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  • Writer's pictureKevin Phillips

Understanding Substance Use Disorder Treatment: Goals, Progress, and Levels of Care

We believe in a patient-centered approach to Substance Use Disorder treatment. To be effective it must align with diverse goals and adapt to each individual's journey. Let's explore the key elements of our treatment philosophy and process.

 

Program Goals

 

The goals of SUD treatment can vary widely depending on the stakeholder:

  • A spouse may demand sobriety

  • Courts may mandate a certain duration of treatment

  • Probation and parole aim to reduce recidivism

  • Child welfare agencies focus on child safety

 

Patients themselves often have evolving goals as they progress through recovery:

  • Detox: Alleviating pain

  • Post-acute withdrawal: Regaining mental clarity and sleep

  • Residential treatment: Meeting court mandates, reconciling with family, pursuing a healthier life

  • Intensive outpatient: Avoiding relapse, understanding behavioral patterns, finding employment and housing

  • Outpatient: Managing stress, becoming trustworthy, balancing life responsibilities

 

Our aim is to create a structured environment that holds patients accountable while nurturing motivation and providing support for recovery.

 

Assessment and Treatment

 

We use the ASAM Criteria to assess the severity of a SUD and determine appropriate levels of care. This involves evaluating six dimensions of a patient's condition and mapping behaviors to diagnostic criteria informed by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) published by the American Psychiatric Association.

 

Some patients minimize their condition due to lack of motivation, denial, or shame. Our providers work to build a positive therapeutic alliance while accurately assessing needs. We often reassess patients as they become more comfortable with self-disclosure. Openness and transparency are an indication of a reduction of shame and suggests progress in recovery.

 

Some patients present with co-occurring mental health disorders or challenging social environments that undermine recovery. Our primary goals are to maintain a non-judgmental stance, build trust, and encourage compliance with treatment.  

 

Treatment Progress

 

We track progress across six dimensions informed by the ASAM criteria.

 

1. Substance use and withdrawal potential

2. Biomedical conditions

3. Emotional, behavioral, and cognitive conditions

4. Readiness to change

5. Relapse potential

6. Recovery environment

 

Signs of progress in treatment includes willingness to address

  • Deferred medical issues

  • Past trauma

  • Mental health

 

We also look for increased motivation to change. Most patents begin treatment with a certain amount of ambivalence for recovery. It is not uncommon to see this transition very quickly to what we sometimes call, “flight into health.” This looks like unrealistic confidence in one’s ability to continue in recovery. It is mostly a naïve attempt to rush the recovery process. Progress in recovery involves a serious-minded assessment of the real challenges a patient faces as they begin their recovery work.

 

Other signs of progress in treatment include the development of coping skills. Patients learn to identify and regulate their emotional experience. They learn that the ability to feel bad sometimes is sometimes better for you than trying to feel good all the time.  The ability to feel a genuine emotion is a good sign. To be able to feel the emotion and name it, is even better.

 

A person in treatment learns to take the potential for relapse seriously. One goal of treatment is to develop a meaningful Relapse Prevention Plan. Early in treatment, many patients RPP amounts to little more than, “I got this.”

 

A meaningful RPP includes a lists such as  a patient’s unique stressors, the people who put their recovery at risk, and the places they have used in the past and that they plan to avoid in the future. It also includes detailed action steps that help them choose healthy ways to manage stress before it gets out of hand. It includes healthy people who support their recovery, people they can call on for help. And, of course, it includes safe places where they can go to build a new life.

 

Finally, we see progress in recovery as patients adopt new prosocial values and behaviors. Instead of holding on to resentment, they learn to let go. Instead of thinking the worst about people, they learn to give people a chance. Instead of invading another person’s personal boundaries – both physical and emotional– they wait for invitations.

 

Levels of Care

 

  • Detoxification: For active users with withdrawal potential

  • Residential Treatment: For those unable to stop use without support in a 24/7 structured environment

  • Intensive Outpatient (IOP) Treatment: 9-19 hours/week for those who've stopped use but need daily support to prevent relapse

  • Outpatient (OP) Treatment: Up to 9 hours/week for those with stable recovery and support systems

  • Recovery Services: Post-treatment support to help our patients build a more hopeful future

 

SUD treatment passes through these levels of care, but it is not always linear. Our flexible approach allows us to meet patients where they are and support their unique path to recovery.

 

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