Written by: Juliana Pang, Addictions Therapist
Taking the step to seek treatment for your addiction is a life-changing one.
Having decided to reach out for treatment, you may be wondering what type of treatment options would be most suited for your addiction problem, whether it be drug abuse, alcohol addiction, compulsive gambling, or gaming behaviours.
You may be wondering whether you should go into an inpatient rehabilitation centre or opt for outpatient therapy programmes. What factors would help determine whether going into a rehabilitation centre or outpatient therapy would work for you? And if opting for outpatient programmes, how intensive should the treatment sessions be?
Intake Assessment
To kick start the decision process, you are strongly encouraged to get a thorough intake assessment done by an addictions therapist to determine the severity of your condition and the level of care required.
Level of Care
The American Society of Addiction Medicine (ASAM)[1] produced 6 key criteria for patient placement:
- Risk Level of Intoxication or Withdrawal
- Bio-Medical Considerations
- Psychological or Behavioural Complications
- Readiness to Change
- Risk Potential of Relapse
- Recovery Environment
These criteria are applicable to the abuse of drugs, alcohol, prescription medications, gaming, gambling, sex, or pornography addictions alike.
Risk Level of Intoxication or Withdrawal
If you are suffering from intense intoxication and withdrawal symptoms, some of which could be panic attacks, paranoia, aggressive behaviours, seizures, intense cravings, severe stomach cramps, delusions, depression, or suicidal thoughts. It would indicate that an elevated level of care is needed.
Bio-Medical Considerations
Apart from the addiction, you may have underlying medical conditions and require prescribed medications or managed medical care.
If you are on long-term antidepressants, antipsychotics, kidney, or liver medications, has physical ailments such as injuries or weakened immunity, you may wish to opt for a higher level of care in a rehabilitation centre.
Some of you may also experience significant weight loss or nutrition deficiency and this may require managed meal plans in a rehabilitation centre.
Psychological or Behavioural Complications
If you have tried quitting your drug, alcohol, or addictive behaviours many times and failed, you would be experiencing feelings of despair and hopelessness.
It is likely to be challenging to sustain the energy and motivation to work on your recovery in an outpatient environment without the structured scaffolding of a rehabilitation centre.
If for any reason, you feel that your behaviours induced by the addiction may be harmful to yourself, to young children or vulnerable persons in the home environment, it may be best for you to do your recovery in a rehabilitation centre.
Readiness to Change
Next, you may wish to ask yourself how ready you are to make this change to stop your addiction.[2]
Are you seeking treatment because you have come to realise that your addiction is a chronic mental health problem and that you require professional support to help you stop?
If you still believe that the addiction is no more than a bad habit and that you are well-able to manage the consequences, you may be more likely to opt for outpatient treatment.
However, depending on the presence of the other factors, your family members may want you to consider inpatient as it may well be that you are in denial of the severity of your addiction.
Risk of Relapse
Related to the readiness for change, you may want to think about the possible risk of relapse.
If you have the financial means and easy access to your drug of choice, alcohol, or addictive behaviours, you may find that being in a controlled environment like a rehabilitation centre would provide you with a buffer zone of safety.
Recovery Environment
Addiction has been described as a disease of lost connection. Substances and addictive behaviours are often used to fill the voids left by existential, emotional and/or social loneliness.
In the unfortunate situation where you may be estranged from your family and living alone or with friends who may be struggling with their own problems, you may find that the rehabilitation centre provides a supportive environment for recovery
Pragmatic Considerations
Having determined the level of care, you will want to find out the cost of treatment and the time investment required.
Rehabilitation Treatment
If you choose the inpatient rehabilitation option, you can opt for a 1 to 3 months treatment programme. Depending on the choice of the rehabilitation centre, you will be asked to follow a structured programme that is designed to meet your needs for individual therapy, group sessions, and family therapy. Medication management will be provided where clinically necessary.
Pros of Inpatient Treatment
Some of the advantages of opting for treatment in a rehabilitation centre:
- 24×7 managed care
- Structured full-day programme to keep you engaged in a range of recovery activities
- Provide a brief respite from life problems
- Opportunities to build connections with other persons in recovery who can become recovery peers in the longer term
- Safety in secured facility to prevent you from accessing your addiction and causing a relapse
- Your caregiver will benefit from a much-needed rest when they know that you are in a safe environment.
Cons of Inpatient treatment
The downside to inpatient care includes:
- Financial costs. An inpatient programme could range from 10k monthly upwards, depending on the location, types of accommodation, facilities and treatment modalities provided.
- Opportunity cost of having to take time away from your work or life, which while helpful, may not be pragmatic.
- Continued success of recovery post programme hinges upon a well-managed transition back to the home environment.
Short Duration Hospital Detox
If you are unable to commit to a month-long rehabilitation programme, you may wish to opt for hospital detox treatment which is usually a short stay of 5 to 10 days to detox the body of the substance and regain a state of physical well-being before outpatient treatment can follow. The charges could range between $500 to $1k daily.
Outpatient Treatment
Outpatient treatment comes in a range of treatment intensity and duration. Treatment modalities and types of treatment plans will vary depending on the provider of care and the patient’s condition.
Intensive Outpatient Programme
If you are unable to go to an inpatient rehabilitation centre for any reason, the next level of care is the Intensive Outpatient programme (IOP).
In an IOP, the programme structure is usually 3-4 times a week, comprising of individual, group and family sessions with sessions running between 1-2 hours. Programmes will include psychoeducation on addiction, development of a relapse prevention plan and processing of underlying issues.
Where clinically required, patients can access medical care through their outpatient treatment centre or their preferred healthcare provider.
You can choose to taper down the intensity of the programme as your recovery progresses.
You may wonder what is the frequency and duration of outpatient treatment that would be best for you. This decision is best made by you in consultation with your therapist.
Pros of Outpatient Treatment
There are several advantages of outpatient treatment:
- Costs are more manageable as it can be paced according to the patient’s financial ability. It is often reimbursable by insurance coverage.
- Less disruptive to your daily life as you can continue to perform your functions at work, school, or home.
- You could benefit from being in the company of loved ones at home.
- If you are concerned about having more support, you can supplement your treatment by attending 12 Step support groups.
Cons of Outpatient Treatment
What then are the downsides of outpatient treatment?
- Continue to have to deal with your life stressors.
- Continue to have access to your supplier of drugs or other substances.
- Your family members may find it exhausting to manage the consequences of your addiction.
- Dropout rate is anecdotally higher
Conclusion
Choosing to seek treatment for addiction recovery is one of the most important decisions you will make. Recovering from addiction is a process that lasts long after rehabilitation. It requires dedication to put the strategies you learn in treatment, counselling, support groups, and other types of therapy into practice.
Do approach an addictions therapist who can conduct a comprehensive assessment to determine the most suitable level of care for yourself or the person affected by addiction, be it drug, alcohol, or any addictive behaviours. The options are to be discussed and best made in collaboration with the patient, their loved ones, and the treatment team.
[1] https://www.asam.org/asam-criteria/about-the-asam-criteria
[2] Prochaska & DiClemente, 1983
Visions assist clients in identifying their problems and provides images, names, languages, qualifications, and experience of specialists who can help: https://visionsbypromises.com.sg/our-team/