Which Treatment is Right for Me
IF YOU ARE PREGNANT...
IF YOU ARE PREGNANT, DO NOT START ANY KIND OF DETOX OR TREATMENT, WITHOUT CONSULTING YOUR OB/GYN FIRST. Tell your healthcare provider the truth about your drug and alcohol use. Suddenly stopping your use of some drugs can cause damage to, or loss of, your pregnancy. But continuing to use is even more dangerous. That’s why professional help is so important. When you tell your healthcare provider the truth about your drug and alcohol use your provider will be able to make an appropriate treatment recommendation for you and your pregnancy.
WHICH TREATMENT IS RIGHT FOR ME?
It’s important to note there is no “one size fits all” treatment. One person may do well in a 12-Step based program, while another may prefer a program that provides supportive medication. Still others prefer a blend of both supportive medications and 12-step programs. Some people may need a medically supervised detox, while for others, intensive outpatient may be the appropriate level of care. A good treatment program will thoroughly assess the new patient, discuss treatment recommendations, and then individualize treatment according to that person's life circumstances and needs. People come to treatment at different stages of addiction, with a variety of problems and concerns. One person may be young and pregnant, with a brief history of heroin use; another might have a 10-year history of alcohol misuse, and struggle with homelessness. A great treatment plan is one that is comprehensive and that takes in to account a person’s unique life circumstances and goals.
There are two main things to consider when choosing a treatment for you or your loved one: "Levels of Care," and "Types of Treatment."
Levels of Care looks at the intensity of the treatment, from hospitalization (most intensive) to outpatient treatment (least intensive). Some people need hospitalization, others meet once a week in a private counseling session.
Types of Treatment outlines the various approaches to treatment that are offered in area treatment programs.
This page is not meant to be comprehensive - only a brief summary. We recommend you do your own research, and not just on the internet – make an appointment with an addiction professional to learn more about what’s out there for you.
Click here for a two-page, printable brochure of treatment facilities and providers in the Louisville area. Note that there are initials like “IP” and “MAR” associated with each facility. This tells you what kind of programs and/or levels of care are offered. For the best and the latest information, check with the facility to see if their treatment options have changed.
LEVELS OF CARE
Medically Supervised Detox/ Medical Stabilization
The length of time needed to complete a full detox varies greatly, depending on several factors: which particular drug/alcohol the person consumes, how much and how often, and for how many years. The detox experience is also impacted by a person’s medical issues - their overall physical health. Medically supervised detox is recommended for people who have excessive use of alcohol, benzodiazepines (such as Xanax, Klonopin,Valium) or barbiturates. Symptoms during withdrawal also vary. With heroin, nausea, vomiting, muscle cramps, runny nose, aching bones and cravings are common. With alcohol, increased heart rate/palpitations, sweating, tremors, nausea and vomiting are common; in severe cases, hallucinations, heart attack, stroke and seizures can occur. In a Medically Supervised Detox program, medical staff provide medications to prevent or lessen these symptoms. Not everyone needs a medically supervised detox, but many do choose Medical Stabilization for relief from otherwise difficult withdrawal symptoms, such as those associated with heroin withdrawal.
Social detox provides a supportive environment for detox without medications. Social detox units are typically staffed by peers (volunteers and/or paid staff) who may have been through a social detox themselves, and are now stable on a recovery path. They are especially suited to relating to the intense discomfort and cravings, and can offer suggestions from personal experience, and encouragement, as well. Some staff may have had additional training, and be well-suited to help with the psychological aspects of withdrawal, especially the desire to leave treatment and start using again.
For people addicted to alcohol, benzodiazepines or barbiturates, Medically Supervised Detox is recommended over social detox. That’s because withdrawal from these drugs/alcohol comes with a risk of life-threatening seizures, stroke and cardiac events. Some people are at much greater risk than others. Consult with a professional, and as always, tell the truth about how much and how often you consume alcohol or other drugs, so that you get accurate and good professional advice from your provider.
Inpatient Programs (IP)
These programs are a “hospital level” of care. Because of the expense involved, many insurance companies will now provide coverage only for a few days of inpatient treatment programming . After completing an inpatient program, many people are referred to an outpatient program (OP), or an intensive outpatient program (IOP), to continue the education, fellowship and other aspects of recovery.
Residential Programs (RP)
These programs can last for a month or more; as the name implies, people in these programs live on site, 24 hours a day. These programs are often housed in their own, free-standing facility. In the case of adolescent residential treatment, daily attendance to school, there on-site, is often available. Residential programs usually offer a variety of psychoeducational groups to address various aspects of addiction: dealing with triggers; dealing with cravings; building new coping skills; and, in 12-Step programs, spiritual connection/growth. These are only a few of the group possibilities.
Intensive Outpatient Programs (IOP)
These programs are for people who have no risk of withdrawal, or, who have already completed a withdrawal protocol/program. Intensive outpatient programs usually consist of groups that meet 3 – 4 times per week for several hours each time; they frequently offer morning or evening tracks to accommodate work schedules. Individual counseling and Family Programming maybe available through these programs, as well.
Outpatient Programs (OP)
These programs are for people who have no risk of withdrawal, or who have already completed a withdrawal protocol. Outpatient programs usually consist of groups that meet once a week; individual counseling may also be available. Medication-assisted recovery programs (methadone and/or suboxone) are usually offered at this level of care, and there are many 12-Step, Abstinence-Based programs at this level of care, as well.
TYPES OF TREATMENT
12-Step and Abstinence-based Treatment
This approach includes fellowship, education, group meetings, pursuit of spirituality and social supports as important components of treatment and recovery. They may offer group counseling and individual counseling. Additionally, it’s common to find cognitive behavioral therapy, and motivational interviewing approaches incorporated into these programs. There may be emphasis on nutrition and exercise, as part of a holistic approach. Programs utilizing the 12-Steps may require AA and/or NA meeting attendance, reading AA- and NA-approved literature, getting a sponsor and working the 12-Steps.
Medication Assisted Recovery
Many therapies utilize medications for successful recovery from, and management of, chronic conditions, such as heart disease and diabetes. When we talk about medication assisted recovery in addiction treatment, we’re usually referring to medications for the treatment of heroin (and other opiates) addiction (click here for more information on medications used in treatment of alcohol addiction). Medication Assisted Recovery (MAR) provides a medication that keeps the person from having withdrawal symptoms, so they can stabilize and begin the process of reclaiming and rebuilding their lives. Suboxone and Methadone are one class of medication; Naltrexone (Vivitrol) is another. All three will be discussed below.
Methadone is usually obtained in specially-licensed clinics, rather than by prescription from an individual doctor. Methadone can come in a liquid, pill or wafer form. In Louisville, our two methadone facilities use a liquid form. The medication lasts 24 – 36 hours, meaning that once a person is stable on the medication, they can take their medication once a day, and go about their day without the rollercoaster of addiction’s highs and lows. Methadone is taken orally, and cannot be misused by injecting. It also blocks the “high” from any other opiates, so if a person slips and decides to use a street opiate, that person will not get “high” because methadone is literally in the way. Methadone is considered a “full” blocker. Methadone has been researched for over 40 years, and has been repeatedly shown to be safe when used appropriately. It has been the “gold standard” of treatment for pregnant women who are addicted to opiates for decades, although suboxone is now being used as a medication for pregnant women, as well. Methadone has been used for pain relief in the past, however it is no longer typically prescribed for pain. Some methadone programs include the 12-Steps as part of their individual or group counseling program; clients in methadone treatment are frequently encouraged to attend either AA or NA support groups. While there are some who have found ways to misuse methdaone, for many who are serious about recovering, methadone is a life-saving medication that makes it possible for them to live a stable, productive life.
Suboxone (buprenorphine + naloxone)
Suboxone is the brand name for "buprenorphine + naloxone". Suboxone can be obtained at special dispensing clinics, and also through doctors with special training and licenses. Suboxone contains Naloxone. If a person is tempted to misuse suboxone by trying to inject it, the naloxone prevents them from getting high, and can make them feel very sick. Suboxone is considered a “partial” blocker, as it does prevent a person from getting high on opiates, if they try to do so while taking their suboxone medication. Depending on the dose level, suboxone stays in the system from 24 – 60 hours, making it possible for people to stabilize with one dose per day. Suboxone provides little to no pain relief. While there are some who have found ways to misuse suboxone, for many who are serious about recovering, suboxone is a life-saving medication that makes it possible for them to live a stable, productive life.
Naltrexone is medication which is marketed under several other names, including Vivitrol. Naltrexone prevents a person from feeling “the high” should they choose to use while taking Naltrexone. In the case of opiate addiction, a person should be completely free of all opiates before beginning a first dose of Naltrexone. It is often prescribed after a person has completed another program to assist with avoiding relapse; in some cases, Vivitrol is offered through our corrections system. Naltrexone is also used to help people who struggle with alcohol misuse.
Naltrexone is available in pill form and by injection. The injection lasts 30 days, whereas the pill-form wears off in about 48 hours, so the pill must be taken every day in order to remain effective.