP is a full day treatment, and while the days and hours can vary from program to program, PHP often occurs for at least 5-6 hours daily, Monday through Friday (although some PHP programs also break up the clinical hours during the week and offer weekend programming.) PHP is often used as aftercare following a detox or residential rehab stay, but it can also be an initial access point to care for patients that meet ASAM criteria, may not need a detox, and don’t necessarily need or cannot go to an inpatient rehab or residential treatment center. It is an outpatient level of care.
Intensive Outpatient (IOP) Treatment
Similar to PHP, intensive outpatient (IOP) treatment is an outpatient level of care that can either be a next step in the treatment continuum for a person after detox or residential treatment or be an initial access point to care for individuals that meet criteria or cannot go away to rehab. IOP is like PHP but is less clinical hours weekly for the patient. Each IOP program is different in terms of scheduling, but typically an IOP program is, at minimum, 9 clinical hours a week. Additionally, some IOPs are comprised only of group therapy, while more comprehensive IOP programs will offer group therapy as well as individual and family therapy, psychiatry, and med management.
Outpatient treatment programs are typically a step down for a patient that has been enrolled in an IOP level of care. It is traditionally comprised of one or two group therapy sessions a week and can also include additional therapy approaches like individual therapy and psychiatry, in the context of a program. Many PHP or IOP programs step patients down to outpatient once they have identified an ability to live in recovery and incorporate the skills and approaches learned in treatment to their everyday lives. Many outpatient programs also incorporate some holistic approaches.
One piece of the continuum of care that can be a step down after detox and inpatient rehab or a step down after extended care, PHP, IOP or outpatient programming, is seeing an individual clinician on an outpatient level. This piece of the continuum can also be incorporated and integrated as additional services while a patient is in an extended care, PHP, IOP, or outpatient level of care. This would be seeing an individual therapy, a counselor, and/or a psychiatrist monthly, bi-weekly or weekly, as clinically needed. This could also include a patient engaging with a specialist while also attending a program. A good example of this might be a patient in an IOP program, who also attends family therapy outside of the program with their spouse, significant other, or family unit with a licensed marriage and family therapy or a couple’s counselor. Another example may be a patient in an IOP group that has significant trauma, so while attending IOP groups they also see an individual therapist that specializes in EMDR.
Sober Living/Recovery Housing
Structured, supportive housing is a key piece in the addiction treatment continuum. This is often referred to as a sober living, a recovery house, or a halfway house. This is a safe, structured living environment for the patient as they begin their recovery. This part of the continuum can occur right after detox or inpatient treatment, or in conjunction with or after the other levels of care such as PHP, IOP, or outpatient treatment. Sober living, and there are different types of sober livings with more or less structure and more or less rules depending on the home or organization, offers individuals accountability and a safe sober place to learn to live in early recovery.
Case Management/Sober Coaching
Within the addiction treatment continuum can be additional supportive services. One of these are case management specialists and sober coaches. These are professionals that can be hired when the need arises to offer additional levels of support and accountability for the person in early recovery.
Peer Recovery Coaching/Support
Another additional supportive service that can be found within the addiction treatment continuum and is a newer service within the field of addiction treatment and recovery, is peer recovery coaching and peer recovery support. This is a professional, who has been certified and is a person living in recovery, that can offer the patient additional support while helping to support them in recovery goals and objectives. They also offer an additional level of accountability.
Community-Based Recovery Meetings
Community-based recovery engagement is vital in achieving long-term recovery. This is a non-professional piece of the continuum. Typically associated with long-standing 12-Step recovery fellowships like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), these are free, community-based recovery organizations. However, this piece of the continuum does not necessarily mean only 12 Step fellowships. As we know that everyone’s recovery can look different and take different avenues, this piece can also include groups like SMART Recovery, organizations like Refuge Recovery or Celebrate Recovery, or local Recovery Oriented Systems of Care (ROSC) organizations, or unaffiliated, loosely structured recovery groups in an individual’s local area.
One piece of the addiction treatment continuum that is vital, and often used within every level of care and stop along the continuum, is the accountability measure of drug testing and monitoring. Most treatment centers or organizations incorporate drug testing as part of their protocols, as well they are mandatory for many individuals seeking recovery once they are involved in the criminal justice system. However, any reputable sober home or recovery organization will incorporate drug testing and monitoring for their residents, and many case management professionals or sober coaches will also incorporate drug testing into their services.
If you or someone you know needs help for addiction or co-occurring disorders, please give us a call. Innovo Detox offers the latest in evidence-based medical, psychiatric, and clinical care for those in need of detox and medical stabilization in Pennsylvania and the surrounding Mid-Atlantic area. If we aren’t the best fit for you or a loved one, we will take the necessary time to work with you to find a detox, rehab, treatment center or provider that better fits your needs. Please give us a call at (717) 619-3260 or email our team at [email protected]. For more information on our company or services, please visit our website at www.innovodetox.com.