The National Institute on Drug Abuse (NIDA) reports that residential treatment involves programs where clients stay in the same facility where they receive treatment, but the facility is not a hospital or medical clinic. Clients in residential treatment facilities have access to medical care, but they do not require 24-hour medical supervision for a mental health disorder, medical condition, or some other issue. However, these individuals often require very close supervision and structure.
Many of the clients in residential alcohol treatment centers have recently been released from inpatient treatment in a hospital or clinic and are continuing with their treatment for alcohol abuse; may have a toxic home environment, such as one that involves abuse; or have a complicated history of multiple relapses and attempts to maintain their sobriety. Some of these individuals may have significant issues with co-occurring mental health conditions, disabilities, or other medical conditions that require structure and close supervision.
There are no formal guidelines that have been developed to decide whether someone needs to be in an inpatient unit or residential treatment unit. The decision is most often made on the basis of an assessment performed by a physician and other mental health worker, and the client’s requests or expressed needs. These individuals are generally not believed to be a significant danger to themselves or others, and they can function relatively independently, but they are still in need of strict supervision and structure.
Rules and Regulations
The formal rules and regulations associated with the operations of residential treatment programs can vary from state to state. One can check with their own state website to determine the specific regulations associated with residential treatment centers that specialize in the treatment of mental health condition, such as substance use disorders.
People who suffer from substance use disorders, such as an alcohol use disorder, are often rebellious or nonconformists who naturally look to bend or get around rules and regulations. As a result, clients in residential treatment centers must be given a specific set of rules and regulations, and must follow them in order to remain in the facility. These guidelines ensure that the person is performing the behaviors needed to engage in a successful program of recovery. Specific rules and regulations will vary from facility to facility, but there are regulations that are standard across the industry. Some of these are outlined below.
- The use of smartphones or computers is limited and strictly regulated in many of these facilities if their use is allowed at all. This is because individuals often neglect responsibilities, chores, and therapy sessions due to spending time on these devices.
- Romantic relationships with other residents are prohibited. These facilities have severe limitations regarding the development of a romantic relationship or sexual encounters among residents. It is very rare that partners will be placed in the same residential program, but if this does happen, there are strict rules and regulations regarding the type of contact that can occur between partners.
- Mandatory attendance at therapy sessions is required. Unless the individual is extremely ill or has some other extenuating circumstance, it is required that they attend all of their therapy sessions.
- There are limitations on the use of television and listening to music.
- All residents are expected to engage in complete abstinence from alcohol and drugs.
- Prescription medications are dispensed to the individual as needed. Individuals are not allowed to have any drugs, even over-the-counter drugs, in their possession. In many facilities, even the possession of mouthwash containing alcohol or medication containing alcohol is prohibited.
- Smoking may be allowed in some facilities, but only in designated areas.
- In most facilities, all residents are subject to random alcohol and drug screenings.
- The possession of any weapon is strictly prohibited.
- Aggression and violence directed at other residents, staff, or anyone in the facility is strictly prohibited and punished appropriately.
- Residents are expected to report any violations of drug use, individuals harboring medications, violence, or sexual harassment by other residents.
- There are strict restrictions on where the person can go. There are often restrictions regarding what areas of the facility a person can enter and when a person can enter them.
- Individuals must receive permission to leave the facility and must adhere to a specific return time.
- In cases where individuals are attending 12-Step meetings outside of the facility, they are expected to go directly to the meeting and come directly back.
- Residents in some of these facilities may have visitors, but visitation is restricted to specific hours.
The schedule is highly structured, and individuals are expected to follow it. Schedules are designed to promote structure and ensure that residents get needed treatment.
- This is generally a particular time that people must be out of bed in the morning.
- There are specifications on when the person can use the bathroom and groom (e.g. when they can shower, brush their teeth, etc.).
- Meal times are strictly scheduled and enforced.
- If the individual is responsible for preparing their own meals, there are rules and regulations as to when and how this can be done.
- If meals are prepared by a group of individuals, every resident will be informed of when they are part of the meal preparation team and what their responsibilities are.
- If there are telephones in the facility, there are strict rules regarding when these can be used.
- In many facilities, residents are assigned chores on either a daily or rotating basis.
- Facilities may have scheduled house meetings to discuss specific issues, and residents are often required to attend these meetings.
- Therapy sessions for each individual are scheduled, and any free time is also scheduled. Residents are required to abide by their own schedule.
- Free time and recreation time are also scheduled, and residents are expected to comply.
- Bed time is typically between 9 p.m. and 11 p.m. Residents are expected to have their lights off and be in bed at the designated time, and are only allowed to get up to use the bathroom. All recovery residences have curfews. Some may have stricter curfews for newer residents and offer more lax curfews for residents who have been in the facility a while and have no disciplinary issues.
- There are formal procedures for residents to use when expressing grievances or when they wish to request special privileges. Residents are expected to abide by these procedures.
- Facilities that treat specific types of individuals, such as individuals with co-occurring disorders, may have specific rules designed to address the particular group that the facility specializes in treating.
Each facility has a different approach to handling violations of the rules. Sanctions for violating the rules are dependent on the rule being violated, how often the person has violated the rules, and other extenuating factors. Sanctions can vary from the loss of certain personal privileges to being expelled from the program. Expulsion is most often an option when the individual has repeatedly been using drugs or alcohol, been aggressive to residents or staff, or just not complied with the overall program, and it is believed that they are in danger of impeding the progress of others in the program.
Why Strict Rules Must Be Enforced
Because individuals who are members of residential treatment programs for alcohol use disorders often have very severe manifestations of their substance use disorder, these individuals require a very structured program in order to focus on their recovery. As mentioned above, people who are diagnosed with substance use disorders may attempt to break or sidestep rules, and the most efficient way to help them adjust to a recovery program is the imposition of a strict schedule. This is because successful recovery requires self-discipline.
In addition, a strict set of procedures and the imposition of structure facilitate recovery in the residence. Numerous research studies have continually found that residential treatment programs with strong structure often have better treatment outcomes compared to facilities with more lax structure. Aside from the need to keep order in the facility, there is a practical application to the use of structure and rules in a residential treatment program. Adherence to a structured program and strict schedule can help an individual get on the right road to recovery early and help them maintain their recovery upon being released from the facility.