Many different kinds of professionals provide treatment for substance use disorders. In most treatment programs, the main caregivers are specially trained individuals who are certified or licensed as substance abuse treatment counselors.
Most treatment programs in Vermont assign patients to a treatment team of professionals. Depending on the type of treatment, teams can be made up of social workers, counselors, doctors, nurses, psychologists, psychiatrists or other professionals.
What types of treatment programs are available?
Outpatient and intensive outpatient programs provide treatment at a program site, but the person lives elsewhere (usually at home). Outpatient treatment is offered in a variety of places: health clinics, community mental health clinics, counselors’ offices, hospital clinics, local health department offices, or residential programs with outpatient clinics. Many meet in the evenings and on weekends so participants can go to school or work.
People who do best in an outpatient program are willing to attend counseling sessions regularly, have supportive friends or family members, have a place to live, and have some form of transportation to get to treatment sessions.
Intensive outpatient treatment programs require a person to attend 9 to 19 hours of treatment activities per week. These activities may consist of a combination of individual, group, and/or family therapy sessions. Intensive outpatient programs can last up to several months with continuing care afterward.
Inpatient treatment, provided in special units of hospitals or medical clinics, offers both detoxification and acute medical and/or mental health services. People who have a severe mental disorder or serious medical problems in addition to a substance use disorder are the people most likely to receive inpatient treatment. The length of stay varies by condition but rarely exceeds seven days.
Short-term residential programs provide a living environment with treatment services. Several models of residential treatment (such as the therapeutic community) exist. Treatment in these programs is determined by medical need, and usually last 30 days or less. If your loved one is in a residential treatment program, it is important that you know and understand the program rules and expectations. Residential treatment may help people with very serious substance use disorders who have been unable to get and stay sober or drug free in other treatment.
Opioid treatment programs (OTPs), sometimes known as “hubs” in Vermont, offer medication assisted outpatient treatment for people who are dependent on opioid drugs (such as heroin, OxyContin®, or Vicodin®). These programs use a medication, such as methadone or buprenorphine, to help a person not use illicit opioids. OTPs provide counseling and other services along with the medication.
The Care Alliance, also referred to as the Hub and Spoke system, is a statewide partnership of clinicians and treatment centers providing Medication Assisted Treatment (MAT) to Vermonters who are addicted to opioids.
What happens in treatment programs?
All treatment programs begin with a clinical assessment of a person’s individual treatment needs. This assessment helps in the development of an effective treatment plan.
The treatment team, along with the person in treatment, develops a treatment plan based on the assessment. A treatment plan is a written guide to treatment that includes the person’s goals, treatment activities designed to help him or her meet those goals, how to tell whether a goal has been met, and a timeframe for meeting goals. The treatment plan helps both the person in treatment and treatment program staff stay focused and on track. The treatment plan is adjusted over time to meet changing needs and ensure that it stays relevant.
Program staff members may ask for urine or other samples from people seeking services for drug testing in order to confirm the effectiveness of the treatment plan.
Based on the assessment and the client’s stated needs, counseling will help the person seeking services move toward a lifestyle that reflects his or her goals and values. This includes changing the client’s relationship to drugs and alcohol.
Group counseling is different in each program, but group members usually support and try to help each other develop a healthier life. They share their experiences, talk about their feelings and problems, provide mutual support and encouragement, and receive information and education about the effects of alcohol and drug use on their bodies.
Family counseling works with families and couples in intimate relationships to nurture change and development. This type of treatment is especially critical for adolescents. Parents need to be involved in treatment planning and follow-up care decisions for the adolescent. Family members also need to participate as fully as possible in the family counseling the program offers.
One common form of treatment is relapse prevention planning. It teaches people how to identify their relapse triggers, how to cope with cravings, how to develop plans for handling stressful situations, and what to do if they relapse. A trigger is anything that makes a person crave a drug. Triggers often are connected to the person’s past use, such as a person he or she used drugs with, a time or place, drug use paraphernalia, or a particular situation or emotion.
Recovery centers provide a supportive, welcoming, safe, substance-free environment for groups to hold meetings. Centers realize that there are many paths of recovery and offer many different groups for individuals and families in recovery. Centers offer a range of services, and will often offer support, education, information, referrals to community services, and recreational opportunities.
Participants in self-help groups support and encourage one another to become or stay drug and alcohol free. Twelve-Step programs are perhaps the best known of the self-help groups. These programs include Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). Members themselves, not treatment facilities, run self-help groups. In many places, self-help groups offer meetings for people with particular needs.
Many treatment programs recommend or require attendance at self-help groups. By attending, many people make new friends who help them stay in recovery. The number of meetings required varies by treatment program – some programs encourage participants to attend “90 meetings in 90 days,” as AA and NA recommend. Some treatment programs encourage people to find a “sponsor,” that is, someone who has been in the group for a while and can offer personal support and advice.
Self-help groups are very important in most people’s recovery. It is important to understand, however, that these groups are not the same as treatment.
There are self-help groups for family members, too, such as Al-Anon and Alateen.
Many people with a substance use conditions also have mental health conditions such as depression, anxiety, or post-traumatic stress disorder. Treating both the substance use and mental health conditions increases the chances that the person will recover and lead a life that reflects their individual goals and values. The program may provide mental health care, or it may refer a person to other sites for this care. Mental health care can include the use of medications.
Many programs use medications to help in the treatment process. Although no medications cure dependence on drugs or alcohol, they can help people prevent relapse and can be lifesaving.
Medication is the primary focus of some programs, such as the medication-assisted opioid treatment programs (OTPs) or “hubs” in Vermont. Methadone is a medication that prevents opioid withdrawal symptoms for about 24 hours, so the person must take it daily. Taken as directed, it does not make a person high but allows him or her to function normally. In fact, methadone blocks the “high” a person gets from an opioid drug.
Some people stay on medication assisted treatment for a very short period of time, as determined by the person and the doctor. Others stay on medication for long periods of time or for life. This is called medication maintenance treatment.
People who receive this treatment often have good jobs and lead happy, productive lives.
If your family member is taking medications for HIV infection or AIDS or for any other medical condition, it is important that medical staff members know exactly what he or she is taking. Mixing some medications with methadone or buprenorphine may mean that your family member will need special medical supervision or changes in medication dosage.
Buprenorphine is another medication that may be used to treat opioid dependence and is sometimes used by OTPs. Buprenorphine was approved for treatment by primary care doctors in their offices. A doctor treating a patient with buprenorphine generally will provide or refer the patient for counseling, also.
Even when a person has successfully completed a treatment program, relapse can be a common occurrence in one’s path of recovery. The longer a person stays in treatment, including follow-up, the more likely he or she is to stay in recovery. Once a person has completed treatment, a program may offer options for continuing care or referral for recovery supports to maintain sobriety and treatment progress.
Substance use conditions affect every part of a person’s life. For that reason, treatment must touch every part of a person’s life as well.
Treatment is more than helping someone stop drinking alcohol or using drugs. It means creating a healthier lifestyle, developing new and positive coping strategies, and connecting with a new and sober support system. Research shows that with treatment, positive influences, and a healthy lifestyle, recovery is absolutely attainable.