In 2015, just over 15 million American adults struggled with alcohol use disorder (AUD), the National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports. As such, alcoholism is a disease that impacts millions of Americans and their families every year. The Centers for Disease Control and Prevention (CDC) publishes that excessive alcohol abuse accounted for nearly 90,000 deaths per year between 2006 and 2010.
Alcoholism is a treatable disease, although less than 10 percent of those needing treatment in 2015 actually got it, NIAAA reports. Fortunately, there are several different types of treatment programs that can offer a wide range of options for people struggling with alcoholism.
Treatment programs range from outpatient services to residential programs. Inpatient, or residential programs, provide around-the-clock care and individuals remain on site for the duration of the program while outpatient services are scheduled around a person's existing obligations and not as structured or intensive. Partial hospitalization programs, or PHPs, provide a kind of middle ground between inpatient and outpatient treatment programs.
The Commission on Accreditation of Rehabilitation Facilities (CARF) defines a partial hospitalization program as being a time-limited and medically supervised treatment program that can provide therapeutic, intense, and comprehensive clinical services in a structured environment that is a freestanding program. Services are to be provided between three to five days per week for several hours per day (usually around four hours each time). Evening and weekend hours may be offered by some PHP facilities. These programs can help to treat mental illness, addiction, or a combination of the two.
Partial hospitalization programs provide evaluations regarding a person's condition, treatment services, and therapies to prevent and minimize relapse. These programs are short-term and often offered to serve the following purposes:
- As an alternative to a residential or inpatient program
- As a transitional program after hospitalization or an inpatient program and before outpatient services
- As a step-down service from a more structured program
- When symptoms require more acute care than outpatient programs can provide
PHPs provide intensive and structured programming for several hours a day, multiple days per week. Individuals are able to return home each night. As a result, PHPs are best suited for people who have a stable and secure environment to return to each night, and those who do not require around-the-clock medical and mental health supervision and treatment. PHPs can be beneficial for people who have family, work, or school obligations that require them to be home in the evenings or at some point during the day. PHPs are more flexible than an inpatient program in that individuals may be able to continue to fulfill their everyday obligations, and schedule sessions and clinical hours around existing schedules.
PHPs often have the same structure and intensity as an inpatient program while a person is in attendance, meaning the person may not have access to smartphones during sessions. PHP programs can be used as a step down from hospitalization or a residential treatment program, and individuals may transition seamlessly from one to the other. They can also be transitional programs designed to fit in between the time in a residential treatment program and outpatient services. Essentially, partial hospitalization programs are short-term and can be very beneficial to someone who is experiencing difficult symptoms, but not symptoms that require 24-hour care, Psych Central explains.
PHPs for Alcoholism Treatment
Alcoholism is a complex disease that impacts each person in their own way. A partial hospitalization program can provide intensive programming to help a person manage the symptoms of alcoholism, prevent relapse, and learn new life skills for recovery. Someone who struggles with alcoholism will likely suffer from compulsive alcohol abuse, cravings for alcohol, and difficult withdrawal symptoms.
Alcohol withdrawal can be life-threatening about 3-5 percent of the time in the case of severe alcohol withdrawal, or delirium tremens (DTs), the New England Journal of Medicine (NEJM) warns, which can mean that medical detox is often the optimal first step in the treatment of alcoholism. A medical detox program may precede a PHP and can help a person become physically stable before moving on to address the psychological, social, and behavioral aspects of alcohol abuse and alcoholism via an addiction treatment program.
About 8 million Americans struggle with both addiction and a mental health disorder, according to a 2014 national survey published by the Substance Abuse and Mental Health Services Administration), making co-occurring disorders fairly common. When someone struggles with co-occurring disorders, a higher level of care is often beneficial. A PHP can provide one step down from an inpatient program that can be optimal for a person who still needs to be home at some point each day.
During a PHP session, individuals may receive intensive therapy and counseling, participate in life skills training sessions and support group meetings, and receive other clinical services as needed, similar to a residential treatment program. Trained medical, mental health, and substance abuse providers work with individuals during PHP sessions as needed.
As alcoholism is highly individual in nature, PHP sessions may differ in intensity and frequency from person to person, depending on the individual's circumstances and symptom severity. Therapy and counseling services are provided in both group and individual settings. Behavioral therapies are some of the most common treatment modalities for alcoholism, serving to help people develop new life skills, coping mechanisms, communication abilities, and relapse prevention tools.
Cognitive Behavioral Therapy (CBT) can help a person to recognize that some of their thought patterns may be self-destructive and explore how these negative thoughts give way to undesirable behaviors. By learning how to control thoughts and finding a new and healthier way to look at things, a person can then bring about change in their behaviors and actions. Potential triggers can be uncovered and discussed, and individuals can learn how to manage them as they arise, thus serving to help a person cope with stress and minimize relapse.
Medications are often useful in treating alcoholism. The National Institute on Drug Abuse (NIDA) publishes that there are three medications approved by the Food and Drug Administration (FDA) to treat alcohol addiction, which include disulfiram (Antabuse), naltrexone (ReVia, Vivitrol), and acamprosate (Campral).
Naltrexone and disulfiram serve as alcohol-abuse deterrent medications, and they are generally reserved for later in treatment after alcohol is completely out of a person's system. They can be helpful during a PHP to enhance treatment compliance. Acamprosate, and a fourth medication topiramate (Topamax) may help to dispel withdrawal symptoms and alcohol cravings.
Other medications may be useful during treatment for alcoholism to minimize the emotional and/or physical side effects of withdrawal. Alcohol withdrawal can include gastrointestinal upset, pain, insomnia, anxiety, depression, tremors, and other symptoms that may be managed by specific medications designed to target these symptoms. A PHP program can help to monitor a person's health and wellbeing, and use medications as needed to improve and manage possible symptoms and side effects of long-term alcohol withdrawal.
PHPs can be a great option for a person who doesn't quite require 24-hour care, but would still benefit from many of the intensive and comprehensive services of a highly structured addiction treatment program. When it’s the right fit, a PHP can be a beneficial form of treatment that can help to set someone up for long-term recovery.