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What kind of program
Freestanding Inpatient Rehabilitation
These programs live by their ability to create a life-changing experience. Many of them do amazing work in the short time they have.
Hospital Based Rehabilitation Unit
The quality depends on the particular unit and hospital. Some insurance policies may only reimburse for an unit that is part of a general hospital. Hospital based rehab units may be more able to work with patients who have complicating psychiatric or physical illness.
Hospital Detoxification Unit
Withdrawal from alcohol and sedative medication is the most dangerous, though opiate withdrawal is extremely intense. Freestanding rehab programs may do detoxification, but the hospital may have more medical backup for complicated or difficult cases. Increasingly, detoxification is being done on an outpatient basis.
Watch out for the problem of the patient who finishes the detoxification feeling better than in years, and is suddenly no longer motivated for treatment. Before entering an unit that does detoxification only, be sure that a very strong route has been established for follow up rehabilitation, either inpatient or outpatient.
Long Term Residential Program
Following rehabilitation, many individuals lack the impulse control and sober habits to successfully maintain a recovery in their community. This is especially true of young people, who have maturational work to do as well as recovery.
For these individuals, long term residential treatment may make the difference between success and failure. Professional staff in rehab programs will help evaluate the need and feasibility of long term residential treatment.
Staff in rehab programs are also a good source of up to date knowledge about the quality and services of long term residential programs.
The term "rehab" usually refers more to programs that are associated with an AA or 12 step tradition. Therapeutic Communities have their origins with Synanon and such programs oriented primarily for heroin abusers. Nowadays, many are much stronger supporters of total abstinence and the 12 step principles. They may encourage and require residential stays of up to 2 years. When the addiction is serious enough to warrant such a long length of stay, these programs may offer an approach that is uniquely effective.
Should you focus on programs exclusively for a special population?
Special programs for special populations have advantages and disadvantages. Addicted people have a tendency to think that they are "different" from everyone else. That is part of the isolation. If they find themselves in a program that is specialized for just the group they identify with, that "uniqueness" defense may melt away. On the other hand, feeling like a special member of a special group may actually strengthen the sense of being different, and with it a need to pick and choose among recovery tools and supports. Picking and choosing is not good for early recovery.
Criterion: If membership in a special group is likely to be a real barrier to mainstream treatment, then do try to find a special program of high quality. Otherwise, a mainstream program with people of roughly similar background may be more helpful.
Matching the program to the person
A major part of recovery is "identifying" with other recovering people. Extreme cultural/educational differences may be an impediment to seeing the commonality of addictions. In general, some diversity is useful. It is often surprising who an individual most identifies with, on the other hand, adding culture shock to the stress of rehabilitation is not therapeutic in itself. Local vs. Long Distance:
Many insurance companies emphasize local treatment. One advantage is that family members can more easily participate in the family program. On the other hand, the cost of airfare is a small fraction of the total outlay, and the program's ability to provide just the services you need may justify travel. Especially for young people, being away from familiar "people places and things," may be an advantage. Rehab programs away from home may also have ties with long term residential programs in their locale.
Local vs. Long Distance:
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