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Alcohol Treatment Stages

INTRODUCTION

If you or someone you care about has an alcohol or drug problem, help is close at hand. At Sunshine Coast Health Centre, we often receive inquiries from individuals or family members that confuse the different stages of alcohol and drug rehab treatment that are available. These treatment stages are designed to address various services need as people with drug and alcohol problems progress from active addiction to addiction recovery.

For example, someone with an active alcohol or drug addiction will first need to complete detoxification so that the symptoms of withdrawal don’t interfere with their ability to participate in group or individual counseling. Similarly, someone who continues to relapse between weekly outpatient sessions would probably be a better candidate for day treatment or residential alcohol and drug treatment.

Each program plays a role in a client’s long-term sobriety. Therefore, one stage of treatment is not better than the other. Remember alcohol and drug rehabilitation is a process, not an event. Try to familiarize yourself with the following services:

DETOXIFICATION (DETOX)

Detoxification is a medical procedure designed to stabilize individuals who have consumed mood-altering substances to toxic levels. Going “cold-turkey” from alcohol or drugs in people who have consumed on a daily basis can lead to withdrawal. Since withdrawal can result in potentially life-threatening medical complications, around the clock supervision by medical staff is recommended. The length of stay in an alcohol and drug detox program varies but is typically less than 3 days. Longer stays in detox may be required if opioids or alcohol are involved or if there are other medical conditions. During detox, little or no counselling is provided to the client.

Typically, detox is provided as a “stand-alone” service apart from residential drug treatment. However, Sunshine Coast Health Centre offers both detox and residential treatment. This allows a client to be admitted promptly without requiring “clean-time” and permits clients to transfer immediately from detox to residential treatment (patients in government programs often have to return home and wait for an available residential bed). Additional information is available on our alcohol and drug detox.

Other terms: stabilization, withdrawal management.

Note: technically, detoxification is not considered “treatment” since there is typically little or no counseling provided during detox.

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OUTPATIENT ALCOHOL AND DRUG TREATMENT

Outpatient is a counselling service offered once or twice a week with, typically, one to three hours per session. The number of sessions may vary depending on progress of client. Outpatient treatment can be one-on-one or in groups. Employee Assistance Programs (EAPs) typically provide outpatient counselling as part of their service package.

Outpatient treatment can precede inpatient treatment if a client’s addiction severity requires additional supervision and structure. Outpatient treatment can also follow inpatient treatment. Commonly referred to as “continuing care” or “after care,” this form of outpatient treatment is a necessary transition for a client when returning to his/her home community.

At Sunshine Coast Health Center, your counselor and clinical supervisor work with you to connect with outpatient treatment weeks before your actual discharge.

Canada Drug Rehab is a website produced by Sunshine Coast that lists a comprehensive listing of outpatient treatment services across Canada. 

DAY (OR INTENSIVE OUTPATIENT) ALCOHOL AND DRUG TREATMENT

Day treatment is an alcohol and drug program offered several hours per day, several days (or nights) per week for several weeks. Day treatment is an alternative to residential drug rehab since the client returns home every day after treatment.

Typically, day treatment is less expensive than residential treatment because it does not include the cost of accommodation and, frequently, meals. Day treatment, however, needs to be close enough to home so that the client does not have to pay for overnight accommodation.

The one risk to day treatment is that there is not as much supervision as there is in residential treatment. Another disadvantage to day treatment is that, since clients do not spend as much time together, the cohesiveness of the peer group may not be as tight as one would find in residential treatment. Finally, the availability of day treatment is limited in Canada in comparison to outpatient or residential treatment.

More information on day treatment is available in TIP 8: Intensive Outpatient Treatment for Alcohol and Drug Abuse.

Other terms: intensive outpatient treatment.

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RESIDENTIAL (OR INPATIENT) DRUG TREATMENT

Residential alcohol and drug treatment, sometimes referred to as primary treatment, is a program that is necessary when substance use has progressed to dependence. Residential alcohol and drug rehab programs provide around the clock supervision, group and individual therapy, education, meals, and accommodation.

Inpatient addiction treatment is similar to residential treatment but is typically reserved for hospital-based settings.

An important component of the residential treatment program at Sunshine Coast Health Centre is discharge planning. This service helps clients connect to rehab programs in their home community such as outpatient alcohol and drug counselling and self-help groups.

More information is available in the Sunshine Coast Health Center Drug Rehab Programs & Services section.

Other terms: inpatient, intensive inpatient, rehab, rehabilitation, primary treatment.

SOBER (OR TRANSITIONAL) LIVING

Sober living is a less-intensive drug rehab program that is usually a minimum of 60 days in duration that can last as long as two years. Sober living is provided to clients who have completed residential treatment but require a greater level of support than what is available at home. Amount of time allocated to actual therapy, level of supervision, and qualifications of staff varies but is generally less than residential drug treatment. Clients may or may not be permitted to work while in a sober living program.

Sunshine Coast Health Centre will refer clients that are in high risk of relapsing directly to sober living following discharge. If clients do not have sober living in their home community then staff will recommend a temporary relocation to a city where a good sober living program is available.

Other terms: support recovery, extended care, second stage, stage 2 housing, recovery home, half-way house, Oxford houses, transition homes.

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SELF-HELP GROUPS

Self-help groups are composed of individuals who desire to quit drugs and/or alcohol as a common goal. These groups are run by peers instead of by health professionals such as counsellors, doctors or psychologists. There is no cost to participants and are supported by voluntary donation of members. Better known self-help groups include Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).

For more information or for assistance locating a meeting in your community call Sunshine Coast Health Center toll-free at 1.866.487.9010 or visit the Canada Drug Rehab website for a directory of NA, AA, CA, and Al-Anon meetings in your home community.

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There is a growing body of knowledge making a strong case both academically and experientially that individuals who combine self-help group support with addiction counselling have the greatest opportunity for successful recovery. See the Addiction Self-Help Groups section of this website for more information on self-help and peer support.

Other terms: mutual-support groups, peer support, mutual aid, meetings, 12 Step meetings, AA, Alcoholics Anonymous, NA, Narcotics Anonymous, CA, Cocaine Anonymous.

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THE FOREMOST AUTHORITY ON DRUG TREATMENT STAGES

American Society for Addiction Medicine (ASAM) is the foremost authority on drug treatment stages. In 1991, ASAM published the Patient Placement Criteria (1) which focus on six assessment dimensions to define bio-psychosocial (2) severity:

  1. Acute intoxication and/or withdrawal potential
  2. Biomedical conditions and complications
  3. Emotional/behavioral conditions and complications
  4. Treatment acceptance/resistance
  5. Relapse potential
  6. Recovery environment

 

Criteria listed under these six dimensions help guide placement to one of four levels of care (stages), which is the first part of matching patients to treatment.

The four levels of care are named to be descriptive of the intensity of service provided:

Level I– Outpatient Treatment

Level II– Intensive Outpatient/Partial Hospitalization

Level III– Medically Monitored Intensive Inpatient Treatment

Level IV– Medically Managed Intensive Inpatient Treatment

Provincial health ministries like the Patient Placement Criteria because it helps ensure that tax dollars are not spent unnecessarily on care that exceeds the minimum required for effective treatment.

The main benefit to clients is that they receive treatment in the least intensive – but safe – setting where they can test out recovery skills in as close to ” real world ” situations as possible and minimize re-entry problems.

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It is important to note that self-help groups are not listed in the Patient Placement Criteria because most self-help groups are focused on self-care not professional care. That is, support is provided by the peer group, not counsellors or medical professionals. However, self-help groups such as AA and NA hold meetings in many hospitals across North America and are recommended by both outpatient and residential counsellors as an important adjunct to treatment.

(1) Source: Hoffmann, N.G., Halikas, J.A., Mee-Lee, D., and Weedman, R.D. Patient Placement Criteria for the Treatment of Psychoactive Substance Use Disorders. American Society of Addiction Medicine, Washington, D.C., 1991.

(2) Note: Bio-psychosocial is an approach that treats the whole person including psychological, biological and social needs – not just the addiction.

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RESOURCES

Printed Resources – Drug Treatment Stages

Addiction Treatment Matching: Research Foundations of the American (2004) provides current research on the feasibility, utility, and need for wide utilization of Patient Placement Criteria (PPC). Chronicles the development and refinement of the PPC. Presents the science to support the use of ASAM criteria. David R. Gastfriend, American Society of Addiction Medicine (ASAM).

Online Resources – Drug Treatment Stages

Treatment of Dually Diagnosed Adolescents: The Individual Therapeutic Alliance within a Day Treatment Model (July 2000) Elizabeth Driscoll Jorgensen, Richard Salwen, National Institute on Drug Abuse (NIDA). NIH Publication 00-4151.

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Levels of Care

Level I: Outpatient treatment

Level II: Intensive outpatient treatment

Level II: Medically monitored intensive inpatient treatment

Level IV: Medically managed intensive inpatient treatment

SOURCE: Center for Substance Abuse Treatment. Intensive Outpatient Treatment for Alcohol and Other Drug Abuse. Treatment Improvement Protocol (TIP) Series,
No. 8. DHHS Pub. No. (SMA) 94-2077. Rockville, MD: Center for Substance Abuse Treatment, 1994b.

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