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.
The various aspects of residential treatment can include:
- Medical support of abstinence or co-occurring mental disorders, if necessary
- Various behavioral therapies to help the person understand and manage triggers and cravings
- Family or couples counseling to strengthen support for abstinence outside the program
- Education and skills development to prevent relapse
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.
These types of aftercare programs can include:
- Continued involvement in 12-Step or similar programs
- Contingency Management or programs that reward continued abstinence
- Motivational Interviewing or other telephone follow-up meetings with counselors
- Self-monitoring programs where people can check in and gain feedback if needed
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?
The length of the detox process depends on some degree on the substance in question. This is because some substances take longer to clear from the body than others, as measured by the substance’s half-life; this is the term used to describe the amount of time it takes for half of the substance to be cleared from the body.
On top of the detox time itself is the timeframe for withdrawal symptoms. These are caused by the body’s reaction to the loss of the substance, especially if the body has developed a tolerance to or dependence on the substance.
Withdrawal symptoms start within minutes to days after the person stops taking the substance. Physical and psychological symptoms can last for weeks or months after that, depending on how long the drug was taken, how high the dosage was, and the individual’s specific constitution and physical qualities.
On the whole, the detox portion of the treatment process, by itself, can last a week to a month, depending on the above factors. Treatment can often begin after the drug has been removed from the system but before withdrawal is fully completed.
How long should a person be in residential treatment?
Some programs offer 28-day treatment, while others can go for up to 90 days or more. What determines the length of time in treatment? Again, it depends on the individual’s specific needs.
As stated above, the longer a person is able to stay in treatment, the more likely the person will achieve and maintain recovery over the long-term. What that amount of time is, however, will again depend on the person’s specific level of addiction, constitution, personal challenges, and commitment to success in drug treatment.
When a person enters a treatment center, the professional staff continually assess the person’s addiction history, other mental health disorders, and social support system, among other factors, and the treatment program is structured to fit those issues, including the suggested length of time for treatment. As the person progresses through treatment, depending on the effect treatment has on the individual, the treatment time may be adjusted to give the person the best chance at leaving the program with the tools, skills, and confidence needed to maintain recovery. Each person may need a different amount of time for the program to work.
The key is that it is important to stay committed to treatment for the recommended amount of time. That way, the person is most likely to be able to avoid relapse after treatment is over.
What is outpatient treatment?
Outpatient treatment is rehab treatment that enables people to live at home and go to work or school, rather than residing in a treatment center. The person goes to the treatment center for up to several days per week, a few hours each time, to receive treatment before returning home.
Outpatient treatment can serve several purposes; it may be used by people who have a very low-level substance abuse issues and who do not have a high risk of relapse, or it may be used for people who are unable to get away from their responsibilities, such as high-level executives. One of the most beneficial uses of outpatient treatment is as part of the continuum of care, where an individual has already completed residential care and needs a little extra support in the transition back to daily life.
However, when a person is at a stage in the continuum of care where relapse is a high risk or going home would be otherwise counterproductive to treatment, outpatient care is not recommended. In this case, the person is more likely to be able to learn to manage addiction through an inpatient or residential program.
What is an intensive outpatient program (IOP)?
IOPs are outpatient programs that are particularly intense. These are defined as outpatient programs that provide nine hours or more of treatment per week. Also known as partial hospitalization programs, these types of programs are for people who may not be able to stay in residential care or who have completed residential care but are still at a higher risk of relapse and need more consistent monitoring and support.
As with other levels of treatment, IOPs are more likely to help a person achieve recovery from addiction if the person stays in treatment long enough. However, when used as part of the continuum of care, these types of programs can increase the likelihood that the people treated will be able to maintain sobriety well beyond the first year after treatment. In fact, in some cases, up to 43 percent of those who participate in IOPs have maintained recovery for at least three years.
How long does outpatient treatment last?
Similar to inpatient care, outpatient treatment can be as little as four weeks or as long as several months, depending on the person’s needs. Whether it is an IOP or a regular outpatient treatment program, the length of time to stay in the program depends on how long it takes the person to become self-sufficient enough to manage the substance abuse disorder with lower levels of support while maintaining a low relapse risk.
For many types of treatment – both inpatient and outpatient – experts believe that anything less than 90 days in treatment is not enoughto help the person make the lasting physical, emotional, and behavioral changes that support sobriety. Working with the treatment team to adjust treatment as needed over time is the best way to manage the length of time spend in treatment, whether inpatient or outpatient.
After outpatient care, what’s next?
After outpatient care, there are still elements to the continuum of care that can be used to encourage the person to stay motivated, remain confident about maintaining sobriety, and avoid relapse. One way to do this is for people to continue involvement in community services or groups, like 12-Step groups or a counseling program that had been started during treatment. Other methods might be provided by the treatment center for weeks to months after formal treatment is completed. Some of these methods include:
- Motivational Interviewing: calls to the client to check in and verify continued sobriety
- Self-analysis: calls from the client to an automated system to track and follow up on issues
- Contingency Management: rewards given to people who stay clean over a certain amount of time
These types of programs depend to some degree on the idea that the person has reached a certain level of self-sufficiency and management, but may occasionally need a reminder or boost to keep up the good work. In addition, these programs can help manage relapse if it does happen, returning the person to a higher level in the continuum of care to manage the substance abuse condition for as long as is necessary.