healthy man after sub-acute medical detox

Inpatient Drug Rehab: Complete Support for Recovery

According to the National Survey on Drug Use and Health, around 23.5 million Americans aged 12 or older need treatment for a substance use disorder in any given year. However, only around 10 percent of people who need treatment for an addiction receive it. The National Institute on Drug Abuse stresses that good intentions and willpower are almost never enough to end an addiction for the long-term.1 Treatment is almost always necessary for lasting recovery.

Substance use disorder treatment takes place in a variety of settings. Here, we look at inpatient drug rehab, which involves living at a residential treatment facility while undergoing treatment. Inpatient treatment is the best choice for many people in recovery, and we’ll examine why that is, how inpatient treatment works and how you can get the most out of an inpatient drug rehab program.

Inpatient Drug Rehab and the Continuum of Care

The continuum of care in addiction treatment is a system that ensures people entering treatment receive the appropriate level of care for their unique needs. The American Society of Addiction Medicine identifies four main levels of care in rehab:2

Level 1: Outpatient Services

Outpatient rehab is the first and least restrictive level of care for people in treatment. Outpatient treatment involves living at home while receiving nine or fewer hours of programming each week, which take place during the day at the treatment center.

Level 2: Intensive Outpatient and Partial Hospitalization Services

The second level of care is divided into two sub-levels. Level 2.1 is intensive outpatient treatment, which, like outpatient services, enables individuals to live at home and continue working while in rehab. Intensive outpatient treatment involves up to 20 hours of programming each week. Level 2.5 is partial hospitalization services, which provide more than 20 hours of programming each week during the day, with clients returning home each evening.

Level 3: Clinically Managed or Medically Monitored Inpatient Services

Level 3 is divided into four sub-levels, all of which involve living at a residential treatment facility. The first three sub-levels are clinically managed residential programs. Level 3.1 is low-intensity treatment; Level 3.3 is population-specific, high-intensity treatment; and level 3.5 is the highest-intensity, clinically managed residential treatment program. Level 3.7 is a medically monitored, intensive inpatient program involving around-the-clock nursing care for those with severe medical, emotional, behavioral or cognitive problems.

Level 4: Medically Managed Intensive Inpatient Services

Level 4 is the most restrictive and most intensive level of care for addiction treatment. It involves 24-hour nursing care and daily care under the supervision of a physician. Level 4 is for people who have severe problems that require intense medical or psychiatric care.

As individuals progress through treatment, they step down to the next level of care, which will be less intense than the previous level. As they move through the levels, they gain more freedom and independence until they’re ready to continue in recovery on their own.

Detox: The First Step of Inpatient Drug Rehab

Detox is the first stop in any addiction treatment program. During detox, all traces of alcohol and drugs are allowed to leave the body so that brain function can begin to return to normal and you can focus on recovering from the addiction.

Detox addresses drug or alcohol dependence. Addiction and dependence aren’t the same things, although they generally occur together. While addiction is characterized by compulsive drug or alcohol use despite negative consequences, dependence is a physical reliance on a substance that causes withdrawal symptoms to set in when the substance is withheld.

How Dependence Develops

Heavy substance abuse causes the brain to compensate by changing the activity of neurotransmitters. For example, alcohol initially increases levels of the neurotransmitter GABA, which produces feelings of calm and relaxation. At the same time, it suppresses the neurotransmitter glutamate, which produces feelings of excitability. But with heavy alcohol abuse, the brain suppresses the activity of GABA and increases the activity of glutamate in an attempt to normalize brain function. This leads to tolerance, which means that you need larger doses of drugs or alcohol to get the same effects smaller amounts once produced.

At some point, neurotransmitter function may shift, and the brain will now function more comfortably when the substance is present. Then, when you stop using suddenly, the normal function of the neurotransmitters rebounds. In the case of alcohol, GABA is no longer suppressed and floods back. Glutamate activity is cut back to normal levels. This sudden shift in neurotransmitters produces physical withdrawal symptoms, which vary by drug.

Treating Withdrawal in Detox

Withdrawal symptoms can range from mild to severe, and they can last for days or weeks, depending on factors such as:

  • Age

  • General state of physical and mental health

  • Biology

  • The substance of abuse

  • How much of the substance is in the body at the time of detox

  • The length and severity of dependence

Medical detox is available through most high quality treatment programs and involves medications that are provided as needed to treat withdrawal symptoms and reduce the risk of dangerous complications associated with detox. A variety of complementary therapies, such as restorative yoga, acupuncture or meditation, may be used in detox to help reduce physical and emotional discomfort and increase feelings of wellbeing.

Assessments in Detox

During detox, a range of assessments help care providers determine the severity of your addiction and identify problems in your life, such as relationship problems, financial issues, employment or housing needs, and medical or mental health issues. This information is used to determine where on the continuum of care you should enter treatment. It’s also used to develop a comprehensive, individualized treatment plan that addresses your multiple needs for the best chances of recovery.

Detox Alone Isn’t Treatment

Detox alone does very little to address a drug or alcohol addiction, which is far more complex than dependence. Without treatment following detox, most people will relapse very quickly. A study published in the Irish Medical Journal found that around 90 percent of people with an opioid addiction relapsed after detox–59 percent of them within a week. Those who attended an addiction treatment program after detox either didn’t relapse or had a significantly delayed relapse.

The relapse rate for addiction is similar to the relapse rates of other chronic diseases like diabetes or heart disease. According to the National Institute on Drug Abuse, around 40 to 60 percent of people will relapse after a period of recovery. Treatment reduces your risk of relapse and promotes long-term recovery.

Inpatient Drug Rehab Treatments

Inpatient drug rehab provides a high level of support and supervision in the early weeks and months of recovery. Clients in an inpatient program spend their days engaging in therapy and other treatment programming. You’ll put in a lot of hard work during inpatient drug rehab, but there are plenty of opportunities for rest, relaxation and fun, too, which is equally important.

As you progress through inpatient treatment, the environment will become less restrictive, and you’ll develop more independence. When the time comes, you’ll leave inpatient rehab and move along the continuum of care to an intensive outpatient program.

Ideally, inpatient rehab will last 90 days. Anything less, according to the National Institute on Drug Abuse, is of limited effectiveness.3 That’s because just as it takes time to develop an addiction and the faulty thought and behavior patterns that come with it, it takes time to re-learn healthy ways of thinking and behaving and make crucial lifestyle changes that support life in recovery.

The therapies and other interventions used in inpatient drug rehab address a wide range of issues. Through treatment, people in recovery:

  • Identify and change dysfunctional patterns of thought and behavior that perpetuate the addiction.

  • Develop emotional coping skills for handling stress and negative emotions.

  • Identify and address issues that underlie the addiction, which often include trauma, stress and co-occurring mental illnesses.

  • Identify strengths and values to find purpose and meaning in a life of sobriety.

  • Repair relationships damaged by the addiction and develop healthy interpersonal and communication skills.

  • Amass a toolkit of skills and strategies to prevent relapse.

  • Develop missing life skills that support independence in recovery.

  • Learn to relax and have an enjoyable time without needing drugs or alcohol to do it.

The Substance Abuse and Mental Health Services Administration stresses that a holistic treatment approach offers the best outcomes of rehab.4 Holistic treatment addresses your physical, mental and spiritual health to promote whole-person healing. According to the National Institute on Drug Abuse’s Principles of Effective Treatment, an effective treatment program will address all of an individual’s multiple needs.5 A variety of traditional and complementary therapies and other interventions are used in inpatient drug rehab to accomplish this.

Traditional Therapies in Inpatient Drug Rehab

Traditional psychotherapies, commonly known as “talk” therapies, are the foundation of addiction treatment. Cognitive-behavioral therapy is the most commonly used and most effective therapy for addiction. This therapy helps you identify and change the thought distortions that keep you mired in addictive behaviors. Through cognitive-behavioral therapy, you’ll learn to think and behave in healthier ways and develop coping skills that help you navigate discomforts in your life.

Other traditional therapies used in treatment include:

Acceptance and commitment therapy

Acceptance and commitment therapy, which helps individuals develop psychological flexibility; accept and detach from, rather than avoid, unpleasant emotions and experiences; and develop ways of thinking and behaving that align with personal values.

Dialectical behavior therapy

Dialectical behavior therapy, which reduces conflicts in your interpersonal relationships and helps you develop a tolerance for distress; gain a sense of control over your life; build self-respect; and achieve feelings of freedom and completeness.

Family Therapy

Family therapy, which helps families restore function to the family system; resolve interpersonal conflicts; develop healthy communication skills; and learn how to best support a loved one in recovery.

Complementary Therapies in Inpatient Drug Rehab

Complementary therapies are experiential, or hands-on, therapies that have been shown through research to effectively treat addiction when they’re used alongside traditional “talk” therapies. Complementary therapies help people look at their problems in new ways, develop coping skills, and gain greater self-awareness. Complementary therapies commonly used in treatment include:

Art or music therapy

Art or music therapy, which helps people make sense of difficult experiences and express difficult emotions through art- or music-making. Art and music therapy help improve self-esteem, self-awareness and communication skills.

Yoga

Yoga, which promotes physical and emotional strength and flexibility and reduces stress. Yoga improves body-awareness and promotes emotional healing.

Meditation

Meditation, which promotes acceptance, rather than avoidance, of difficult experiences and emotions. Meditation is a powerful stress reducer, and it produces feelings of inner peace.

Other Interventions in Inpatient Drug Rehab

A variety of other interventions are used in treatment to promote long-term successful recovery. Based on an individual’s unique needs, these interventions help address a range of problems and issues. Other interventions used in treatment include:

Psychoeducational Groups

Psychoeducational groups, which educate clients about issues surrounding addiction and recovery. The better you understand addiction, recovery and how relapse occurs, the better your chances of staying sober. Psychoeducational groups are part education and part psychotherapy and help you develop skills and strategies for preventing relapse.

Life Skills classes

Life skills classes, which help individuals gain essential life skills to help improve functioning across all of life’s domains. Life skills classes teach a wide variety of skills, including self-care, domestic, relationship, financial, and vocational skills.

Support Groups

12-Step or alternative support groups, which reduce feelings of isolation, promote personal accountability and provide a high level of peer support.

Vocational Rehabilitation

Vocational rehabilitation, which helps individuals develop workplace skills and find and maintain employment in recovery.

Education Assistance

Educational assistance, which helps people return to school. This may include helping study for and complete a GED, or it may include applying for financial support for higher education or other post-secondary training.

Legal Assistance

Legal assistance, which helps those with legal problems navigate the court system.

Housing Assistance

Housing assistance, which helps individuals find and secure safe and stable housing.

Medical and mental health services

Medical and mental health services, which ensure any physical or mental health problems are addressed and treated.

Is Inpatient Drug Rehab Right for You?

Inpatient drug rehab isn’t the right fit for everybody. Where you begin treatment on the continuum of care depends on a number of factors and is based on the assessments taken during the detox process.

In general, inpatient treatment is necessary for people who have:

  • A severe addiction or a long history of addiction.

  • Been through treatment before.

  • An unsafe or unstable living environment.

  • Little support at home or in the community.

  • A co-occurring mental illness, such as depression or anxiety.

  • Little intrinsic motivation to recover.

Inpatient treatment has a number of benefits over intensive outpatient or outpatient treatment, including:

  • Around-the-clock support and supervision.

  • The opportunity to focus solely on recovery.

  • The absence of daily stressors, including unhealthy relationships, financial problems and other issues that can distract from treatment and recovery.

  • The opportunity to develop healthy relationships with staff and peers in recovery.

  • Reduced feelings of loneliness and isolation, which can quickly lead to relapse.

While inpatient treatment is more expensive than outpatient treatment, it’s generally more effective, according to the Substance Abuse and Mental Health Services Administration. 

How to Get the Most Out of Inpatient Drug Rehab

The more involved and engaged you are in your treatment program, the better the chances of successful, long-term recovery. Here are some ways to get the most out of your stay in inpatient drug rehab.

Be Honest

Honesty with yourself, your peers and your care providers is paramount to success in rehab. Addiction requires lying to yourself and others, and recovery requires being honest about your thoughts, feelings and experiences. It’s not always easy to be honest, but the non-judgmental and highly supportive environment of inpatient rehab makes it easier.

Stay Open-Minded

During rehab, you’ll learn a great deal about yourself. Developing greater self-awareness can come with incredible surprises and lessons, but only if you stay open-minded to new ideas and meaningful change.

Be Fully Present

During therapy and therapeutic groups, stay focused and in the present moment, where change occurs. Participate fully in discussions, and strive to understand and embrace different points of view.

Complete Assignments

During treatment, therapists may issue assignments to be completed before the next session. Take homework seriously, and put thought and effort into completing it.

Apply What You’re Learning

As you learn skills and strategies for coping with negative emotions and stress and changing dysfunctional thought patterns, put them to practice right away.

Involve Your Family

Family involvement in treatment improves the outcomes of rehab. Encourage your family to participate in family therapy and any family workshops offered by your program. Family programming helps the people closest to you better understand addiction, recovery, and how to best support you after treatment. Individual therapy for family members can help them work through their own issues surrounding your addiction, such as guilt or resentment, and it helps them end enabling and codependent behaviors.

Treatment Works

Most people in treatment who engage with their program and stay in treatment for an adequate period of time successfully recover from an addiction. Recovery brings with it a higher quality of life and a greater sense of purpose and wellbeing. If you’re ready to make positive changes in your life and find authentic happiness in sobriety, an inpatient program, like Everlast Recovery, can help you enjoy successful recovery for the long-term.


Resources

  1. https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-addiction
  2. https://www.asamcontinuum.org/knowledgebase/what-are-the-asam-levels-of-care/
  3. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-long-does-drug-addiction-treatment
  4. https://www.samhsa.gov/find-help/recovery
  5. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment