Drug treatment is provided in a number of different settings. The nature of these settings and the services they generally provide are discussed below, starting with the setting that has the most intensive services—hospitals.
The services provided in hospital-based programs include:
The time spent in hospital-based treatment depends on the patient’s current need to receive treatment in a confined setting and his or her capability to access, safely utilize, and benefit from treatment in a non-confined setting.
Partial Hospitalization Programs and Intensive Outpatient Programs
Partial hospitalization programs and intensive outpatient programs provide intensive structured treatment for individuals who require more than the general services that are available in outpatient settings. The American Society of Addiction Medicine patient placement criteria specifies that structured programming in partial hospitalization programs should entail 20 hours per week and that intensive outpatient programs should entail 9 hours per week.
Partial hospitalization programs may include services such as:(1)
Intensive outpatient programs include individual therapy, group therapy, family therapy, and urine toxicology.
Residential treatment is for individuals who do not meet the clinical criteria for hospitalization but have lives and social interactions dependent upon substance use. Residential treatment is also for those who currently do not have sufficient motivation and substance-free social supports to stay abstinent in an ambulatory setting. The duration of residential treatment should depend on the time it takes for the individual to meet specific criteria that would predict his or her successful transition to a less structured and restrictive treatment setting. Treatment in residential settings can include a wide array of psychosocial treatments as well as pharmacological treatments.
Therapeutic communities are generally reserved for individuals who are unlikely to benefit from outpatient treatment, such as those who have a history of multiple treatment failures, those who are impaired in social relational skills and do not have the ability to attain and sustain employment, resulting in lack of adherence to outpatient treatment. The therapeutic community theory views substance abuse as a deviant behavior and offers individual, social, and vocational rehabilitation through the community method of social learning. This method is highly structured and its primary interventions include:
Community Residential Facilities
Community residential facilities are often called ‘halfway houses’ or ‘sober houses,’ with the former usually offering more structure and supervision. These facilities provide an outpatient substance-free housing environment for those who are in recovery but cannot manage independent housing without a risk of relapse.
Aftercare typically occurs after an intense treatment intervention and usually includes outpatient care and/or involvement in self-help approaches.
Outpatient settings may include:
The services provided include psychotherapeutic and pharmacological interventions, along with behavioral monitoring.
By definition, case management exists as an adjunctive treatment. The goals of case management are to provide advocacy and coordination of care and social services and to improve patient adherence to prescribed treatment and follow-up care.
Legally Mandated Treatment
Substance abuse treatment may be legally mandated under a variety of circumstances, including substance-related criminal offenses such as selling narcotics, drug-related violence, and driving under the influence. In some cases, mandated treatment occurs in conjunction with drug court programs. Standard procedures for drug court programs include:
Employee Assistance Programs
Employee assistance programs (EAPs) provide an employment-based treatment setting and referral for employees with substance use disorders. EAPs gauge success primarily through job performance.