Residential treatment centers offer different services depending on the facility in question. Many comprehensive addiction treatment programs offer detox programs as part of their offerings. If a program doesn’t offer onsite detox services, they often work in conjunction with a detox program or hospital to ensure all clients get the appropriate help they need.
Licensing requirements for treatment centers differ from state to state. One can visit their state website or look at information from the Substance Abuse and Mental Health Services Administration (SAMHSA) to find a listing of licensing requirements or treatment centers that offer detox services in their state.
Look for Certification
In general, therapists and physicians who deliver medical detox services should be licensed by their state and accredited to offer the services they deliver. Physicians, nurses, and support staff who provide withdrawal management or detox care should have training in this area.
It is highly recommended that anyone who is going to enter any type of withdrawal management or detox program make sure that staff members are certified addiction specialists (CAS). A CAS certificate requires that the person receives intensive specialized training and passes an examination before receiving the certification.
Certified addiction counselors who have National Certified Addiction Counselor certificates are required to complete a minimum of three years of supervised training. Look to organizations such as the National Certification Commission for Addiction Specialists regarding this certification. The American Association of Addiction Medicine (ASAM) is another source that can be used to find licensed physicians who are trained in addiction medicine and detox procedures.
Choosing a residential program that does not have certified personnel who have met the specifications required to deliver effective interventions for withdrawal from alcohol can result in serious complications for the person in recovery.
Inpatient Treatment, Residential Treatment, and Outpatient Treatment
According to numerous sources, including SAMHSA and the book Treatments That Work, there are basic differences between the major forms of treatment for substance use disorders, including alcohol use disorders.
- Inpatient treatment is delivered in a hospital or clinic setting. The client remains in the same setting where the treatment is delivered and often requires 24-hour access to medical care.
- With residential treatment, the client lives in the same setting where they get treatment; however, the setting is not a hospital or medical clinic. Most of the individuals in residential treatment centers do not require 24-hour access to medical care but are believed to require close supervision and may need specialized services.
- Outpatient treatment occurs when the person attends treatment in a clinic or hospital and then returns home. These individuals may require special services but do not require 24 hour supervision.
All of these treatment approaches for alcohol use disorders have three similar general objectives:
- To reduce the use and abuse of alcohol
- To prevent relapse
- To increase the quality of the person’s functioning.
Difference between Hospital Detox Programs and Residential Detox Programs
There are some major differences in the use of an inpatient program in a hospital and a residential program. Hospital or inpatient detoxification programs are institutional approaches. These programs often occur within the psychiatric department of a hospital. The patients in them are quarantined and isolated to the particular floor of the hospital. Many times, patients undergoing withdrawal management in hospital settings are not allowed contact with family or friends, or they have very strict restrictions regarding visitors. In addition:
- Hospital programs extensively use medications for treatment.
- Hospital programs typically implement 12-Sstep programs, such as Alcoholics Anonymous, and require attendance.
- Hospital programs restrict the patient’s use of smartphones and television. Typically, payphones are provided with limited access time; television is often restricted or viewed in a group room; and the use of laptop computers or smartphones is prohibited or severely restricted.
- The program is focused on short-term goals and getting through the withdrawal process without relapse by restricting the person’s ability to access drugs or alcohol.
- The person has very little control over their situation while in an inpatient unit.
Residential programs are far more variable in their restrictions and services. They may or may not utilize use of medications, but if they do, they must have physicians and nurses on staff. These programs will typically advertise the method of withdrawal management they use. For example, some programs may offer an all-natural approach, and use vitamins, nutrition, and other nonmedical approaches. These approaches are best avoided for alcohol withdrawal because individuals who suffer moderate to severe withdrawal symptoms from alcohol are at risk for potentially fatal seizures.
- Residential programs do not have emergency medical care on the premises 24 hours a day. They may be able to provide emergency medical care by transferring the client to a hospital or clinic, but physicians and nurses are typically not on the premises around the clock.
- These programs are generally more upscale and less institutionalized.
- Residential programs have rules regarding the use of private communication devices that are often less strict than clinics or hospital units.
- They typically have more extended visiting hours, but also restrict visitors to specific hours.
- They can be focused on longer-term care (typically a minimum of 30 days to a maximum of one year).
- They may require 12-Step group participation.
- Residential programs often have more extensive psychotherapy services than inpatient units or clinics.
Both types of facilities typically implement a transition to aftercare, although many residential units may have more extensive programs and contacts than inpatient units and clinics.
How an Appropriate Level of Care Is Determined
Intake personnel and referring physicians will consider several criteria to decide which type of setting is best for the person. These criteria include:
- Is the potential client experiencing active withdrawal symptoms from alcohol?
- Is the person’s substance use disorder limited to alcohol, or are there other substances involved?
- Are there any pre-existing medical conditions or mental health disorders that can complicate treatment?
- Are there any potential cognitive disorders that can complicate treatment?
- What is the person’s potential for relapse?
- Is the person ready to make a decision to become abstinent from alcohol?
- Does the person have a home environment that is conducive to recovery?
Depending on the situation, the person may or may not be appropriate for residential or outpatient treatment, and may require admission to an inpatient program. People who are actively experiencing withdrawal symptoms, who have complications such as co-occurring disorders, who are polysubstance abusers, or who have toxic environments may be more appropriate for an inpatient admission initially.
The Features of a Good Program
The National Institute on Drug Abuse (NIDA) suggests an effective treatment program, including a detox program, is made up of certain features.
- Services should be immediately available for the person. The person needs to get into treatment immediately. Long waiting lists are not conducive to recovery.
- Multiple interventions and services should be used. Residential programs that only have one method of detox are limited in their approach and effectiveness. There is no approach that can affect everyone equally. Programs need to be adjustable to fit the needs of the person.
- Staff members should be properly trained and certified, as mentioned above.
- The use of evidence-based treatment protocols is crucial. Only interventions that have sufficient research evidence to document their effectiveness should be used. Using treatment without sufficient evidence is not recommended. These approaches may help established treatments, but should not be the main mode of intervention.
- The facility should be accredited, preferably by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO).
- In addition to the treatment provided, the program should focus on getting the person high-quality aftercare. Aftercare programs continue after the person has gone through the withdrawal period, and they are crucial to the success of long-term recovery.
Other personal considerations should be considered.
- Are there any special needs, such as legal concerns, vocational issues, etc., that should be met?
- Does the facility’s location allow the client to easily attend it and receive visitors?
- Is the facility a good match for the age and background of the client?
Other personal preferences should be considered. Choosing facility that is compatible with the person’s lifestyle or value system (e.g., if the person is religious or not) can make a difference. For instance, people who do not have strong religious convictions may not adapt well to programs that concentrate on the use of 12-Step support groups like Alcoholics Anonymous.
Choosing an alcohol detox program is an important decision. Clients should opt for a program that best suits their needs while using evidence-based treatment methods.