Think you need rehab or some form of addiction treatment but struggling with ambivalence and indecision? Take 10 minutes to try this cognitive behavioral technique called decisional balancing and you might find it easier to evaluate the pros and cons and to choose the best course of action.

One minute you know it’s the right decision and a minute later you feel like you’re overreacting.

Going to rehab: it’s a huge decision, it’s going to disrupt your life and the lives of those close to you in significant ways, it can cost a lot of money and you’re probably not even sure it’s what you need…what do you need?!!

Well, no one else can tell you what’s right for you. You know your body and you know your addiction best, but if you’re having trouble weighing the pros and cons of going to rehab, try this easy exercise to structure your thoughts.

Decisional Balancing

One tool that substance abuse counselors and other mental health professionals use to help their clients make difficult decisions about behavioral change is an exercise called decisional balancing.

Making a decision to change the course of your life is rarely simple, and although one big part of you probably wants treatment, another part of you might wonder if you’re ready, or if you even can achieve lasting change.

• Ambivalence to change is normal and life is rarely black and white, which is why making major decisions about behavioral change, like about going to rehab to quit drugs or alcohol, can be so hard
• Structural barriers (like financial difficulties) can further complicate the decision making process

Decisional balancing exercises help you to identify and structure all the shades of grey – both pro and con – that weigh down the balance of any major decision.

And once you’ve identified all the pros and cons of both action and inaction and written them down in an easily comparable arrangement, you’ll have a more structured framework to base a decision upon.

What was an impossible decision sometimes becomes an obvious choice by the end of a decisional balancing exercise.

An Example of a Simple Decisional Balancing Chart

Write out rough table of 4 squares and label the squares with the titles:

1. Benefits of Going to Rehab
2. Costs of Going to Rehab
3. Benefits of Not Going to Rehab
4. Costs of Not Going to Rehab

And under each title, brainstorm for examples of likely costs/benefits. For example:

Ready to Try a Decisional Balancing Exercise for Yourself?

So are you grappling with a decision about rehab or addiction treatment – or about any type of major behavioral change? If so, why not sit down with a pencil and paper and take 10 minutes to write out the pros and cons of both sides of your dilemma.

If it doesn’t clarify things then you’ve wasted nothing more than a few minutes of your time, but you’ll likely find it easier to choose a course of action once you’ve structured things to enable a side by side comparison of the costs and benefits of both action and inaction.

And if it does work and it does transform ambivalence and indecision into motivation for action, then it is 10 minutes very well spent indeed.¹

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Choosing the right drug rehab is no easy task, and since the right program can make the difference between success and failure, the stakes are high and making the right decision is pretty important. Here are 5 questions you need to ask and answer about any rehab under consideration.

Finding the right treatment program can be tough. Make the right choice and you’ve got an excellent chance at long term recovery. Pick the wrong one and you’re far more likely to exit before completion and far more likely to relapse back to substance abuse. The stakes are high, but how can you know what’s right for you?

To help with this difficult task, the experts at the National Institute on Drug Abuse (NIDA) came up with 5 questions you need to ask and answer about any addiction treatment program under consideration:

Does the program use evidence-based behavioral therapies and, if appropriate, medications?

Does the program employ proven effective behavioral therapies, such as cognitive behavioral therapy, motivational interviewing, motivational incentives and group therapy?

Behavioral therapies help people build and sustain motivation to change and teach the skills needed to maintain recovery, and they are an essential part of the treatment experience.

When appropriate, certain medications can also help those in recovery manage withdrawal symptoms and overcome cravings to use. Medications are most effective when they are combined with behavioral therapies.

Be wary of any treatment program which does not offer behavioral therapies. Some treatment programs may not make use of effective medications on philosophical grounds or due to a lack of staff expertise. Programs which do not or cannot incorporate effective addiction treatment medications into the treatment experience are not likely as effective as programs which make full use of these medications.

Is a personalized treatment plan developed around your individual situation?

You are an individual. Your combination of past experience, culture, health and mental health needs, gender, sexual orientation, motivation and age are unique to you and nobody else.

Because of this, you come into treatment with unique needs and require services adapted to meet your specific needs – there is no one-size-fits-all solution.

The best treatment programs will screen for mental illness and will evaluate your individual situation and develop a personalized treatment plan for you alone, and because addiction does not occur as a problem in isolation from the rest of your life, the best treatment programs will also help to coordinate other services you may need, such as child care, medical care, legal services, education, job training and others services.

Will treatment be adapted to your changing needs?

The types of treatment you need at day 1, day 15, day 100 and day 300 aren’t the same, and it can be difficult to predict the progress you’ll make and the services you’ll need in the future.

The best treatment programs adapt to your changing needs by periodically re-evaluating your situation and making changes as necessary.

Addiction is a disease of relapse and remission. Relapse does not mean that treatment has been ineffective but rather that treatment of a greater intensity is once again required. Because of this, effective treatment programs may try to monitor for drug use so that they can intervene quickly should relapse occur.

Is the treatment long enough?

Treatment should step-down in intensity over time but it should not be overly brief.

Research indicates that 3 months is about the minimum duration you should consider and ideally the program is set up to accommodate periodic stints of higher intensity treatment after slips or relapses.

Although treatment needs to be of sufficient duration treatment does not need to be residential for the entire stretch.

Are you introduced to the 12-Steps or a similar community based support group program?

People who continue to participate in community support groups and/or group therapy such as that offered in AA, NA and other group meeting programs have better recovery rates than people who do not continue to participate in group meetings after the end of a formal period of addiction treatment. Because of this, there is value to an introduction to such programs while still in an addiction treatment program.¹

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For Christian men and women, especially those with financial need, the Adult Rehabilitation Centers (ARC's) run by the Salvation Army can offer needed access to long term and comprehensive residential treatment.

Please note, this website is NOT affiliated with the Salvation Army! No phone number displayed on our pages will connect you with the Salvation Army. For more information about the Salvation Army's addiction mission visit their website.

The Salvation Army is a faith based Christian organization with a mandate to helping the unfortunates of society, including the homeless and those suffering with addictions to drugs or alcohol. 

An international organization, the Salvation Army boasts more than 4 million members in 100 countries throughout the world.

Salvation Army residential drug rehab programs are free for those with financial need, and may require some payment from those that can afford it. The program costs are subsidized through yearly charitable appeals (especially at Christmas) and as well through the proceeds of the Salvation Army stores, which are more often than not staffed by recovering addicts participating in the program.

Most participants in The Salvation Army's Adult Recovery Programs have already received some form of supervised medical detox and often a limited duration of inpatient rehab, but continue to benefit from a long and structured stay within a Salvation Army drug rehab.

How Does a Salvation Army Rehab Work?

The only real requirement for admission into a Salvation Army drug rehab program is that you be sober at the time of entry, that you be willing to participate in a faith based recovery program and also be willing to pay your way through the rehab by working in the Salvation Army stores and peripheral programs.

Residents in a Salvation Army drug rehab, which run for anywhere from 3 months to 9 months in duration, are provided with food, clothing and accommodation, and given access to treatment, bible study, education and work training programs.

Because the Salvation Army is an evangelical Christian organization, faith based methods of recovery are emphasized. The 12 steps of alcoholics anonymous or narcotics anonymous are customarily employed, and recovering addicts will participate in daily 12 steps style or other group recovery meetings. Additionally, bible and scripture study with an emphasis on readings related to spiritual healing and recovery are emphasized. Christian counseling with church leaders and Sunday worship are also encouraged.

Recovering addicts participating in the programs are additionally offered the opportunity for general education courses (high school equivalency diplomas or even higher education courses, for example) or other work related training.

Works as therapy is emphasized in a Salvation Army drug rehab, and recovering addicts are required to help offset the costs of their stay by working in the Salvation Army stores, driving Salvation Army trucks, or otherwise working within the organization. The Salvation Army philosophy of recovery calls for work therapy as a way to re build needed employment skills and personal responsibility, as well as a way to transition safely back into the world of employment and temptation having already learned how to work within a structured and temptation free environment.

Is a Salvation Army Rehab Right For You?

The Salvation Army, although a charitable non profit organization devoted to the provision of affordable or no charge drug and alcohol rehabilitation to those in need, has come under fire for it's discriminatory hiring practices towards gays and lesbians.

The Salvation Army considers same sex relationships immoral and homosexuality a sin, and has does not hire people it feels are morally unfit. The Salvation Army recovery programs are not likely suitable programs for the drug rehabilitation needs of the gay, lesbian and transgendered communities.

For those in financial need, the Salvation Army is there to help. With low cost or free access to long term rehabilitation, the program offers hope to the otherwise hopeless, and has a long tradition of helping the unfortunates of society. Because the treatment is both intensive and long lasting, the Salvation Army offers men and women with severe addictions sufficient periods of sobriety and a way to transition back into the world of temptation over a long period of treatment.

Through work education, spiritual teachings and other educational programming, the Salvation Army strives to better the odds of success and sobriety as it preaches its faith based Christian approach to recovery.

There are Salvation Army Adult Recovery Centers in virtually all major cities of the United States, and most offer treatment for no or very little cost. For more information about the Salvation Army's addiction mission, including locations near you, visit their website.

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With a proper mental health diagnosis in place, therapists can effectively treat the symptoms of addiction. The deeper the dual diagnosis treatment, the better the overall outcome.

As a seasoned intervention counselor and licensed psychotherapist, I have learned how truly important it is to ensure that the patient is provided every opportunity to receive a proper clinical diagnosis.

Enough symptomatic topsoil needs to be removed, before the patient can get in touch with their own emotional bedrock - the place where real healing can occur. 

A Multidisciplinary Treatment Approach

Drug rehab professionals have the opportunity to significantly improve overall treatment outcomes by identifying the root causes of addiction, and then effectively treating them with a multidisciplinary, solution-focused, and compassionate approach. 

With a professional mental health diagnosis in place, drug rehab providers can effectively treat both the overriding and overtly daunting symptoms of addiction, in addition to those of the underlying, and perhaps the more elusive mental health issues and disorders embedded deep within the patient's core. I recommend working together with other like-minded addiction and mental health professionals forming a unified treatment team, ultimately using all clinical findings to create a comprehensive treatment plan.

Here is a list of some of the most commonly diagnosed mental health disorders found right alongside symptoms of addiction:

• Bipolar Disorder
• Generalized Anxiety Disorder
• Major Depression
• Post Traumatic Stress Disorder
• Psychosis

Introducing the Diagnostic Foundations

Recovery is a process, a slow process at times, one that often requires a subtle, yet compassionately firm hand to move it right along. Given all of the potential multi-dimensional underlying issues that could be fueling the fire of substance abuse and addiction, I firmly believe that it is imperative for drug rehab centers to apply the most comprehensive diagnostic tools available if the expectation is to effectively establish a proper clinical diagnosis. 

Here are some diagnostic tools your drug rehab provider may chose to consider:

• Alcohol Use Inventory
• Beck Depression Inventory
• PRISM-IV, Psychiatric Research Interview for Substance Abuse and Mental Health Disorders
• Psychosocial Pain Inventory
• MCMI III, Milan Multiaxial Clinical Inventory 3
• MMPI2, Minnesota Multiphasic Personality Inventory 2
• WMS, Wechsler Memory Scale

Affected Others to Be Proactive

Concerned families and friends can play a vital role in the recovery process. All those impacted by the disease of addiction and mental illness should feel empowered to systematically advocate with purpose and direction on behalf of their addicted loved ones. Rather than taking the role of the squeaky wheel, making just enough noise to get noticed, affected others are encouraged to be proactive by communicating openly with the program, presenting both their individual, as well as their collective issues, concerns, and expectations, in many cases, even before their loved one ever admits into treatment.

Perhaps equally as important, I encourage affected others to come from a place of unified strength, being ready to adapt to change without negotiating away both their individual and their collective conscience. And finally, I recommend a genuine willingness to explore their potential role in both the evolution of the underlying issues, as well as in the implementation of solution focused strategies to support the recovery process for all those impacted.

Documentation Wanted!

Now, given the importance of establishing an accurate clinical diagnosis, in addition to providing a historical record of milestones, medications, and mishaps, I recommend that families consider providing the program with any and all documentation that may help establish a more comprehensive mental health diagnosis, if one is to be found. 

The documentation can then be reviewed with the patient's treatment team who will then be able to use the historical information as clinically appropriate. 

Here is a short list of some of the documentation that may help the drug rehab center establish a more solid diagnostic foundation for dual diagnosis treatment:

• Court Records
• Medical Records
• Psychiatric evaluations
• Psychological testing
• School records

At the end of the day, the deeper the dual diagnosis treatment, the better the outcome. In fact, treating addiction can be similar to treating cancer, in that the more invasive the treatment, the better the prognosis is for long term recovery. 

Therefore, I recommend working with a drug rehab center that meets their clients where they are at, and then is able to take them as deep as they may need to go to get to the root of their individual underlying addiction issues. Similar to properly supporting the cancer patient immediately following surgery, or even after a powerful dose of chemotherapy, I strongly suggest finding a drug rehab center that is able to provide their clients with the therapeutic tools to recover with dignity while their emotional wounds slowly heal after going deep in dual diagnosis treatment.

You’re more likely to get what you want when you know what to ask for – when you know what you need! If you don’t already know exactly what you want out of treatment (most people don’t) here’s a 50 item checklist to give you some ideas.

What do you want from treatment? What kind of treatment do you need? What do you want to learn: what skills do you want to acquire?

If you’re like most people – other than knowing you have a big problem and you need some help, you have no idea what else you need or want from treatment!

So if you don't know what you want, you just know that you need to stop drinking or drugs, then you’re in good company – it’s a normal way to start treatment and you don’t require all the answers, you just need a desire change.

However, by thinking about what you want from treatment, you have a better chance of getting more of what you need. With all the treatment options out there, you can probably get most of the services you want, you just need to know what to ask for. This list of treatment options should help you with this.¹

Print off the list and circle any items you know (or think) you want. Then, with your list in hand, when contacting drug rehabs or other treatment providers, you can ask for specific services – or for referrals to rehabs that offer the specific services you need/want. If nothing else, it helps you start the process as an informed consumer taking an active role in the healthcare process – which is always a good thing.

What Do You Need/Want from Treatment?

Circle any options that apply to you.

1. Do you want to find out if you have a drinking or drug problem, and if so, how serious it is?
2. Do you feel confused about your options and just want to talk to someone?
3. Do you need a medical detoxification to help with withdrawal symptoms and for stabilization?
4. Do you need to fulfill a court order or requirement?
5. Do you want to stop drinking or using drugs?
6. Do you want to cut down (rather than stop) your drinking or drug use?
7. Do you want help for an eating disorder?
8. Do you want help to stop gambling?
9. Do you want help for another behavioral problem (sexual addiction, technology addiction, etc.)?
10. Do you want help stopping tobacco?
11. Do you want to take a medication that helps with alcohol cravings or withdrawal symptoms?
12. Do you want to take methadone (for opioid addiction)?
13. Do you want to take Suboxone (for opioid addiction)?
14. Do you want to take naltrexone (for opioid addiction)?
15. Do you want an introduction to the 12 steps and to AA or NA meetings?
16. Do you want to learn relapse prevention skills?
17. Do you want therapy to work through personal problems?
18. Do you want couples therapy or addiction focused couples therapy to work through relationship problems?
19. Do you want to attend treatment with your spouse or partner?
20. Do you want to address past or present sexual, emotional and/or physical abuse?
21. Do you want faith-based treatment?
22. Do you want treatment that focuses on spiritual growth?
23. Do you want treatment for physical health problems?
24. Do you want treatment for dental health problems?
25. Do you want to improve your health with fitness and nutrition programs?
26. Do you want help dealing with depression?
27. Do you need help dealing with grief?
28. Do you have suicidal thoughts or plans?
29. Do you want help dealing with anxiety?
30. Do you need help dealing with shyness or socializing?
31. Do you want to learn to manage stress?
32. Do you want to learn anger management skills?
33. Do you want to learn better problem solving skills?
34. Do you want to learn how to be assertive?
35. Do you want to improve your self esteem?
36. Do you want to work on dealing with loneliness?
37. Do you want help with sexual problems?
38. Do you need help with legal problems?
39. Do you need help handling financial problems?
40. Do you need help getting government benefits or services that you may qualify for?
41. Do you need help getting a job or receiving job training?
42. Do you need child care services while you receive treatment?
43. Do you want to learn better parenting skills?
44. Do you want to get custody of children that have been taken from you?
45. Do you want to get tested for HIV and other STDs?
46. Do you want to learn how to have fun without using drugs and alcohol?
47. Do you want treatment in a single gender environment?
48. Do you want to see a doctor about physical health problems?
49. Do you want short duration treatment?
50. Do you want long duration treatment?

Using Your List

Once you’ve gone through this list and circled all of that you want out of your treatment experience, you have a document in hand to work from when contacting treatment providers. When you can tell an admissions professional specifics about what you want or need, they can quickly:

1. Inform you whether or not their program fulfills your requirements.
2. If it doesn’t, they can direct you to other treatment options that meet your needs.

Of course, you probably can’t have everything you want or need at the outset, but by asking for the services that you think you need, you take control of your healthcare and you increase the odds of a meaningful and satisfying treatment experience.

Treatment professionals must be cognizant of the unique challenges facing this population of addicts, and must have specific programming set up to meet the unique needs of the borderline personality patient.

An increased risk of suicide, trust issues, the necessity of additional pharmacological therapy, decreased cognitive compliance and family support complications all need to be addressed for optimal treatment. Long term and intensive continuing aftercare will generally be required, and there will best be a single case manager overseeing all clinicians and health care workers employed on the treatment of the borderline personality patient in drug rehab.

Patients with borderline personality disorder are at a very high risk for substance abuse behaviors. Their frequent affective or mood fluctuations, plus their difficulties communicating and interacting in socially acceptable ways when coupled with a greatly decreased level of impulse control, make the use of drugs and the eventual addiction to drugs very common.

Although the treatment of borderline personality patients in drug rehab is very complicated and presents unique challenges, effective treatment is necessary for a number of reasons. Firstly, borderline personality patients concurrently abusing drugs or alcohol are at a significantly elevated risk for suicide, or other harmful behaviors (self mutilation, risky sex etc.). Secondly, when the already low levels of impulse controls are further diminished by intoxication, these patients are at great risk for provoking attacks upon their person, and can quite often become injured through their provocative behaviors.

Some special considerations for the drug rehab treatment of borderline personality disorder patients are increased suicide risks and thus a need for personal monitoring, a need for a comprehensive assessment period, the appointment of a specific case worker, appropriate pharmaceutical symptoms management, individual counseling with a professional familiar with the issues of borderline personality disorder, and long term continuing case management and aftercare.

Addiction Therapy

Although limited duration therapies have shown some promise, there is a consensus that for best effect, therapy needs to continue over the medium to long term, and the patient should maintain therapeutic involvement for years rather than months.

Group therapy

Group therapy is a very commonly employed therapeutic tool during a period of drug rehab, and research has shown that borderline personality disorder sufferers can also benefit from inclusion into group therapy, and through participation in 12 steps programs such as AA or NA.

If possible, a group of other borderline personality abusers is ideal, but when unavailable, a group of fellow recovering substance abusers is appropriate.

Individual therapy

Combined with appropriate pharmacological symptoms management, the use of ongoing psychotherapy has proven the most effective strategy for the treatment of borderline personality disorder recovering addicts. There are a number of unique issues that present when counseling a substance abusing borderline personality disorder patient, and as such any professional employed for the counseling should have an awareness of the unique and pertinent issue to treatment.

A hallmark of the disorder is an inability to trust, and this can limit the effectiveness of one on one therapy. To best earn trust, there should be an explicit discussion of the roles and aims of the therapy, and an agreement of these roles.

The presentation of cognitive dichotomies or splitting ideations is another hallmark of the disorder. People are generally seen as all good or all bad, and there is little grey area between the two. The therapist needs to be aware of splitting ideations, and be aware of splitting ideation as it may relate to members of the therapeutic team. As a relapse prevention strategy, therapists need to work with the patients to decreases this extreme dichotomy of thinking, and to encourage the consideration of the real complexities and gray areas of both people and situations.

Impulse control difficulties increases the likelihood of relapse and as a strategy of relapse management, therapists should encourage introspection and consideration in exchange for impulsive or knee jerk reactions.

Disease education

Many patients benefit from and appreciate some form of disease education and symptoms management instruction. Education can include how best to understand and control symptoms, as well as strategies for relapse prevention, and general work training and other life skills courses.

Family involvement

Family involvement in drug rehab is normally very beneficial to both the recovering addict and as well to the family, and this may or may not be true when considering the unique needs of the recovering borderline personality disorder patient in drug rehab. An evaluation of the relationship between the recovering addict and the family should be made before determining whether familial involvement is likely to promote healing or to induce further destructive behaviors. When appropriate, such as when the family maintains a continuing relationship with the borderline personality disorder addict, either financially or socially, the involvement of the family can be beneficial. Family can learn more about the disease, and the interaction of the psychological symptoms with substance abuse, and can learn the best strategies for long term support.

The impact on the family of substance abuse in a borderline personality disorder patient can be significant, and harmful, and this period of education and therapy can benefit the family greatly.

In Summary

Always beneficial, long term aftercare needs to be considered of vital importance for the continued abstinence promotion of recovering borderline personality disorder patients.

The case management team should continue to intervene in the recovering addict's life both to prevent relapse, as well as to prevent other socially or personally destructive behaviors; and the involvement in peer group sessions should be encouraged. Most importantly, the continuation of intensive individual therapy needs to occur, and the continuing modifications of pharmacologic management as symptoms expressions change.

Although drug rehab for borderline personality disorder patients can be increasingly complex, a comprehensive and tailored therapeutic strategy can induce lasting behavioral change and sobriety. Any drug rehab facility for borderline personality disorder patients must be aware of the unique needs and demands of this sub group of people, and have appropriate case management skills and professionals employed in the therapy.

Treatment Aspects

An accurate picture of both the level of abuse and addiction as well the severity of behavioral symptoms needs to be attained before admission for the effective planning of treatment.

Borderline personality sufferers are notoriously untruthful when self reporting their levels of substance abuse and other behavioral problems, and as such the best way to obtain an accurate risk assessment is through the inclusion of all current and past community care and health workers assigned to the patient.

Because the care of the borderline personality patient generally involves a number of professionals working concurrently, the patient benefits most when a single case manger is appointed to make the ultimate decisions on assigned care and therapeutic protocols.

Suicide risks

Borderline personality disorder patients have an almost 10% chance of successfully committing suicide, and this risk is elevated through substance use and during periods of stress. Because the risk of suicide or self harmful behaviors is so high, the drug rehab staff must be aware of the risks and monitor carefully the behaviors of the patient during their stay. In extreme cases, pharmacological restraint may need to be administered in acute suicidal risk periods.

Pharmacological intervention for borderline personality disorder symptoms management

There are a number of pharmaceutical interventions employed depending on the severity of the disorder, and the sub type as presented. Patients with concurrent substance abuse generally present with an impulsive destructive type of borderline personality disorder, and for this subset, the use of SSRI's for impulse control and mood balancing has proven most beneficial. On a case by case basis the use of other anti depressant, anxiolitics and even neuroleptics or anti psychotics may be deemed appropriate.

Proper pharmaceutical intervention can have a very beneficial impact on symptoms expression, and can induce a much more receptive state of mind for drug dependence therapies and other interventions.

Depending on the statistics that you believe, the incidence of dependence within the gay and lesbian population is 2 to 3 times higher than the general population. Obviously, the epidemic levels of substance abuse need to be tackled effectively, and gay, lesbian and transgender people need rehab options that effectively treat their addictions, while remaining sensitive and cognizant of the unique issues facing their particular community.

While some have argued that the prevalence of addiction as reported is exaggerated due to methods of collecting data from within gay bars (one of the few gay friendly public venues across the country) even accounting for the collection methods, data clearly indicates a high level of abuse. Thankfully, in response to this abuse, many treatment centers have begun to offer gay, lesbian and transgender specific rehabs, as well as gay, lesbian and transgender friendly rehabs, within a mixed population of heterosexuals.

Proponents of the two types of rehabs debate their relative merits, but the option to choose is a newfound luxury to many in the gay and lesbian community, and with greater choice comes a better ability to select a treatment facility in which you truly feel comfortable.

Substance Abuse Within the Gay Communities

Negative emotions, social pressures, discrimination and lifestyle behaviors may all contribute to the prevalence of addictions within the gay community.

While no two addicts, whether gay or straight, will have identical backgrounds leading to abuse, there are some societal conditions that seem uniquely able to induce substance abuse, and many of these societal conditions are imposed upon the gay and lesbian communities.

Negative emotions

Feelings of shame can often induce substance abuse for coping, and feelings of shame within the gay and lesbian community seem to trigger high levels of use and abuse. Whether shame from a failure to meet familial expectations, personal shame through the hiding of a true sexual orientation, or shame at behaviors that may conflict with taught values of an upbringing; shame plays an important role in understanding the high levels of abuse within the gay, lesbian and transgender communities. Shame leads to anger and to resentments, and to an intolerable internalization of negative emotions. Often substance abuse is the only perceived release from these feelings.

Discrimination

Discrimination also induces abuse. Gays and lesbians experience persistent discrimination for their lifestyle and relationships, and the sensation of discrimination, which is very unpleasant, can provoke substance abuse as a way of coping. Intolerant communities create environments of hate that can be very traumatic to endure. Additionally, due to the discrimination of gays and lesbians, one of the few completely safe and accepted environments within the community is the gay bar; and when much social interaction occurs within a bar, the possibility for substance abuse and addiction increases.

The period of coming out can also induce substance abuse. Always a very stressful and confusing period, the trauma of a major life change can create an environment very conducive to substance abuse and addiction.

Lifestyle

Additionally, some parts of the gay lifestyle, and the party and play mentality of some club going gays and lesbians, increases the risks of abuse. Crystal meth, long prominent within the gay club scene, has emerged as a substantial problem within the gay community, and since crystal meth also leads too often to risky sexual behaviors, the combination of crystal meth and a loss of inhibitions can be deadly.

Similarities to Conventional Rehab

Although the causes to abuse may be unique within the gay and lesbian community, the treatment of addiction remains primarily the same.

Gay and lesbian addicts in recovery should have their unique needs met, but the best way to enable recovery is through the traditional methods of individual therapy, group sessions and peer counseling, behavioral modification and cognitive training, drug and alcohol abuse education, meditation and reflection, good nutrition, recreation and an enforced period of sobriety.

Whether gay or straight, our biology remains the same, and we all tackle a very similar experience with addiction.

How Does Gay/ Lesbian Rehab Differ?

Gay and lesbian rehabs need not differ substantially from conventional rehabs, but there needs to be an awareness of the unique life stresses and experiences of members within this community, a sensitivity and acceptance of sexual orientation, and specific programming available that meets the needs of the unique challenges facing gays and lesbians in recovery.

The most vital factor is simply that a recovering gay or lesbian addict feel very comfortable within the rehab environment, and feel able to open up and heal without fear of repercussion or discrimination from either the staff or the other participating addicts in recovery.

Some argue that a gay only rehab environment is the only truly safe place for recovery, and conversely others opine that since the "real world" is a mixed world, healing within a community of diverse individuals, yet in a gay aware and safe place, is the better alternative.

A gay and lesbian rehab must address the sexual orientation and distinct needs of participating gay addicts directly. Research has shown that gays and lesbians prefer to have their sexuality addressed directly by staff within the facility, and to factor in their sexual orientation, and the unique stresses they face as a result, in all aspects of programming.

Although a mixed rehab environment can work well, any gay and lesbian friendly environment should offer some specific programming and education to meet the unique and specific needs of participating gay and lesbian addicts.

Choosing a Gay & Lesbian Rehab

Ultimately, the first priority when evaluating a gay and lesbian rehab program should be the strength of the programming offered within. The treatment approaches and philosophy of recovery should match internalized beliefs, and the addict should feel comfortable with the staff and the facility.

Secondly, the degree of gay specific programming should be evaluated. Participants will have to select whether they are more comfortable within a gay only environment, or within a gay friendly but mixed environment. Ultimately this decision should be made after considering a personal comfort level with the individual facilities, staff and programming.

The last, but not unimportant evaluation, is an evaluation of the facilities, the recreation offered and the comfort level of the accommodations. The rehab period is difficult and can be uncomfortable, and whether you are gay or straight, being comfortable in the environment can make the process just a little bit easier.

Thankfully the unique needs of the gay, lesbian and transgender community are being better met through a variety of rehab programs designed with the unique needs of this community in mind; and since the abuse statistics within the gay and lesbian community are so high, gays and lesbians with substance abuse problems need to take the first step to healing at a gay and lesbian rehab program.

With time, increasing tolerance and acceptance of the community, maybe addiction rates will decline, for now; gay and lesbian rehab is a very sensible option.

The primary advantage of a public drug treatment facility is the relatively low or even no cost involvement, and although publicly funded drug rehabs vary in relative quality, some do offer an excellent standard of care. Many of these programs have low income requirements for entry, and due to a limited number of available spaces, inclusion into a public program can require a waiting period. Additionally, due to demand for these available beds, treatment may be limited in duration to increase the availability of treatment to the greatest possible number of recovering addicts.

Private drug treatment does not necessarily imply an excellent standard of care, but most private facilities will offer a better standard of accommodation, more intensive and longer therapies, and a more comprehensive programming. For people with good insurance coverage or the means to afford private drug treatment, this type of drug treatment is generally preferable.

Choosing a Facility

Any drug treatment is preferable to continuing abuse, and there are many excellent and comprehensive public drug treatment centers, but in general, those people that can afford the costs, or have good coverage for treatment, prefer to recover at a private drug treatment facility.

The accommodations and facilities are more pleasant and comfortable, there is no delay to entry, the therapies offered are intensive, the programming varied, and the family can choose the most convenient facility for full familial participation in the process.

A large percentage of patients who enter drug rehab programs fail to complete the recommended duration of stay, and anything that improves the likelihood of a successful completion increases the odds of eventual sobriety.

Simply because a drug treatment is privately run does not necessarily equate to quality treatment, and there are some substandard facilities in both the private and public sectors. Recovering addicts and families need to evaluate carefully the programming and therapies as offered at any facilities under consideration, and make certain that they offer excellent programming likely to induce eventual and long lasting sobriety and better health.

Once the decision is made to get help, parental involvement continues to play an integral role in the drug rehabilitation process. Although during drug rehab your teen may no longer be living under your roof, you as parents remain the strongest people of influence in his or her life, and you need to remain supportive and involved even as your teen receives treatment in a residential facility.

Research has shown that a high level of parental involvement throughout the residential drug rehab period is the single greatest factor influencing eventual completion of the program and long term sobriety. Occasional phone calls are not enough, and parents need to be involved with the therapy, education and counseling, to encourage the best eventual outcome.

The period of residential drug rehab is a period of enormous growth and challenge for an adolescent coping with a transition away from drug or alcohol abuse, and the process is rarely free from trauma or abuse. Parents need to remain involved, and remember that some of the behaviors as exhibited against the parents are not necessarily true expressions of emotion, but a process of acting out against the facility and the required changes to be made.

Parental Involvement Can Make the Difference

Acting sooner rather than later is always a positive step, and generally, if parents are considering the need for a residential rehab, there probably is a real need for it.

The earlier an addiction is tackled, the better the ultimate prognosis and most people who battle addictions throughout their lives started down the road to abuse as teenagers. Abuse and addiction rarely solves itself, and outside professional intervention is usually required. Because the behaviors of addiction, and the difficulties involved in selecting a treatment facility, can overwhelm, it can be useful to enlist the services of a professional addictions therapist or interventionist for advice on how best to enable the transition into rehab, and for recommendations on the most suitable local rehab.

The most important thing that parent can do during the period of residential rehab is to maintain continued contact, regardless of the resentment and anger that may be expressed by the recovering teen; and to get fully involved in all of the family therapy and education as is offered in the rehab program. Making sure to heal the family as the rehab heals the addict ensures that the recovering addict comes home to a strong and supportive family, and reduces the risks for younger siblings.

Parental Involvement for Long Term Treatment Success

The growth and change needs to occur from within, but parental involvement in drug rehab is the single greatest indictor of long term success.

A rehab facility that does not offer, or worse, does not allow significant parental involvement should never be considered.

Parents should be prepared to expect a range of emotional expressions during this transitional period, and because your teen may greet you with anger and or hatred, this does not necessarily represent truly felt emotions, and should never deter parents from continuing involvement in the rehab process.

Parents and siblings of the recovering teen addict need to participate in healing family therapy sessions. These sessions with a psychologist or addictions councilor help the teen and the family to better understand the abuse and the behaviors that have occurred, and help the family to heal some of the rifts caused by the behaviors of abuse. Although emotionally difficult and draining, family therapy in drug rehab teaches the family as a whole a better model for support of the recovering addict once back home, and helps to resolve any underlying family dynamics that may be contributing to the expression of abuse behaviors.

Education for the family is another important facet of rehab programming, and through educational seminars, parents come to better understand the progression and mechanisms of addiction and learn more effective discipline and support models most likely to allow for long term success and sobriety.

Peer group sessions with other families are beneficial to the family and adolescent addict alike, and through a mutual expression of the pain and heartache caused by teen addiction, there can be some measure of healing and better understanding promoted.

Phone calls and family visits are equally important, and your son or daughter needs regular parental support and encouragement throughout this very challenging and frustrating period of self growth. Even if this contact is difficult, it's very necessary and shows the recovering addict that family and parents offer unconditional love and support, and this can be the most helpful of all.

Choosing a Treatment Facility

Whenever a child is abusing drugs or alcohol, the stress on the family and on the parents especially is profound; and when the decisions to intervene and mandate residential treatment is ultimately made, the stress of selecting an appropriate rehab facility can begin to overwhelm.

What type of facility is needed? How much will it cost? Will it work? The questions parents ask themselves can compound the difficulty of the situation.

Teens require a treatment facility specific to their age, and do not do well in rehab for adults. The rehab facility should be close enough to home to allow for frequent visits and family participation. The treatment facility should encourage family participation, and there should be a significant component of family education and therapy involved. The rehab should offer high school equivalency courses, and should offer a positive, disciplined and comfortable place for your son or daughter to recover.

Professional advice and support during the intervention period can both help parents with the needed intervention, and also in selecting an appropriate facility, and even to arrange transportation to the facility for reluctant participants.

Your adolescent son or daughter may not want to admit their problem, and may be adamant that they do not need rehab. Using a professional intervention service can strengthen parents from the emotional manipulation of addicted teenagers, and allow for as smooth a transition as possible into the rehab facility.

Parents Also Need Healing

When a son or daughter is suffering with an addiction, and the family is dealing with all of the negative behaviors and pain created by this addiction, it is too easy for the family to suffer just as the addict is suffering.

The family cannot offer useful strength and support to the teen addict in recovery if it falls apart, and as such it is vitally important for the family to look after itself as the addict recovers.

Alanon or Narcanon meetings have proven invaluable to many parents and families struggling through addiction; and the method of family preservation preached has been clinically proven very effective both for better family heath, and as a very effective way to support a recovering addict through the transition to sobriety. Experts recommend that families try a minimum of 6 meetings to best evaluate their comfort level with this style of peer group support.

The drug or alcohol addiction of an older sibling is statistically very likely to promote the later addiction of a younger sibling, and as such it is important that even when one member of the family requires an inordinate amount of attention, that other family members are not neglected. It's important to speak candidly about the situation with other siblings, and to thank then for any increasing responsibilities they may heave been required to take on as a result of the addiction of a brother or sister. Some one on one time with each child needs to be maintained, and important events like birthdays, and the attendance at plays, recitals and sporting events should be considered a continuing priority.

Parents should also examine their own alcohol and drug use, and should consider maintaining a drug and alcohol free home during the period of adolescence.

The First Step… Getting Help

When speaking with parents who have enrolled their children in a residential rehab program for drug or alcohol abuse, you invariably encounter a great deal of personal pain, sadness, frustration and anger; but you also hear of guilt and regret.

Most parents regret having allowed a situation to get so desperate before being forced into action, and most would recommend needed action and intervention sooner rather than later.

The truth is that if your son or daughter is using or abusing drugs and alcohol, the problem is not likely to go away on its own; and if you continue to witness abuse behaviors despite your best efforts to intervene, it's time to consider whether professional outside help may be required. Intervention at an earlier stage in the abuse and addiction makes the eventual treatment easier and improves the odds of recovery; and since research indicates that addicts do not need to be willing or motivated participants at the time of entry to a rehab facility to benefit from the program, waiting for your son or daughter to agree to needed treatment is not necessary for success.

Conservative estimates report that more than 6 million Americans are battling with an addiction to pain pills, and many of these people are co abusing alcohol and other drugs in combination with prescribed opiates.

The poly drug abuse of pain pills and alcohol has negative implications for increased dependency, increased bodily harm and risks of fatal overdose, decreased cognitive and psychological performances, exacerbated detox and withdrawal symptoms and complicated drug treatment and aftercare.

The addiction to any one drug is problematic, and when the addiction occurs to more than one concurrent substance the treatment needs to be correspondingly intensive.

The dangers of pain pill and alcohol addiction remain high within our society, and a recent survey of high school kids indicates that as many as 20% of high school seniors had abused both pain pills and alcohol to get high.

What Are The Dangers?

Because both opiates and alcohol are central nervous system depressants, the dangers of accidental overdose are magnified when these two substances are consumed concurrently.

The risk of accidental overdose, which is relatively low when taking pain pills alone, becomes very real when pain pills in large doses are combined with even small amounts of effect multiplying alcohol.

Alcohol and pain pills when taken together can also increase the toxicity of the corresponding substance. For example, when vicodin in high doses is taken with small to moderate quantities of alcohol, the danger of acute acetaminophen toxic effects on the liver are increased. These liver effects can be both chronic and acute, and unfortunately, it only takes a single incidence of excessive acetaminophen and alcohol consumption to induce liver failure and with it the likelihood of an eventually fatal condition.

The dangers of dependence and deepening addiction are maximized when the intoxicating effects of opiates are enhanced through the use of alcohol. With greater perceived pleasurable affects the psychological addiction strengthens, and drug taking behaviors become increasingly entrenched and difficult to eliminate.

Research has additionally shown that poly drug addiction induces significant cognitive declines, far worse than those induced by the abuse of a single drug. When cognitive declines are increased, whether these declines are permanent or eventually reversible, the treatment and necessary internalization of the lessons of rehab and teachings of abuse avoidance are complicated and eventual recovery is more challenging.

Aftercare

A lengthy and intensive period of aftercare remains the best way to maximize the adherence to the lessons of rehab, and to ensure long term rehab compliance and sobriety.

Aftercare may occur within a rehab facility or elsewhere, and should consist of continuing peer group therapy (NA or AA) and continuing case management from a psychologist or addictions professional. Halfway houses or other transitional rehabilitation facilities may be employed when the need for additional temptation reductions and relapse minimization is deemed necessary.

The co-occurring abuse of alcohol and pills is a large, and increasing societal problem. The seeming acceptance of both prescribed pharmaceuticals and a few drinks a night make this poly addiction relatively easy to fall into, and unfortunately, the addictions to both substances exacerbates the effects and the dangers of the other substance.

The withdrawal and detox period is dangerous and difficult, and most people will require medical supervision and medical care for symptoms minimization during this difficult period.

A rehab facility with an awareness of the treatment needs of poly drug addiction to alcohol and pills, and one that offers comprehensive and long lasting aftercare should be considered the best solution for poly drug addictions to alcohol and pills.

Drug Rehab Treatment

Methadone or other opiate substitution therapy should not be considered when there is a corresponding addiction to alcohol.

Continuing alcohol abuse reduces the benefits of opiate substitution therapy, and there remains a significant risk of overdose and other health risks. The best program is an intensive and residential period of rehab, of sufficient length to provide a period of sobriety and with enough counseling and education to provide a new model for drug free living once released.

The treatment for a poly addiction to alcohol and pills proceeds in a similar manner to conventional rehab, and individual therapy, peer group therapy, education, cognitive behavioral classes, and meditation and introspection are combined to offer the recovering addict a number of strategies to future abuse avoidance.

Because the poly abuse of alcohol and pills can increase the severity of either addiction, and also increases experienced cognitive declines, rehab needs to be intensive and long lasting to offer the best probability of long term sobriety.

Detox off of alcohol and pills

Because there is a concurrent addiction to more than one substance, there is a need for a corresponding detox off of both substances.

Research has shown that the GABAergic effects of an alcohol detoxification affect the detox from opiates through an intensification of the experienced withdrawal pains of the opiate detoxification.

Treatment generally incorporates benzodiazepines to inhibit GABAergic systems and to minimize the exacerbation of opiate withdrawal symptoms. The detox from a poly drug addiction to alcohol and pills is more challenging, will take longer and will be more uncomfortable for the recovering addict. Because the alcohol withdrawal alone can be dangerous and even fatal, the medical management of a poly drug addiction to alcohol and pills is very necessary, and since the alcohol withdrawal exacerbates the intensity of the opiate withdrawal symptoms, few people will be able to suffer the discomfort of the withdrawal if left within the home environment and access to drugs and or alcohol. Safe and effective withdrawal requires medically monitored and sequestered detox.

What Are The Reasons For Poly Drug Addiction?

Pain patients using pharmaceuticals in a legitimate attempt to control chronic or severe pain sometimes increases the potency of the analgesic effects through the addition of central nervous system depressing alcohol to their pharmaceutical treatment regimen.

More commonly, people prescribed prescription pain medications use alcohol in conjunction with the pills to increase the pleasurable effects of the pills.

The concurrent use of alcohol has an exponential magnification of the intoxication of the pharmaceutical, and both drugs when co consumed increase the effects of each other. The pills increase the effects of the alcohol, and the alcohol increases the effects of the pills. The resultant intoxication when alcohol and pills are taken together is far greater than the sum of either intoxication when taken separately. With increased intoxication comes increased dependence and addiction.

Some pain pill patients may also consume alcohol to minimize negative side effects experienced from the drugs, to increases the potency of a limited supply of opiates, or to minimize withdrawal symptoms that may begin to occur between dosages.

Image Copyright: Ktpupp

Because of the debilitating effects on the body and mind of drug and alcohol abuse, those patients with already compromised health must be encouraged as much as possible to minimize or eliminate their substance use and abuse. Additionally, because substance abuse can lead to a decrease in other medications compliance, drug abuse can exacerbate the symptoms and progression of an otherwise very treatable disease. Substance abuse also increases the prevalence of risky sexual and transmission behaviors, and as such achieving sobriety within this subset is also of public health importance.

The treatment needs of HIV and AIDS patients are both similar and as well more complicated than the treatment required for a single diagnosis of substance abuse. An HIV or AIDS patient may be suffering from additional health complications that require frequent medical interventions during a period of rehab, and they may also require life saving medications that may complicate the recovery process. Mentally, the prevalence of co occurring psychiatric disorders is significantly higher, and since any dual diagnosis complicates treatment, the existence of HIV or AIDS, substance abuse and a corresponding mental illness makes the effective rehabilitation of this group problematic.

AIDS, can cause cognitive declines, and patients struggling with these cognitive challenges, and the anxiety accompanying these declines, have more difficulty internalizing the lessons of drug and alcohol rehab and using the strategies and therapies of rehab to good effect in drug and alcohol avoidance.

In short, the treatment of HIV or AIDS affected substance abusers is very complex, but because drug or alcohol abuse can greatly damage an already weakened body, can reduce HIV medications compliance and cause an exacerbation of psychiatric conditions, HIV and AIDS patients with substance abuse issues desperately need intervention and intensive and appropriate drug residential rehab.

Individual Therapy

Private sessions with a psychologist or addictions therapist can help the recovering HIV positive addict to develop a sensible relapse prevention strategy, as well as to deal with many of the issues surrounding abuse and disease progression, and to continue to work through the psychological issues associated with both abuse and declining health.

The therapist or councilor working with the HIV or AIDS patient must be fully informed and educated about the mental health issues facing this sub group of addicts and must be aware of the interaction between mental health and AIDS HIV, the exacerbation of mental health issues through abuse, and the possible interactions of HIV AIDS medications and mental health and substance abuse.

Because disease progression can induce changing psychological issues, the therapist or psychologist must be prepared to continually re diagnosis and respond to emerging issues throughout the course of treatment.

Complete abstinence is not considered to be a reasonable goal when faced with the marked cognitive declines of the later stages of AIDS, and the therapist or psychologist must determine whether a harm reduction or abstinence model is preferable for the individual patient.

Essentially, the therapeutic goals are similar, but the underlying complexity of the treatment is increased, and therapists not educated to the challenges and complexities of HIV and AIDS, may not accurately diagnose or recognize certain pertinent issues.

Aftercare and Case Management

Long term sobriety and harm reduction best occurs when recovering HIV and AIDS patients continue with comprehensive aftercare under the supervision of a case management worker.

Through disease progression, there may be certain incidents (the first emergence of symptoms or the development of AIDS) that increase the likelihood of relapse and further abuse, and case management workers should be present to intervene when necessary.

The best aftercare regimen continues peer group and individual therapy with case management that may include social assistance (housing and employment) when appropriate.

HIV and AIDS patients suffering concurrent substance abuse issues need immediate intervention and treatment. Substance abuse exacerbates the health declines of the disease and lowers treatment compliance. Continuing abuse increases the transmission of HIV AIDS through risky sexual and drug taking behaviors, and continuing substance abuse exacerbates the commonly experienced psychological challenges facing these patients.

HIV and AIDS patients recovery from substance abuse presents complex challenges to addictions professionals, but because the harm of substance abuse is magnified within this group of addicts, intervention needs to occur, and treatment needs to take place with an understanding of the unique issues and challenges of HIV and AIDS substance abusers.

How Does It Differ From Conventional Rehab?

HIV and AIDS patients do not necessarily require a specific facility for their treatment, but any facility attempting to treat substance abuse for HIV or AIDS patients must provide additional programming and medical access.

The involvement of outside case workers and doctors will need to be incorporated into the treatment plan, and there needs to an awareness of the pharmaceutical requirements of these patients, as well as any pharmaceutical side effects issues.

Medical team involvement throughout the rehab stay ensures optimal health promotion and adequate pharmaceutical therapies. Community care workers, existing doctors and addictions professionals will need to work together to develop a medical care plan cognizant of the special challenges facing this community of drug abusers. Medical monitoring needs to continue throughout the rehab, and there needs to be an understanding of the possible HIV and AIDS complications, and how they may interact with detox and continuing recovery.

Mental health professionals also need to be very involved in the regular monitoring of these individuals.

Because HIV and AIDS can induce significant mental health strains in the non abusing HIV positive community, these mental health issues are exacerbated when accompanied by substance abuse. Mental health professionals need to be a part of ongoing care, and appropriate medications and therapies offered with the unique requirements of this population in mind.

Assessment and Pre-Intake

Due to the increased complexity of care, the pre-intake assessment should be more rigorous than normal, and should include consultation with all current medical personal and case management workers within the patient's network of support. An accurate picture of currently prescribed medications, therapies and health issues needs to be incorporated into the treatment plan. Because very low T cell counts indicate an increased probability of cognitive declines and mental health challenges, an examination of recent medical testing, or the performance of testing at intake needs to occur.

Family Involvement

When present, family offers the strongest long term and aftercare support network to the recovering HIV or AIDS addicts, and the family benefits from inclusion into the rehabilitation process.

Because the community of HIV and AIDS patients may define family in a less traditional way, the inclusion of any people the addict considers to be family is appropriate.

Family education and therapy helps supporting family better understand the disease progression, the interaction of disease and substance abuse, and helps family to best support the addict in their goal of abstinence or harm reduction.

HIV-Specific Peer Therapies

Because of the unique challenges facing this population in recovery, peer therapy works best when peers are in fact other HIV positive addicts in recovery.

This population may be both hetero and homosexual as long as there is respect and comfort with issues of sexual orientation. Traditionally segregating HIV positive substance abusers by sexual orientation has been less effective than by segregating this group between early and late onset stages of disease.

The life challenges faced by substance abusing HIV and AIDS patients are more similar when groups are segregated by a disease progression model than any other model, including gender or sexual orientation. Patients dealing with the initial diagnosis and asymptomatic phases may not do well in a group of substance abusers with late stage AIDS, and may be uncomfortable dealing with the obvious health and mortality issues within such a group.

If at all possible, the most effective peer group counseling separates people by disease progression, and them by type of drug abused, and lastly by other issues such as gender, sexual orientation and age. This type of extreme segregation of groups is not usually possible.

Answers to common questions, such as: Do you need detox? Where can you get detoxed? How much does it cost? Social or medical…clinic or hospital…how do you know what kind of detox you need? How do you know when withdrawal symptoms are dangerous?...

You probably can’t stay clean and sober until you learn some recovery skills; that’s basically why you get addiction treatment - to learn the skills you need to avoid relapse and maintain your recovery.

But you can’t settle down and start learning while experiencing uncomfortable, or even life-threatening, withdrawal symptoms.

So you need to go through withdrawals first, before you can start learning how to stay sober and you need to stay as safe and comfortable as possible during this process.

You enroll in a detox program to:

1. Stay safe and comfortable
2. Preserve your dignity
   
3. Make it through the acute withdrawal period to a point where you’re stable enough to start participating in an addiction treatment program

Do you need detox?

Read on to find the answers to questions like:

• Do you need detox help?
• What is detox, where can you get it and how much does it cost?
• What happens in detox?
• What are some different types of detox programs and how do you know which kind you need?

What Is Detoxification?

Detox is the process and interventions associated with transitioning from a state of dependence/intoxication - through the acute (first stage) of withdrawal symptoms - to relative stability.

Withdrawal symptoms can be uncomfortable or even dangerous, so people often require nursing supervision and medications to alleviate discomfort and improve safety.

Ideally, a detox program preserves your dignity and keeps you as safe and comfortable as possible during the withdrawal process.¹

Where Can You Get Detoxed?

Once you decide you want to detox you have a number of options. You can detox with/at

• Your family doctor (your family doctor can provide ambulatory [outpatient] detoxification services, and if she can’t, she can refer you to an appropriate level of care)
• A hospital emergency room (especially when withdrawal symptoms can be life-threatening, such when detoxing from alcohol or sedative hypnotics...simply show up and tell them what you need to do)²
  
• A freestanding detox clinic
• A freestanding substance abuse treatment facility
• Intensive outpatient and partial hospitalization programs
• An acute care or psychiatric hospital³

To find facilities in your area that provide detoxification services, visit the Substance Abuse and Mental Health Agency’s (SAMHSA) Treatment Locator Tool.

With this tool you can search for substance abuse treatment within a radius around your home address or zip code. With the advanced search, you can select to search for facilities that provide detox.

Once you have a list on your computer screen, a couple of hours on the phone calling local facilities is all that’s needed to get started!

Finding Services

The squeaky wheel gets the grease…

Demand for services often exceeds supply, especially demand for free or more affordable services.

It is possible that, at this very moment, there are no detox facilities in your area willing to admit another client.

However, you cannot claim an inability to find a detox slot until you have actually done some leg-work and searched for it.

If you’re serious about getting detoxed, no matter what your financial situation, do not give up until you have:

• Spoken to someone at your county health/mental health or substance abuse office to ask for treatment and, if necessary, to get put on a waiting list for care
• Spoken to your family doctor (if you have one) about your options and to ask for a referral
• Done a search for detox clinics on the SAMHSA Treatment Locator website, and then called each one in your area (If you need low cost services, ask each facility if they can accept payment on a sliding scale based on your income)
• Traveled to local hospital emergency rooms to request services

The 2 Basic Models of Detox

Drug and alcohol detox centers operate on either a medical detox or social detox model of care.

Medical Detox

In a medical detox, doctors and nurses supervise your withdrawal and doctors will prescribe medications, as necessary, to improve safety and increase comfort.

Social Detox

In a social model detox, staff are not necessarily medically trained (they usually are not). Social model detoxes tend to be cheaper and based in less clinical environments. Staff help clients through the withdrawal process with group and individual counseling, coordination of care and by providing a supportive, comfortable and drug and alcohol free environment.

Because of their non medical nature, social detox clinics are not equipped to handle clients with severe physical dependencies to alcohol or sedative hypnotics, like benzodiazepines or Z drugs.⁴

The Three Essential Steps of the Detox Process

No matter what type of detox facility you choose and no matter what substance or substances you must withdraw from, all people going through the withdrawal process must complete the same three essential steps.

1. Evaluation
2. Stabilization
3. Preparation for Continuing Treatment

1. The Evaluation

You must get evaluated. The assessment professional will evaluate your current state of intoxication/withdrawal, assess for current physical or mental illness and gather information on your social and psychological situation and functioning.

2. Stabilization

Stabilization is the process of transitioning from intoxication - through withdrawal - to a clean and sober state of stability.

3. Preparation for Future Addiction Treatment

Although many people choose to exit care after detox, detox alone does not teach you how to avoid relapse or build a better life of sobriety.

For this reason, detox staff will emphasize the benefits of continuing treatment and prepare you to transition into an appropriate level of care.

The 5 Levels of Detox

Not everyone needs the same types of interventions. Some people can withdrawal quite safely at home, with only minimal outpatient support, while on the other end of the spectrum, some people need around-the-clock hospital supervision.

But how can you know what you need?

Well, you probably can’t, but don’t worry, it’s not your job to self-diagnose.

Once you initiate the detox process, such as by checking in at a detox clinic or by going to a local hospital, you will receive a professional intake evaluation. The intake professional will then recommend a level of care, based on the results of this intake examination.

According to the American Society of Addiction Medicine (ASAM) the 5 levels of detox care are:

Level 1 - Ambulatory Detoxification without Extended Onsite Monitoring

This is the least intensive level of detox.

At this level you detox at home, but check-in with your doctor or with an outpatient detox program at scheduled intervals (such as by daily check-up appointments).

Level 2 - Ambulatory Detoxification with Extended Onsite Monitoring

In level 2, you still sleep at home each night, but you spend a significant period of each day under nursing observation at a centralized detox site.

Level 3 - Clinically Managed Residential Detoxification

A level 3 withdrawal is a 24 hour a day social detox that occurs in a residential facility. Staff members in a level 3 detox have no medical training.

Level 4 - Medically Monitored Inpatient Detoxification

People in a level 4 detox require 24 hour a day medical monitoring, such as in a medical detox clinic.

Level 5 - Medically Managed Intensive Inpatient Detoxification

The most intensive level of detox, people in a level 5 detox require significant medical monitoring. A level 5 detox occurs in an acute care hospital setting.

Determining an Appropriate Level of Care

To build a level of care determination, as assessment professional will evaluate your situation across a number of domains, and then make a subjective decision based on your needs, resources and abilities.

Intake workers typically assess your situation across 6 variables. These 6 variables are:

1. Current Intoxication and Predicted Withdrawal Severity

Someone who has a history of complicated withdrawals and who enters the detox process with a blood alcohol level of 0.35 likely needs a higher level of care than someone who is detoxing for the first time and who walks in relatively sober.

2. Health Problems and Medical Complications

A person with uncontrolled high blood pressure, for example, might require augmented medical monitoring during sedative withdrawal.

3. The Co-Presence of an Emotional, Behavioral or Cognitive Complication

Psychiatric problems and thinking abilities can affect a person’s ability to stick with detox. For example, while a cocaine user might normally try detoxing on an outpatient basis, a person with uncontrolled ADD might require the additional structure of a social model residential program.

4. Readiness to Change

People who really want to change may not require as much assistance as those who display less motivation.

5. Relapse History and Ability to Maintain Abstinence

People who can’t maintain even short periods of abstinence won’t do well in an ambulatory detoxification protocol.

6. Living Situation

Someone who is homeless, for example, or living in a very unstable home, might require the structure and safety of a residential facility.

Complicating Factors 

And if things weren’t complex enough - in addition to the 6 dimensions outlined above, additional variables can sometimes further complicate a treatment recommendation, such as:

• Needing to take care of dependent children
• Being unable to travel to and from an outpatient center each day
• Lacking financial resources
• Being unable to sign or understand informed consent
• Displaying psychosis or violent or aggressive behaviors
• Having suicidal thoughts
• Language or cultural barriers
• Physical or sensory disabilities
• Legal issues

Medical Detox Costs

In Feb 2011, Open Minds Consulting surveyed 15 private medical detox facilities on pricing information. They found that as of 2011, the average price for 24 hours of inpatient medical detox was $1707.00 per day.⁵

Note: costs will vary, insurance can offset much or all of the expense and many facilities will offer services on a sliding scale based on your income and ability to pay.

When to Get Immediate Medical Attention

Note: withdrawing from alcohol or sedative hypnotics without medical supervision is dangerous. To be blunt - you could die. Withdrawal symptoms can go from moderate to life-threatening very quickly and it is difficult to predict in advance who will experience severe withdrawals. Do not do this on your own.

However, if for any reason you find yourself going through the withdrawal process without medical assistance, be on the look-out for the following signs and symptoms that may indicate a serious problem.

Experiencing any of the following warning signs during the acute withdrawal stage indicates a need for immediate medical attention:

• Abdominal pains
• Hallucinations or increasing anxiety
• Psychosis
• Running a fever of more than 100.4 f
• Large changes in resting heart rate (up or down) or large changes in blood pressure
• Upper or Lower GI bleeding (blood in stool or in vomit)
• Neurological warning signs, such as a change in the responsiveness of your pupils to light
• Signs of seizure (read on below)
  

Warning Signs of Seizure

When detoxing from alcohol or sedative hypnotics, you need to be especially concerned about seizures. Two physical signs that warn of an increased risk of seizure are ankle clonus and heightened deep tendon reflex (when detoxing from alcohol, you are at greatest risk of seizure between 6 and 48 hours after abstinence or decreased consumption.)⁶

Ankle Clonus

Ankle clonus is an occurrence of multiple rhythmic contractions and relaxations of the ankle.

To test for ankle clonus, flex your foot upward as far as you can and then release it. Normally, your foot will return to a normal position. If you have ankle clonus, your foot will continue to jerk up and down through a serious of uncontrolled muscular contractions and relaxations.⁷

The presence of ankle clonus (sustained for more than 2 beats) indicates worsening central nervous system functioning and impairment of upper motor neurons - and this is often associated with the commencement of generalized seizure activity.⁸

Heightened Deep Tendon Reflex

When you tap on a tendon it contracts and causes a muscle movement - such as when you get tapped on the tendon of the kneecap when sitting, which causes your lower leg to kick out.⁸

Heightened or exaggerated deep tendon reflex is a warning sign of possible seizure.

Do not play around with the possibility of seizure, especially when they are easily prevented by the short term use of small doses of benzodiazepines. If you experience any warning signs of seizure - go to the ER.

Take-Home Message

• A detox program helps you stay safe and comfortable and preserves your dignity
• Detox should never end treatment. Consider it something that allows you to begin treatment
• You can find detox services in a range of settings, such as in your doctor’s office, through an outpatient program or residential rehab, in a specialized detox clinic or in a hospital
• There are 5 basic levels of detox, and it’s important to get matched to an appropriate level of care. You get matched to an appropriate level of care based on the results of your intake assessment
• Withdrawal can be dangerous. If you find yourself going through unsupported withdrawal symptoms, pay very close attention to warning signs of serious medical problems

Image Copyright: Kate Dreyer

An overview of what you need to learn in drug rehab, the changes you need to make and the therapies used to teach you what you need to know.

What's it going to take to get clean and sober - and stay that way?!!

Is getting away from your everyday environment, staying sober for a month or more and rebuilding your health all that’s really needed for rehab success? Or is there more to it than just this?....

Well, a month of sobriety and healing gets you feeling enormously better - there’s no doubt about this - but unfortunately, a month’s break without effective therapies is simply a temporary recess... just a short break that ends quickly after you get back home. Because unless you learn new skills and make substantial changes, you fall back into old patterns and habits - and it all just starts all over again.

So you go to rehab for 2 essential reasons:

1. To get out of your environment for long enough to get stabilized, build a short stretch of abstinence and start to recover physically and mentally
2. To get an intensive crash-course on all the skills you’ll need to avoid relapse and maintain your recovery once back in the ‘real world’

Therefore, the most successful programs teach you an array of skills you’ll use every day to avoid relapse while building a more satisfying life.

Read on to find out more about:

• Some of the skills you’ll need to learn to give yourself a reasonable chance at maintaining recovery after the end of a rehab stay
• Some of the many changes you’ll have to make along the way
• Some of the therapies and interventions used in quality addiction treatment programs to help you out with these essential tasks of learning and change

In Treatment - What You Need to Learn

Why search out a program that employs qualified professionals and makes use of evidence based therapies to help you along?

Well, to put it simply, recovery from addiction is an enormous task, you have much to learn and many changes to make, and if these changes were easy or just happened naturally - you wouldn’t need treatment in the first place, would you?

Some of the most important skills you need to learn include:

• Overcoming ambivalence to change and building and maintaining strong motivation to do the work required for lasting recovery.
• Learning coping skills to help you manage cravings and identify and avoid high risk situations.
• Learning to rearrange your life to find pleasure and reward in healthy and positive activities (such as by adopting a fun exercise-routine) rather than needing to seek reward from drugs or alcohol.
• Learning healthier ways to deal with negative emotions or states, like anger, sadness, frustration or boredom.
• Learning better communication skills and other interpersonal skills necessary to support strong relationships.
• Learning how to build and make use of a sober support network.

Treatment - To Help You Make Some Big Changes

Good intentions aren’t enough, to build a life of recovery you’ll have to make some substantial changes, such as:

• Changing the way you think - Learning to recognize and correct negative self-talk (I need a drink, I can’t handle this etc.) for example
• Changing environmental variables - Reducing your exposure to environmental variables that threaten your recovery. For example, if a full wallet triggers cocaine cravings - have a trusted family member take over your finances for you
• Changing how you respond to negative emotions - Learning to recognize negative states that often precede cravings to use or drink and then using behavioral tools to reduce your risk
• Changing social relationships - Cutting ties with people who threaten your recovery¹

The Kinds of Therapies Proven to Work

The following are some examples of the more common types of evidence based substance use disorder therapies and interventions

Motivation Enhancement Therapies

Interventions designed to help you overcome ambivalence to change so you can get and stay motivated to do the hard work of recovery.

Addiction Focused Family and/or Couples Therapies

Therapies that involve loved ones and life-partners increase the odds of lasting recovery. Loved ones learn how to support the recovery process and family members learn to change dynamics that may contribute to the problem. Additionally, since stress and anger can lead to relapse, improving relationship satisfaction can decrease relapse risk. 

Group Therapy

Professional-led group therapy sessions allow a group of peers to explore topics of recovery together.

Cognitive Behavioral Therapy (CBT)

By changing the way you think you can change the way you feel and act. Through training and practice exercises you can learn to replace maladaptive thinking patterns with new healthier outlooks, and this can help a great deal.²

Relapse prevention programs are often CBT based.

Contingency Management

It’s difficult to work toward a goal when you feel no pleasure after achieving it.

People often suffer through feelings of blunted reward and depression during early recovery, and this makes it harder to feel satisfaction and happiness after meeting recovery goals, like a first week of abstinence, for example.

And when achieving a goal doesn’t bring pleasure or satisfaction, it’s hard to stay motivated to keep working at achieving future objectives.

So under contingency management, you work for incentive vouchers (like for movie tickets or gift certificates) that serve as external rewards for achieving your goals.

And then after a while, once your brain recovers enough, the satisfaction of maintaining recovery becomes all that’s needed to reward you for your efforts

12 Step Facilitation

Provides an introduction to the 12 steps and the working of steps 1 through 5, and increases the likelihood a person will continue with community self-help groups, like AA or NA, once out of the primary treatment phase.

Remember - Treatment Takes Time

1. So you have a lot to learn and you need to make a lot of change - this can’t happen overnight
2. Addiction is considered a brain disease because it causes lasting changes to the structure and functioning of the brain. These brain changes alter your thinking and memory systems, your ability to concentrate and even your ability to plan or control your impulses. The brain will heal, in time - but only if you give it time!

For these 2 reasons, it’s important that you stick with addiction treatment for a while. Research suggests that treatment that lasts for less than 90 days doesn’t work well, and in most cases, treatment that lasts for longer than 90 days is most effective.¹

Treatment does not have to be residential for the whole period, in fact you should ‘step-down’ to lesser intensities of care, as you are able.

Image Copyright: Lanier67

Step by step instructions on finding rehab treatment when you don’t have insurance.

Getting into rehab without insurance takes a little work and patience, but it is possible.

With good insurance, finding a rehab is easy. However, even if you don’t have insurance and/or the money to pay up-front, you can still find rehab treatment - you’ll just have to work harder to find it and you may have to sit on a waiting list for a while before a treatment slot opens up.

Here are some ideas on how and where to find a low-cost rehab that’s billed on a sliding scale that’s related to your ability to pay, specifically:

• Instructions on accessing SAMHSA’s database for low-cost providers and those willing to work for payment on a sliding scale related to income.
• Instructions for accessing your state’s substance abuse services.
• A complete state by state list of phone numbers and links to state government run treatment services agencies.
• Other community resources, such as Christian faith-based treatment programs.

1. Use SAMHSA

SAMHSA, the Substance Abuse and Mental Health Services Administration, runs a database of most addiction treatment providers in America. You can search this by location to find providers who offer payment assistance or treatment on a sliding scale. Once you get a list of potential providers, it’s up to you to get on the phone and contact each in person, to find out about availability and fit.¹

To use the SAMHSA searchable database:

1. Visit the SAMHSA treatment locator 
2. Click on your state and then enter your ZIP code to search for providers within a radius around your home.
3. Find and click on the ‘select services’ button and then narrow down your search by searching for providers offering ‘a sliding fee scale’ or ‘payment assistance’.
4. Contact each provider by phone to inquire about services.

TIP  – When talking to addiction service providers, ask each if they can help you access any state, county or city assistance programs that can help pay for your treatment.

Alternatively, you can also access the SAMHSA database through their free 1 800 number at 1800 62 HELP, or for the hearing impaired, at 1 800 487 48891 800 487 4889.

• Though finding free or low cost treatment can seem like an impossible task, actually, a significant majority of treatment providers, 76%, offer either payment assistance or sliding scale treatment for eligible patients.²  

Services for Veterans

Veterans can also look for treatment though Veterans Affairs

2. Visit Your State's Website

You should also visit your state’s website to access state-run behavioral health or addiction treatment programs.

To do this:

• Search online by entering your state’s name and .gov in your search engine, for example ‘Maine .gov’. You should find your state’s website at the top of the list of search results.
• Once on your state’s website, search for addiction services. States use different terms for this, so try searching for ‘behavioral health’, ‘mental health’ or ‘addiction services’.

Or

• Click on State Substance Abuse Agencies and then choose your state in the drop–down menu that pops up.
• This will provide you with a 1 800 number for treatment services in your state, and in most cases, a link to your state’s substance abuse services website.

You can also scroll to the end of this article where you will find a complete listing of 1 800 numbers and links to all state addiction treatment service agencies.

3. Ask around at AA or NA Meetings

If you don’t find treatment through SAMHSA or your state, or if waiting lists are unacceptably long, you can also try attending a few different AA, NA, SMART Recovery or other community meetings, so you can ask about local services.

• Since many people attending these meetings will be familiar with local treatment, you may learn about treatment options that you didn’t find through SAMHSA.
  
• You may also get the inside scoop on the best service providers – and those to avoid.

People at self-help group meetings are generally very welcoming, but if you haven't been before, you may feel more comfortable by preparing in advance and learning more about what happens at AA and NA meetings.

4. Consider Free Faith-Based Treatment

If you are comfortable with faith-based care, and/or if professional treatment is not available to you, you may have local treatment options through Christian organizations like the Salvation Army and others.

State by State Treatment Help-Lines

Phone numbers and links to state government addiction treatment services.

Since websites and phone numbers will change over time, please leave a comment below if you find a broken link or an incorrect phone number. This will help us keep this info correct and up to date.

As of July 20th, 2014:

• Alabama: (800) 367-0955 - http://www.mh.alabama.gov/sa
• Alaska: (907) 465-4841 - http://dhss.alaska.gov/dbh/Pages/default.aspx
  
• Arizona: (602) 364-4558 - http://www.azdhs.gov/bhs/recipients/addiction.htm
• Arkansas: (501) 686-9164 - http://humanservices.arkansas.gov/dbhs/Pages/default.aspx
• California: (916) 440-7400 - http://www.dhcs.ca.gov/individuals/Pages/SUD-Services.aspx
• Colorado: (303) 866-7495 - http://www.cdhs.state.co.us/obh
• Connecticut: (860) 418-7000 - http://www.ct.gov/dmhas
• Delaware: (302) 255-9398 - http://www.dhss.delaware.gov/dsamh/index.html
• District of Columbia: (202) 727-8857 - http://doh.dc.gov/service/doh-substance-abuse
• Florida: (850) 487-2920 - http://www.dcf.state.fl.us 
• Georgia: (800) 715-4225 - http://www.mygcal.com
• Hawaii: (808) 692-7506 - http://health.hawaii.gov
• Idaho: (208) 334-5934 - http://www.healthandwelfare.idaho.gov
• Illinois: (800) 843-6154 - http://www.dhs.state.il.us/page.aspx?item=29725
• Indiana: (800) 662-4357 - http://www.in.gov/fssa/dmha/2578.htm
• Iowa: (866) 242-4111 - http://www.drugfreeinfo.org
• Kansas: (785) 296-3471 - http://www.kansasbehavioralhealthservices.org
• Kentucky: (502) 564-4456 - http://dbhdid.ky.gov/kdbhdid/default.aspx
• Louisiana: (225) 342-8916 - http://new.dhh.louisiana.gov/index.cfm/page/95/n/115
• Maine: (207) 287-2595 - http://www.maine.gov/dhhs/osa/help
• Maryland: (410) 402-8600 - http://www.mdcsl.org
• Massachusetts: (617) 624-5111 - http://www.mass.gov/dph/bsas 
• Michigan: (517) 373-4700 - http://www.michigan.gov/bhrecovery
• Minnesota: (651) 431-2460 - http://mn.gov/dhs
• Mississippi: (601) 359-1288 - http://www.dmh.ms.gov/alcohol-and-drug-services
• Missouri: (573) 751-4942 - http://dmh.mo.gov/ada/help.htm
• Montana: (406) 444-3964 - http://www.mt.gov
• Nebraska: (800) 648-4444 - http://www.dhhs.ne.gov/networkofcare
• Nevada: (775) 684-4200 - http://www.health.nv.gov
• New Hampshire: (603) 271-6738 - http://www.dhhs.nh.gov/dcbcs/bdas/index.htm
• New Jersey: (609) 777-0702 - http://www.state.nj.us/humanservices/das/home/index.html  
• New Mexico: (505) 476-9295 - http://www.bhc.state.nm.us
• New York: (877) 846-7369 - http://www.oasas.ny.gov/providerDirectory
  
• North Carolina: (800) 662-7030 - http://www.ncdhhs.gov
• North Dakota: (701) 328-8920 - http://www.nd.gov/dhs/services/mentalhealth/licensing.html
• Ohio: (614) 466-2337 - http://mha.ohio.gov
• Oklahoma: (800) 522-9054 - http://ok.gov/odmhsas
• Oregon: (503) 945-5763 - http://www.oregon.gov/OHA/amh/pages/index.aspx
• Pennsylvania: (717) 787-9564 - http://www.ddap.pa.gov/portal/server.pt/community/ddap_home_community/20800
• Rhode Island: (401) 462-1000 - http://www.bhddh.ri.gov/SA
• South Carolina: (803) 896-5555 - http://www.daodas.org
• South Dakota: (605) 773-3123 - http://dss.sd.gov/behavioralhealthservices/community
• Tennessee: (800) 889-9789 - http://www.tn.gov/mental
• Texas: (512) 206-5145 - http://www.dshs.state.tx.us/MHSA
• Utah: (801) 538-3939 - http://www.dsamh.utah.gov
• Vermont: (802) 651-1550 - http://healthvermont.gov/adap/adap.aspx
• Virginia: (800) 451-5544 - http://www.dbhds.virginia.gov/OSAS-default.htm
• Washington: (866) 789-1511 - http://www.adhl.org
• West Virginia: (304) 558-0627 - http://www.dhhr.wv.gov/bhhf
• Wisconsin: (608) 266-2717 - http://www.dhs.wisconsin.gov/substabuse/index.htm
• Wyoming: (800) 535-4006 - http://www.health.wyo.gov/mhsa/index.html

You can find low-cost addiction treatment, but you’ll likely have to do some leg-work to arrange it and you may need to wait for a treatment slot.

• Because finding low cost treatment can be a frustrating experience, and because it’s easy to lose motivation over time, enlist a supportive loved one to help you arrange treatment and to keep you motivated to move forward with the process.
• While waiting for treatment, you can get a head-start on recovery by attending community self help meetings, like AA, NA or SMART and by working to control your intake, as much as you can.

Do you need residential addiction treatment or would outpatient treatment work just as well? To find out, read do you need to go to rehab?

How to improve the overall treatment experience by knowing how to work with and within the federally mandated Privacy Rule embedded deep within HIPPA.

Confidentiality is a cornerstone of substance abuse and mental health treatment. It provides the patient with the privacy needed to establish trust and confidence in the foundation of both the therapeutic process and in the providers that have been entrusted to their care.

Maintaining the integrity of patient information and records is therefore a fundamental part of treatment. The Privacy Rule found within The Health Insurance Portability and Accountability Act of 1996, or HIPAA as it is more commonly known, is essentially a federally mandated safeguard, that for the purposes of this post at least, helps to support the therapeutic process by establishing guidelines on how private information may be shared with others.

“Unfortunately, I can neither confirm, nor deny that there is a patient here by that name.”

If you have ever been told the above-mentioned phrase by a counselor at a drug and alcohol rehab center, you are probably all too familiar with some potentially significant flaws in the system. I can’t remember exactly where I heard it first, but somewhere early in my career, someone much more seasoned than me imparted, “You are only as sick as your secrets.”

Although getting someone to admit into a drug and alcohol rehab center is without question a vital part of the recovery puzzle, it may be equally as important to ensure that there is a robust and healthy channel of communication while that person is in treatment.

Maintaining a Channel of Communication

In simple terms, the doctor needs to know the symptoms in order to effectively treat the disease. With that said, the true symptoms of the disease of addiction are sometimes lost and often distorted deep within the dark manipulative mantle of the addict mind.

I have worked with hundreds of families all across the country and throughout the world. From Scarsdale to Calabasas, London, Bogota, and beyond, there appears to be a universal desire among all families to provide drug and alcohol rehab centers with as much collective information as possible so that they “know the truth” and get “the facts straight” while they treat the patient.

I firmly believe that all drug and alcohol rehab centers must carefully consider the significance of this collateral information as part of both the diagnostic and corresponding treatment experience. Given both the long-term organic effects of consuming mood altering substances and the manipulative nature of the addict mind, this information may prove to be a highly transparent window into the truth. In other words, by the nature of the disease itself, the person battling an addiction may not necessarily be able to be the best historian.

Stakeholder Involvement from the Beginning

At the same time, it is also important to keep in mind that sharing goes both ways. Not only do most of my clients want to share important information with treatment providers, they want to receive it as well, especially with regard to ...

• diagnosis
• treatment
• compliance
• progress
• planning

One of the most powerful tools to creating that robust and healthy channel of communication I talked about earlier is to lay out the groundwork for it prior to the admission into treatment:

Before the start of an intervention, for example, I encourage the family to select at least one member to serve as the gatekeeper of information. Once the intervention is underway, the identified person in need of help is then asked to accept both the gift of treatment and the plan to maintain an open line of communication with the treatment center.

Considerations for Finding a Program

In my opinion, rather than trying to find a loophole in the statute so that you can try to give and get sporadic bits and pieces of information, the treatment experience may be significantly enhanced for everyone involved by knowing how to effectively work with and within all of the federally mandated red tape, protection, and privacy found within HIPAA.

So while you are out there looking for the best rehab option for your loved one, now you may want to carefully consider finding a program that ...

• is genuinely interested in reviewing the collateral information you have to offer
• demonstrates a willingness to establish a collaborative working relationship with the patient’s primary support system, while at the same time...
• makes protecting patient privacy a priority