What to do if your loved one is struggling with addiction

Someone you loved comes to you and confides a difficult secret: they are struggling with addiction, and they are coming to you for help. But you’ve never dealt with addiction before, so now what? Well-meaning friends may suggest a wide range of things, from “tough love” to posh, incredibly expensive rehab that worked for their neighbor’s uncle. But how do you know what is right for your loved one? You need a crash course in addiction recovery, at a time when you are likely overwhelmed with emotions and confusion. 

First, the basic terminology:

Detox Facilities

Detox Facilities may be standalone or connected to a hospital (and most hospitals can do a basic detox provided other criteria are met). These are much like an “emergency room” for addiction recovery in that they provide stabilization of the client, help ensure their physical safety while they stop or taper off of substances they were on, as quickly/comfortably as it is medically safe to do so. Clients typically stay in a detox facility for 24 hours to 14 days. It should be staffed with a Medical Doctor as well as licensed nurses 24 hours, and they provide around the clock care including medications, food, supervision, and counselors. Some detox facilities provide more than others in the way of clinical care, and this is a personal preference. Clients will of course need some mental and emotional support through such a difficult time, however, much of the mental aspect of addiction cannot be dealt with until the client is physically comfortable and of a clear mind (ie, medically stable, if not completely comfortable, and no longer in physical withdrawal). 

Residential Treatment Centers

Residential Treatment Centers (RTC) for addiction are usually a standalone recovery facility (but sometimes connected to a mental health residential facility). Clients typically stay at these for 30 days or more, depending on the severity of their addiction, length of time of use, how old they are, and other external factors. There is a lot of personal preference in this decision, but you should work closely with the admissions team and treatment team of the RTC you choose to help make the right decisions for the best outcome. All RTC are not created equal, so think about what is most important to your loved one before making this choice. Do they need structure or flexibility? Do they need to be able to communicate with loved ones, children, and/or work on a regular basis, or would they thrive in more isolated environments so they can focus inward? Would they enjoy a program with therapies such as art groups, yoga classes, or horses (equine therapy)? Included at this level are group therapy, Educational/Skills Building classes, individual therapy, support groups, family therapy, and may include focused support groups for young adults, women/men, parenting, executives, and those of retirement age, for example. Residential Treatment Centers usually also include some vocational and/or experiential therapies to help clients navigate their return back to the “real world” in a healthy way. 

Partial Hospitalization Program

Partial Hospitalization Program (PHP) is what we call “full day treatment”, and clients aren’t really hospitalized at all. This is a rigorous program of typically 9 AM – 4PM, Monday through Friday, and clients return home or to a Sober Living Environment after their PHP day has ended.  This level of care may be chosen for after a Residential stay, or straight away after Detox, depending on the needs of the client. PHP must provide at least 30 hours per week of intensive treatment, including individual therapy, group therapy, and psychoeducational/Skills Building Groups, and may include Clinician-led or Peer-led Support Groups and other services such as yoga, art therapy, and parenting groups. Individual sessions with a licensed clinician happen at least once per week, and clinicians can help provide intensive individualized support for the client in early recovery. This may include processing trauma and shame from the client’s past. At this point the client works to create a set of SMART goals that will help support their sober life. These goals may be related to work, family, friends, hobbies, and personal introspection. 

Intensive Outpatient Program

Intensive Outpatient Program (IOP) is a small step down from PHP and includes 10-16 hours of programming per week. Essentially the program is the same as the PHP level of care, just with reduced hours. This level of care may follow a PHP, Detox or Residential stay depending on the needs of the client. This level of care may be received in person or virtually, but it must include at least one hour of individual therapy with a licensed clinician per week. At this level, clients continue to work to achieve stated goals and may create new goals to work towards as their needs change. 

Outpatient Program

Outpatient Program (OP) level of care is a step down from IOP and typically includes 90 minutes-3 hours of programming per week. Again, the program can be the same as the IOP level of care, but with reduced hours, but at this level of care the client should be focused on relapse prevention and maintaining sobriety–not still working through difficult transition periods. OP also usually includes 1-2 hours of individual therapy a month with a licensed clinician. During these sessions, clients should continue to work on and complete goals set in their treatment plans, and create measurable goals which align with their new, healthy lifestyle. Clients may participate at the OP level for years for maintenance and support. 

Support Meetings 

Support Meetings are the most well known treatment support option, and are typically the least intensive. Clients may choose to attend meetings on a regular basis, or only when they feel they need extra support. There are many options to choose from, including the traditional AA/12 step meetings where members usually recount their stories, difficulties, and triumphs. However, many find this type of personal recounting to be hard to endure, and choose to attend more solution focused meetings, such as Centered Support meetings. During Centered Support meetings, members may discuss current events in their lives, but always with an emphasis on how to move through it. Facilitators may allow a free-form group discussion, or may choose to introduce topics such as Mindfulness-Based Relapse Prevention, Cultivating Gratitude, Understanding Cravings, and Acceptance of Yourself as discussion points. Meetings are typically free everywhere, and have a wide range of available dates and times to attend.