Continuum of Care
In order for a person to receive appropriate care for substance abuse or addiction treatment, it is important to make sure that treatment is customized to the person’s specific needs. These needs can be based on a number of elements that include:
- The level of addiction
- How long the substance abuse has been going on
- Whether or not the person has a social network of support
- The person’s ability to respond to certain therapies over others
- Continued access to the substance in the person’s daily life
- Relapse potential
As the treatment professional works to prepare an appropriate treatment program for the client, a wide range of treatment options to choose from for customization provides a higher chance of providing treatment that will work for that particular person. In addition, because an individual’s needs change over time, it is vital for the program to be able to continually readapt, if needed, to make sure treatment is keeping pace with those changes.
Having different levels of treatment available, depending on the client’s specific needs, is referred to as continuum of care.
What Is Continuum of Care?
Continuum of care refers to having different levels of treatment available, so the rehab program can be adjusted based on the individual’s changing needs for more or less intense treatment. It also means making sure that the right therapies are available for the person at each phase of treatment to provide the greatest chance of long-term recovery.
For example, let’s say a person enters a relatively low-intensity treatment program based on the initial assessment, and it is later discovered that the low-intensity treatment isn’t working. Having continuum of care available means that person’s program can be shifted to a higher intensity without having to change treatment centers. The treatment is adjusted to fit the person, rather than the person being expected to thrive in a one-size-fits-all type of program.
In addition, continuum of care means that that person has a program with phases that help in stepping out of the program and back into daily life, making sure that the support provided in each phase is based on processes most likely to help that person transition with a low risk of relapse, which can compromise treatment.
Experts agree that there is no one program that works for everyone, so having a continuum of care is a great way to make sure that treatment can be customized for each individual.
The Elements of the Continuum
A full-service continuum of care involves a number of treatment phases designed to work with the person at each step of recovery. These steps can vary in intensity, depending on the level of substance abuse and the other underlying issues that may accompany the abuse, such as:
- Co-occurring mental health disorders
- Previous substance abuse treatment
- History of relapse
- Family issues, stress, or other personal complications
- Financial or legal issues
The stages of treatment include a range of elements from initial intervention to detox, therapy, and aftercare, along with all the potential steps in between. The full continuum, which includes inpatient treatment followed with outpatient care and supplemented with detox, aftercare, and other potential interventions, has been shown to result in reduction of addiction or mental disorder severity.
This research demonstrates that a full continuum of care is more likely to result in a positive outcome than a partial continuum of care – such as, outpatient care alone. A full continuum of care includes initial intervention, detox, residential treatment, outpatient treatment, intense outpatient treatment, and aftercare.
The first step in the continuum begins with the initial intervention, when the addiction severity is first identified and the decision to enter treatment is made. This leads to seeking out a treatment facility and working with the treatment professionals to develop the initial treatment program.
Sometimes, in the case of an emergency intervention, this step may not happen until after the person goes through detox and withdrawal. Ideally, the detox facility and the treatment center are connected, or at least have a relationship that encourages a continuum of care. However, even if this is not the case, a reputable treatment center can help the person make a smooth transition from the detox facility into the treatment facility.
If this intervention happens before a full substance abuse disorder develops, it may be possible, through prevention strategies, to encourage management of substance use before a problem develops. This, too, is considered to be part of the continuum of care; for some people, this prevention intervention can be enough to avoid developing an addiction or other substance abuse issue.
If the person is still under the influence of the substance, either after a binge or because of continued use and inability to stop taking the substance, detox and withdrawal are undertaken before any other treatment elements can be introduced.
Often, people are tempted to try to detox on their own, without help. However, research shows that people who get help treating substance abuse or addiction are more likely to be able to reach and sustain long-term recovery. After three years post-treatment, about two-thirds of those who received help with treatment were maintaining recovery, compared with less than half of those who didn’t get help. However, this isn’t the only reason to undertake detox through a treatment center as part of the continuum of care.
Detox treatment varies depending on the substance of abuse and the degree of addiction. Certain substances, such as alcohol and benzodiazepines (a group of prescription anti-anxiety medications), can cause dangerous withdrawal symptoms during detox. Other substances may result in symptoms that can be extremely uncomfortable but are not life threatening. All of these can vary based on the particular circumstances of the individual undergoing treatment.
Getting detox treatment from a professional care center with people experienced in managing detox and withdrawal can make the process safer and more comfortable while giving an understanding of how to manage the rest of the treatment program. This makes it possible sometimes to initiate the next steps in treatment and therapy while the client is in the final stages of withdrawal, making a smooth transition from detox to the main treatment program.
Residential treatment is the next stage of care that is important particularly for those who have more severe issues with drugs or alcohol. In residential care, treatment specialists can maintain 24-hour focus on the individual’s progress through treatment, making it easy to adjust the program based on that progress.
Residential treatment makes it possible to give the client access to the full range of therapies and treatments that can benefit that particular person, depending on the circumstances of the person’s specific substance abuse problems, other mental health issues, and family, work, school, or other issues in the person’s daily life that may have contributed to the addiction or abuse.
Research has shown that the length of time spent in residential treatment is an indicator of whether or not the person will be successful in reaching and maintaining recovery. Longer time spend in treatment results in more positive outcomes. For this reason, it is vital for the client to make a commitment to completing the residential treatment program for the period of time recommended by the treatment professionals.
Once a person has been in residential treatment long enough to have success using some of the relapse avoidance skills learned and managing sobriety with less support, there can be a step down into outpatient treatment. With this kind of treatment, the person can go back to living at home and return to a mostly normal daily life, while regular contact is still maintained with the treatment facility. The person may continue with therapy and skill-building programs, as well as taking part in self-help support groups, such as 12-Step meetings.
During outpatient treatment, the individual might be involved in some of the same elements of treatment that were included in residential treatment, which contributes to the continuum of care. The person might attend treatment sessions for a few or even several days per week, for a few hours each day, often up to nine hours per week total.
Through this process, the skills learned in treatment can be practiced in the person’s daily life, and fine-tuned through the outpatient treatment program. Support for continued recovery is readily available, helping with the transition from living with 24-hour support to managing the addiction with less help. The aim is to help the person reach a point of managing the addiction with a minimum of support, leading to the next treatment level.
Research has shown that people who receive outpatient treatment as part of the continuum of care are more likely to achieve recovery and maintain it for at least two years after the treatment program is completed. This includes involvement in a 12-Step program or similar type of self-help peer support group.
Intense Outpatient Treatment
For some people, living at home and returning to daily life outside the treatment program may create a higher risk of relapse than it would for other people. These individuals might have more daily exposure to the substance of abuse, social networks that encourage substance abuse, or co-occurring disorders that require supervision or management for longer periods of time after residential treatment is completed.
In these cases, the outpatient treatment program recommended might be of a higher intensity, with more hours and days spent in treatment – generally more than nine hours per week. This type of treatment is referred to as intense outpatient treatment or a partial hospitalization program (PHP). It is designed to provide a higher level of transition support for those who have these types of challenges.
People who benefit from intense outpatient treatment may be able to step down to regular outpatient treatment after a time, when the skills used to avoid relapse are stronger and the person’s support network outside the treatment program is also stronger.
Aftercare or Post-Treatment Support
Once the treatment portion of the program is complete, the person can return to a new daily life of recovery maintenance; however, this doesn’t mean that the continuum of care is complete. Even after treatment is over and the person is able to manage the addiction alone, stress or other emotional or physical challenges might occasionally increase the risk of relapse. Because addiction is a chronic condition, it requires continual management.
The longer a person is able to avoid relapse after treatment, the less likely relapse becomes in the long run. A reputable, research-based treatment program with a full continuum of care can provide post-treatment support systems on which the individual can draw to motivate continued commitment to recovery and help manage situations that may potentially lead to relapse.
Programs that include aftercare are committed to the full continuum of care, demonstrating that they are also committed to giving their clients the best chance at recovery from their substance abuse or addiction issues. These programs prepare clients for long-term maintenance of their substance abuse disorders.
- How long does detox take?
- How long should a person be in residential treatment?
- What is outpatient treatment?
- What is an intensive outpatient program (IOP)?
- How long does outpatient treatment last?
- After outpatient care, what’s next?
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