Addiction treatment programs are designed for individuals, not groups of people. Programs are tailored to meet the very specific needs of someone who has an addiction, so treatment plans look quite different from person to person.
As a result, says the National Institute on Drug Abuse (NIDA), it’s not always easy to classify drug treatment programs. If every program is individualized, it can be difficult to put those programs into neat buckets by class.
There is one classification that does persist, and it can be useful for people struggling with addictions. That classification is acute.
Acute rehab programs differ from other types of programs in meaningful ways. Understanding what these programs are and whom they are for can help families to make the right choice.
Acute Rehab: A Brief Overview
Acute rehab programs offer addiction treatment in a medical setting. It is considered the strictest form of treatment for addiction, and it is made for people who may not experience relief in a less comprehensive form of care.
People who enroll in an acute rehab program spend the majority of the day, and sometimes the night, engaged in therapies to combat addiction. The issues that might contribute to the addiction, such as medical illnesses or co-occurring mental health issues, are also addressed within the program.
Acute rehab programs are sometimes offered on an inpatient basis. That means people move into the facility for addiction care, and they do not return home until this phase of the care is complete. This is a completely comprehensive form of care that allows people to develop new patterns quickly, far from the stresses of home life.
Acute rehab programs can also be offered on an outpatient basis. People in these programs may go home at night, but they return to the facility frequently, often daily, for care. This allows people to stay connected with their families and their communities during addiction care. It also gives them the opportunity to test relapse-prevention skills early, while they have the support of a treatment team.
Some organizations include medical detox services in their acute rehab programs. In Massachusetts, for example, acute treatment services include 24-hour nursing care to assist with drug withdrawal. This program is made for people 18 and older, who are at risk for health issues due to withdrawal.
But not all states include withdrawal services in their acute programs. For many, acute rehab begins only when medical detox is complete, and it’s time for the person to work on maintaining sobriety. This is the sort of program we’ll discuss.
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What Happens in Acute Rehab?
People who enroll in an acute rehab program have achieved sobriety through medical detox, but they have not yet developed the skillset that can help them maintain the sobriety they’ve achieved. As a result, their sobriety victory could be fleeting. Unless they develop skills, they are likely to return to drugs of abuse.
Behavioral therapy is used to help people develop those sobriety skills. NIDA says behavioral therapies help people with addictions learn how to modify their thoughts and behaviors related to drug use, and therapy helps people to develop healthy life skills. By changing the way people think about substances of abuse, and by helping people to create lives that are full and healthy, therapists work to reduce the need for drugs.
There are a variety of therapy types, including:
- Motivational interviewing, which helps people feel ready to change behavior.
- Cognitive behavioral therapy, which helps people to avoid or cope with situations that spur drug use.
- Systems thinking, which involves examining the systems the person lives and works in, and examining how they help or hinder recovery.
- Solutions-focused therapy, which helps people to focus on the future, not the past.
- Trauma-informed therapy, which helps people to process past experiences.
Therapy teams modify the therapy approach they use based on the person’s past and preferences for treatment. Combinations of therapy are common, and some people use different types of therapy at different points in the recovery process.
Acute rehab programs also work to address secondary addiction triggers. Those might include mental health issues. Underlying mental health concerns, such as depression or anxiety, can lead to a relapse to drugs. People might use drugs as a form of self-medication. By addressing those co-existing issues in treatment, therapy teams might make sobriety more likely.
Health issues might also be a focus of care in an acute rehab program. NIDA reports that people in early stages of recovery can experience changes in appetite, and they can experience difficulties with sleep. An acute program might provide clients with healthful, tasty foods that are easy to digest so people can get the nutrition they need. Inpatient acute programs might also offer very dark, very quiet sleeping areas, and they may enforce a bedtime. This can help people get the rest they need.
Acute rehab programs may also work to address social issues that lead to addiction. They may connect people with community vocational training programs, so people can get the skills they need to find employment. They may offer linkages to housing programs, so people can find safe and affordable places to live when treatment is complete.
This is the sort of program that views an addiction completely and attempts to dig into all of the factors that might cause the addiction to arise and thrive.
Types of People Who May Need Acute Rehab
Some people who have addictions do fine in less strenuous programs. As mentioned, all addictions are different, so a program that is just right for one person might be wrong for the next. There are some people, however, who are likely to need the kind of care offered in an acute rehab program. These are a few of those people.
Addictions can cause a sense of desperation, and that can lead to the risk of self-harm or suicide attempts. People who attempt self-harm once might be more likely to make a second attempt in time. In a study in BMJ, researchers found that 6.5% of people who entered a psychiatric facility for a self-harm episode and were discharged were readmitted again within 12 months due to another self-harm attempt. Many of these people were readmitted within the first month.
Suicide risk is real, and it is dangerous. People who have suicidal thoughts benefit from acute care, as they have nearly constant support and supervision. That can make a suicide attempt less likely.
Similarly, having a secondary mental health issue can make addiction stronger. The National Alliance on Mental Illness (NAMI) reports that people experiencing an addiction and mental illness may benefit from inpatient programs where they receive medical and mental health care around the clock. There are 7.9 million people in the United States with co-occurring disorders like this, NAMI says, so this is a relatively large group of people.
There is also a very strong link between homelessness and addiction, and that link can persist as people attempt sobriety. The National Coalition for the Homelesspoints out that people need a community of supporters in order to rally after an addiction. They need a safe space to live, they need people to talk to, they need love, and they need consistent support. All of that is hard to find when someone is homeless. Enrolling in acute rehab can provide people with the support and community they need so they can focus on recovery.
There are some people who choose acute rehab programs simply because they are just not sure they will have what they need in a different type of program. For some, it has to do with cravings. In a study in the journal Drug and Alcohol Dependence, researchers asked 95 people with an addiction to alcohol to rate their cravings for a drink. That craving rate varied widely, and for people in outpatient programs, a high craving level was tied to a higher risk of relapse.
In a second study in the journal Drug and Alcohol Dependence, researchers assessed decision-making skills in people with addictions to opiates. They were looking for signals of impulsivity, or the ability to make decisions quickly without weighing all of the consequences before the decision was made. Not surprisingly, those people who had high impulsivity scores had a higher risk of relapse, but only in outpatient programs. Those in inpatient programs were protected from the risk by the structure of the program.
Studies like this demonstrate how personal addictions can be and how the impact of an addiction can be different from one person to the next. People may know, deep down, that a specific type of treatment will be right for them while another might not do enough. These are thoughts and opinions that should be listened to. People who get what they need may experience what they want in treatment.
Acute Care vs. Other Types of Care
Some people simply do not get to choose the type of treatment program they enroll in. For example, in a study published in the Journal of Substance Abuse Treatment, researchers point out that doctors with addictions are required to enroll in inpatient programs for addictions. At the five-year point, researchers say, 71% of these doctors are still licensed to practice medicine, and they are still employed.
Statistics like this may lead some families to believe that acute rehab is the only real way to achieve lasting sobriety. That simply is not true. There are plenty of other treatment programs that have the potential to help people understand an addiction and achieve control over drug use.
For example, there are outpatient programs that offer care in combination with a sober living home. In this treatment model, people move into a home-like environment with other people who are in recovery from addiction. Everyone who lives in this community agrees to live by a set of rules that tends to reduce drug use risk. They may all agree to:
- Attend addiction counseling sessions as scheduled.
- Participate in addiction support group meetings.
- Work or volunteer in the community.
- Submit to regular drug testing.
- Clean communal areas.
- Get up and go to bed at a set time.
These people may only head to addiction therapy a few times per week, so their care is not considered acute. But when they are enrolled in the sober home, they are still supported by care around the clock.
Similarly, some people have supportive and sober families that can surround them with care. These families may also draw up rules about conduct and appointments, and they may go to group counseling sessions with the person in order to discuss issues that arise. The person may go to individual therapy sessions regularly, and the family helps to reinforce lessons at home. This can also be a good option for some people.
Treatment works best when people stay enrolled, stay focused, and keep learning. Some groups are at a higher risk of dropping out of any program too early. For example, in a study in the journal Health Affairs, researchers found that more than one-third of people who enter publically funded substance abuse treatment programs don’t complete their course of treatment. People in racial and ethnic minorities were more likely to drop out.
Looking for a close match between the services the person needs and the type of program the person wants is key. That is the best way to ensure that the person has a stake in the treatment program. That stake can help the person persist in care, even when the program seems challenging.
Care After Acute Rehab
An acute rehab program is meant to help a person move through a specific phase of the recovery process. At some point, that program will come to an end. As the United Nations Office on Drugs and Crime points out, it is impossible to predict whether or not an acute program will help the person achieve lasting sobriety. That is not how addiction recovery works.
Addiction is a chronic condition, and relapse to drug use is part of the recovery process. A relapse to use does not mean that the program has failed. It means that the person needs care to move past that relapse episode. For people who have graduated from acute rehab, that care could be provided in a continuing care program.
The American Psychological Association reports that continuing care helps to solidify and sustain addiction recovery. It helps people to develop the skills they need and the behaviors they must have in order to avoid relapse triggers.
Continuing care can also help people to develop a sober community, so they have people to lean on during difficult times.
Continuing care may come in the form of counseling. People may meet with a mental health professional in one-on-one or group therapy sessions in order to build on the foundation of healing developed in acute rehab. They may also utilize 12-step support groups.
Support group meetings are often held in community centers, churches, and other public venues. Once the meeting starts, people can share stories about their recovery, or they can listen to other people discuss their challenges and successes. Some meetings come with an educational component, so people examine readings about addiction and lessons learned. Others come with speakers who illuminate some aspect of the recovery process.
Therapists may have lists of meetings available in the community, or they can often be found online. Many communities post support group meetings weekly, so bookmarking a page with posted times can be an easy way to know when a meeting is coming up.
Support group meetings in the 12-step model offer another method of ongoing support. In this model, people new to recovery are paired with a mentor in the model who has been in recovery for a longer period of time. This mentor helps people new to the program to understand how the program works, and they may help their mentees know what book passages to read or things to study in order to gain a deeper understanding. Mentors are also available for crisis support, so when a deep craving comes up, they can offer guidance until it passes.
These are just a few of the ways healing can persist after acute rehab is finished. No matter what method a person chooses, it is important to stick with the plan. Healing is not considered complete after acute rehab. People will need ongoing care to ensure they can persist through challenges that may come up.
What Happens Next?
Families seeking addiction care may be confused about what program to choose, and they may not know which form the person they love might accept. Addiction treatment programs can help.
Many addiction treatment programs offer intake counselors who can talk with families about the addiction symptoms they’ve seen. These counselors can describe the different types of care they offer, and they can look for synergies between the care the family might need and the services they offer. These counselors can also work out insurance and payment details, choosing a program that fits within the family’s budget.
Starting a conversation like this is easier than it might seem. Intake specialists spend all day talking with families, and they do not discriminate based on the addiction. This is what they do all day long, and they are always ready to help a family in need. The best way to find this out for yourself is to call.
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