What Should I Look For In A Substance Use Treatment Program?

The below was originally a short post on our social media accounts that accompanied a meme we had come across. After it got some greater attention and discussion we thought a repost here would be appropriate.

Photo by @dankrecovery

Let’s talk about this meme for a moment, because while funny on the surface, it’s actually sad and unfortunate that this is the experience many people have in treatment. When lives are on the line, it is really no joking matter.

There are a number of factors that may lead to someone to have this experience in treatment. One factor might be the persons own engagement (or lack there of) in the rehab program. This is often referred to as their motivation or stage of change. People tend to enter treatment motivated by external factors (family, law obligations, coercion by other means). When externally motivated, someone may not be as willing a participant in treatment. While this is not ideal don’t disregard its power as it is still a foot in the door and can lead to a shift to internally motivating factors. Internally motivating factors are generally seen as the type of factors that lead to greater success. A good treatment program may help the person in this shift which could lead to greater interest and engagement in treatment.

More frequently though, it is the quality of the program that leads people to a poor experience in a treatment program. While this may occur innocently (though should not be excused), sometimes this is due to criminally negligent behaviors or blatant misrepresentation of a program’s offerings. Wherever there is money there is the potential for bad actors, and unfortunately the substance use treatment field has their fair share.

How do you know a program you choose for yourself or a family member may be of higher quality? Look for the following information and ask questions:

-What licenses and accreditations does the program have? What percentage of their staff are credentialed or licensed in addictions treatment or co-occurring disorders? Are the doctors present ASAM certified?

The Joint Commission and CARF are two major accrediting bodies. Accreditation means programs have met specific standards that have been determined by an independent organization and undergo routine and regular monitoring. Licensure by the treatment programs local government also means certain standards and monitoring are met.

Individual staff should have valid and recognized credentials based on the state they are in. There are also nationally and internationally recognized credentials to be on the lookout for. Check with your local governments to learn more about credentials and licenses they recognize. In order to earn these, providers need to meet specific education, testing, and work experience requirements. An ASAM (American Society of Addiction Medicine) accredited physician means they have specific training with addictions. Further, a good portion of their staff should have these credentials, not just the leaders or supervisors.

-Do they use evidenced based practices?

Evidenced based practices are research based programs that have data showing they are effective. Many evidenced based practices require ongoing staff training and supervision to ensure fidelity to the program. Many agencies will say they and their counselors use evidenced based programs (and they certainly may use elements of them), but often they do not fully implement these types of programs. Sometimes these programs can be costly for treatment providers to implement and maintain so they are not utilized or not utilized appropriately. However, SAMHSA (Substance Abuse and Mental Health Services Administration) not only keeps a listing of recognized evidenced based practices but has a number of them available for free use for treatment agencies.

-Do they individualize treatment?

In individualized treatment lengths of stay are determined by progress and need, not standards or insurance. Treatment plans or patient care plans focus on the unique issues and problems each participant has. The treatment is tailored specifically to the individual. These treatment plans also change with the individuals response and progress in treatment since needs and issues may change. There is no “one size fits all” treatment approach to recovery.

-Is their staff/treatment team multidisciplinary?

A multidisciplinary treatment team means a number of professionals and staff from varying backgrounds so the agency can concurrently treat a number of needs of the individual during their stay. This means the staff includes not only addictions counselors and mental health counselors but nurses, doctors, social workers, psychiatrists, etc. The more offered and involved in patient care, the better as long as utilized appropriately and the team members are working toward a unified and well communicated plan.

-Do they screen for and treat mental health issues?

This could mean they have an ASAM certified physicians as mentioned previously but can also include clinicians licensed in co-occurring disorders or dually licensed in both addictions and mental health. Often people presenting for addictions treatment have concurrent mental health issues. Mental health and addictions have an intertwined and synergistic relationship. If not identified or treated appropriately, a co-occurring issue can significantly impact a person’s recovery outcomes since there is a significant issue that is being neglected.

-Do they offer their own detox or medication assisted recovery?

While not absolutely necessary, if these services are handled in house, it may be of more benefit to you or your loved one. Detoxification services occur before entering formal treatment and due to the withdrawal symptoms related to certain substances, can be a life threatening concern that requires medical assessment. At the least, if the person has not undergone and appropriate detox, the physical and mental disruption they feel will distract from treatment engagement. Detox being offered on site can lead to a better transition into treatment or the facility may be equipped to handle it medically should a relapse occur in treatment. Medication Assisted Treatment or Medication Assisted Recovery, though controversial (and it should not be), is considered a necessity for many in recovery. MAT/MAR involves use of medications in order to control withdrawal symptoms, acute and post acute, that come along with cessation of substance use. They also can reduce cravings and urges to use substances. Some people utilize these medications short term, others long term. An agency offering these on site, or at least willing to allow the person to use these medications, is offering another valid treatment option to their patients.

-Do they have specialized services?

This is related to the individualized treatment mentioned earlier. What this refers to is services for specific needs based on life experience or culture. For example trauma specific treatment, gender and sexual orientation specific support, culturally competent staff and offerings, etc. Remember we must treat the whole person and their complete needs for the best results and engagement.

-Do they support the family and provide education?

Addiction impacts the whole family system. Everyone involved needs some type of information and/or treatment for the best outcomes. Family members and friends need not only support and education about addiction and the recovery process, they may have their own treatment needs. Can the agency offer this or at least help refer appropriately? This can make a significant difference in outcomes.

-What do they do to assist transition out of their agency?

A good program should have a transition/discharge plan that sets up the person with the next step and the resources needed. The plan should address and offer direction or referral for any outstanding treatment needs and provide support to maintain recovery gains. Telling people where to find support group meetings is not enough. A transition plan may include funding, employment support, housing, medications, medical support, counseling, self help, lower level of care, etc.

Poor treatment can do more harm than good. It is important we understand what is available to ourselves and our loved ones. Ask. Learn. Investigate.

-Chris Dorian, founder of Know Your Why Recovery