Some sources make no distinction between an extended-care program and a long-term treatment program for substance use disorders. For the purposes of this article, the distinction between an extended-care program and long-term treatment follows:
- Extended-care treatment programs are typically provided as additions to traditional inpatient treatment programs. These programs are in excess of the standard 30-day, 60-day, or 90-day length of stay. Extended-care also can refer to post inpatient treatment programs, such as social support groups, outpatient substance use disorder treatment, and outpatient medical management. These programs are best for individuals who have completed the initial stages of substance use disorder treatment and may be ready to return to their previous living conditions.
- Long-term care programs often cater to individuals with severe substance use disorder issues who have not been successful in traditional inpatient treatment facilities or outpatient treatment. They may have had numerous relapses. These programs may provide physician-assisted withdrawal management, 24-hour assistance, access to multiple interventions, and a complete staff that can address every issue associated with the individual’s case.
Some of the differences between the two types of programs include:
- Projected date of completion: Extended-care programs may often have projected completion dates associated with them, whereas long-term treatment programs may not. Patients are released from long-term treatment programs when they are ready to be released.
- Autonomy and responsibility/accountability: Extended-care treatment programs offer more autonomy and accountability compared to long-term treatment programs.
- Relapse: Because long-term treatment facilities offer more intensive forms of treatment and supervision, they may have lower relapse rates compared to extended-care programs.
Extended-care programs may consist of numerous types of interventions that can include sober living homes, intensive outpatient treatment, partial hospitalization treatment, outpatient therapy, inpatient therapy, social support group participation, group therapy, etc.
Despite the manner in which the treatment is delivered, there are important principles that help to make an extended-care program more efficient and to increase the risk of a positive outcome.
Principles of Effective Extended-Care Treatment
According to the books Designing, Implementing, and Managing Treatment Services for Individuals with Co-Occurring Mental Health and Substance Use Disorders: Blueprints for Action and Addiction Treatment as well as information from the National Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration, the principles of effective extended-care treatment include:
- There must be a solid understanding of substance use disorders. Effective treatment programs are based on empirical evidence regarding the understanding of substance abuse and the development of substance use disorders. This includes understanding issues associated with the neurobiology of addiction, the behavioral facets of addiction, and the social facets of addictive behaviors.
- There is no one-size-fits-all approach. Even though treatment often follows a very broad blueprint, treatment for substance use disorders will vary depending on the characteristics of the client and the type of drug being abused. Successful treatment approaches match the person to the particular services and settings that are most appropriate for them. The intervention should also be appropriate given the individual’s age, gender, cultural background, and social situation.
- Treatment should be readily accessible. Often, individuals with substance use disorders are reluctant to enter treatment, uncertain about the effects of treatment, and may even question whether they need treatment. Clients can be lost if treatment resources are not immediately available to them. The treatment should be readily accessible to those who need it.
- Treatment should be comprehensive. Treatment should address the entire person. Effective treatment programs address the individual’s substance use as well as any other medical issues, psychological issues, social needs, legal needs, or vocational issues.
- Remaining in treatment is crucial. The length of time that a person needs to remain in treatment depends on the specific issues that the person brings with them into treatment. Research suggests that a minimum of three months in treatment is needed for most individuals to stop using their drug of choice; however, full recovery is a long-term process that often takes many years to achieve. Because many individuals in treatment often leave their programs prematurely, it is important to include approaches and strategies to keep individuals involved in treatment.
- Substance use disorder therapy is the cornerstone of treatment. Behavioral-based therapies are the main form of treatment for substance use disorders. These interventions help the individual understand their needs, address their motivation to change, provide them with incentives to remain abstinent, and give them the skills to address their issues and fulfill their needs. Therapy can occur in individual sessions, family sessions, group sessions, or combinations of these.
- Medications can help to improve treatment effectiveness. While medications alone are most often not sufficient long-term approaches to treating substance use disorders, they can greatly increase the effectiveness of therapy. For instance, medications used in withdrawal management programs can reduce the distress associated with the withdrawal syndrome and reduce cravings in the early stages of recovery. Other medications can address other issues, such as to treat co-occurring issues like depression.
- Effective treatment programs continue to assess the situation. During admission, clients are given a thorough assessment to identify their issues and needs. This assessment of the treatment, its effectiveness, and the changing needs of the client should be ongoing. This allows the treatment to adjust to the fluctuating needs of the individual.
- It is important to recognize comorbidity for mental health disorders. Substance use disorders frequently co-occur with other mental health disorders. Treatment programs should recognize this and address all of these issues concurrently.
- Withdrawal management (medically assisted detox) is not complete treatment. Although the use of an efficient physician-assisted withdrawal management program can often be crucial to early success in recovery by allowing individuals to safely negotiate the withdrawal process and become involved in treatment, this intervention alone has little effect on long-term drug abuse. Research has shown that individuals who simply attend these programs and do not become involved in formal substance use disorder treatment or a long-term aftercare program will inevitably relapse.
- Treatment does not need to be voluntary. A common misconception is that forcing individuals into substance use disorder treatment will not be successful. Actually, when individuals are forced into treatment from the legal system, family members, their occupation, etc., they achieve successful outcomes at rates that are comparable to individuals who enter treatment on a purely voluntary basis. Thus, treatment programs need to recognize that individuals who are forced into treatment have the same potential to achieve a successful outcome as an individual who volunteers to enter treatment. The approach to keeping them in treatment often needs to be different.
- Objective measures to monitor abstinence should be part of treatment. Even the most successful treatment programs are known to have significant numbers of individuals who suffer at least one lapse or relapse. When individuals in treatment are aware that there drug use is being monitored, this can be a powerful motivator for them to remain abstinent.
- Programs should test clients for high-risk conditions/infections. Part of drug abuse treatment programs should address the consequences of drug-related behaviors that can produce infectious diseases, such as HIV, hepatitis, tuberculosis, and other diseases. Counseling should also be targeted to help individuals reduce the risk of disease or avoid high-risk behaviors.
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Extended-care treatment programs that adhere to these principles will have greater overall success in their treatment outcomes. Not adhering to these general principles will result in the intervention losing its effectiveness and/or frustrated clients who drop out of treatment prematurely.
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