Access to Treatment Services SUD is a disease that can affect every aspect of your wellness: brain chemistry, physical health, mental health, behaviors, mood, and even sleep patterns. With time, your entire life can be changed due to SUD. The same can be said of many diseases: they change your life. We never question seeking longterm treatment and finding ways to manage those diseases, and we shouldn’t for SUD, either. Common Barriers to entering treatment or when in treatment No Insurance- may be the biggest challenge Other people knowing they accessed treatment and being stigmatized for it Not knowing how to navigate the treatment options and how the systems work Not enough access to beds for inpatient services Thinking detox is enough and that further treatment is not required Negative behaviors from staff at treatment facilities Access to MH medications before going into a program (must have the correct amount) Getting medical clearance from a hospital if you don’t have access to MH medications Worries about program restriction periods, being without cell phone access and internet Fear of disconnecting with family Worried courts will issue a warrant because of restriction period in treatment Abiding by rules of program Can leave a program at any time if they are not in a locked facility Peer influences both in and outside of treatment programs Drug use in the program Does not do well in group settings It is up to the YW to learn and understand where YP are in their own use. If and when they acknowledge their use as a problem, the YW can begin to help YP identify and discuss the best treatment options for them. In this process it is important to remind YP that recovery is possible and that you will support them whether they start the process or not. When YP decide that they want to do something different we get excited and are motivated to support them. If YP are considering treatment, it is important for us learn what the common barriers are. YW may find themselves engaged in a conversation with YP regarding these challenges prior to entering treatment, while in treatment or when they want to leave treatment. Know your young person and where they are at in their use. When they acknowledge their readiness it is up to the YW to help YP identify and discuss the best treatment options for them. Remind YP that recovery is possible and that you will support them whether they start the process or not. Types of Treatment services Available: High Intensity to Lowest Intensity. Inpatient/Residential Detoxification –Detox What is it? Substances that require inpatient detox services include alcohol, opioids, benzodiazepines, and other sedatives or barbiturates. People who develop a substance dependence with these drugs specifically can experience severely uncomfortable and potentially fatal withdrawal symptoms (complicated withdrawal) therefore 24 hour care is necessary. Detox is the first step of recovery and prepares a person to participate in further treatment. It is rare that detox alone is enough to sustain long term recovery. Detox can take place in a programmatic or hospital setting depending on the needs of the person. What happens when entering detox? Intake and Evaluation – Demographic information, SUD history, support systems previous attempts at treatment and recovery. Based on Intake and screening information, a person is assigned a treatment team to help create an individualized treatment plan. Medical Evaluation gets done to address any medical issues, nutrition deficiencies or other health concerns. Drug screening and mental health evaluations are completed to address withdrawal symptoms and discuss the most effective way to treat withdrawal and cravings. How long is the stay? The average stay is 7 – 10 days depending on the person’s withdrawal process what drugs they are dependent on and how well the person is doing. A longer stay can be recommended if needed the maximum time period is 28 days. Next Steps and Discharge A review of the person’s stay at the detox will play a part of what the recommendations are for discharge. The client is involved in this process with detox staff members to assure the recommendations are able to be accomplished. This time is utilized to make further adjustments, or changes to the persons treatment plan prior to discharge. Acute Treatment Services - Hospital Setting What it is? “Step down program” for people with Co-Occurring mental health and SUD, who after detox require 24 hour SUD treatment combined with Psychiatric treatment and stabilization. What happens there? Therapeutically planned group living program for people who are motivated and have sufficient potential to respond to active treatment. It is a highly structured environment and helps to manage a person’s behavior in addition to treating mental health and substance use issues. Included with these services, the program also provides individualized therapeutic treatment. The length of stay varies per person and is anywhere from a couple of days to two weeks. A person will be assessed as low risk for severe withdrawal and in need for psych services suicidal ideation [without plan or intent] secondary to their substance use at the time of admission). Services are centered on a clinical approach, which to stabilize behavior shortly after a crisis or may be used as a step-down service from a more intensive level of care. Clinical Stabilization Services What it is? This is a 24/7 residential treatment services for people are beginning to engage in recovery from SUD and are not in need of withdrawal management. Who is eligible? What do they do in stabilization services? People who have completed detox but are at risk for relapse and need extended inpatient services. People who have relapsed but have not used often enough to trigger withdrawal People who are on medically assisted treatment to address withdrawal and are struggling to stop using other substances (not alcohol or benzos). People who are using substances that do not require medically assisted withdrawal management (meth, cocaine, K-2, other amphetamines) These programs focus on intensive education using a harm reduction approach and counseling regarding SUD for patients and their families. Pregnant women receive coordination of their obstetrical care. A person can be in a CSS program up to 14 days and then can be referred to Transitional Support Services if needed. Short term Inpatient Services What is it? Low intensity residential program for people who want to transition to long term residential or halfway houses and not in need of withdrawal management. Who is eligible? Participants who completed detox and stabilization services but need more structured support. Participants with SUD who were incarcerated for two months or more and need residential treatment. Participants must be medically and psychiatrically stable enough to attend appointments in the community on their own. What happens at a short term facility? Two week orientation period with a curfew. Participants will attend house meetings and participate in groups. Case management services are made available to support the set- up of outside MH/medical services for participants to receive once the orientation is over. How long is the program? The typical period in a short term residential is up to 30 days. This can be longer if participant is waiting for a half -way house to have an opening. Case manager can send referrals to long term recovery options prior to a participant’s completion of a short term program. Halfway Houses – Long term services What is it? Halfway houses serve as a residence where participants learn or re-learn the skills necessary to re-integrate into society after incarceration or after being in other institutions. Halfway houses are ideal for participants who’ve already gone through medical detox and have completed an inpatient/outpatient treatment program. Who is eligible? Participants who completed detox and stabilization services but need more structured support. Participants with SUD who were incarcerated for two months or more and need residential treatment. Participants must be medically and psychiatrically stable enough to attend appointments in the community on their own. What happens in a Halfway House? Participants get an evaluation for special needs like housing, medical conditions and job search. There are case management services to provide need based referrals to outside resources. Participants will engage in individual and group therapy support. In addition to begin required daily groups, step meetings, health educations groups along with anger management, and communication skills. How long can a person stay at a Halfway House? Participants can stay in a halfway house for a period of six months to a year or two, as long as they remain sober, refraining from any alcohol or drug use. There is a restriction period and participants are mandated to look for work within 60 days. There usually is a small household fee participants have to pay if they receive SSDI benefits or once they start working. Participants with the help of their case managers can seek out sober living and housing options while they are in the halfway house. Sober Houses What is it? Sober houses are supervised residences participants may move into after completing a substance use treatment program and before returning home. This environment is less structured so participants work, conduct personal business and enjoy leisure activities but are not quite ready for life’s everyday stressors. What happens at a Sober House? Participants are expected to abide the house rules and understand that random drug tests may occur. Participants are responsible for their own recovery and well-being. They must be gainfully employed and are expected to pay rent and do chores to contribute to the upkeep of the house. Participants will be encouraged and supported by fellow residents to attend treatment services outside of the home. Who is eligible? Participants who have gone through some level of rehab prior to living in the home. Participants must be committed to their recovery process and should have treatment supports in place upon living in the home. How long can a person live at a Sober House? The average stay at a sober home is 90 days however a person can stay up to a year or more depending on who owns the home itself. Non- residential treatment options Partial Hospitalization Program- known as a Partial Program What is it? Partial programs are run by medical staff or certified SUD counselors. These programs provide comprehensive care for participants with SUD and co-occurring disorders without a full hospitalization. Who is eligible? Partial hospitalization programs are a good alternative for participants that require in depth treatment services and don’t pose an imminent risk of harm to themselves or others. Participants should not need withdrawal management. What happens in a Partial Program? Intake and Evaluation – SUD history, support systems previous attempts at treatment and recovery. Based on Intake and screening information, a person is assigned a treatment team to help create an individualized treatment plan. Group Therapy - Intensive group therapy to enhance sober behaviors, develop communication skills, introduce structure, and provide guidance. (Mandatory) Family Therapy -educate the family on the consequences of substance addiction on relationships and help to mend broken relationships between the user and his or her family members. (optional) Individual Therapy - Often used as an adjunct service focuses on maladaptive behaviors. How long is it? Most partial programs expect participants to attend six hour sessions five days a week. Based on the participants progress in treatment will determine what the step down process will look like. Intensive Outpatient Program – IOP What is it? Known as a “Step Down” for those who have completed a detox program or any other inpatient rehabilitation program ex: PHP, Stabilization Services or Short term inpatient. How long is it? Typically 90 – 180 days of services 3-5 days out of the week depending on the program. For people who need a higher demand of time and attention (higher level of care) but still are able to function at home. What happens in IOP Treatment? Intake and Evaluation – Demographic information, SUD history, support systems previous attempts at treatment and recovery. Based on Intake and screening information, a person is assigned a treatment team to help create an individualized treatment plan. Group Therapy -IOPs rely heavily on intensive group therapy to enhance sober behaviors, develop communication skills, introduce structure, and provide guidance.(mandatory) Family Therapy -educate the family on the consequences of substance addiction on relationships and help to mend broken relationships between the user and his or her family members.( optional) Individual Therapy - Not the primary form of treatment in IOPs. But it is often used as an adjunct service focuses on maladaptive behaviors. Individual Outpatient Counseling What is it? Treatment for a variety of addictions (alcohol, opioids, tobacco and gambling). Programs require one to two hours of therapy once or twice a week. This process begins with an evaluation and includes relapse prevention strategies, education, CBT, motivational approaches to treatment using harm reduction strategies Who is eligible? Participants with an SUD must have health insurance and be able to attend scheduled appointments. How long is it? Dependent on participant needs, and progress.
