Getting Help Pt. 2

By Kim Duffy

Kelly J. Lundberg, Ph.D.Associate Professor, Department of Psychiatry
Director, Assessment & Referral Services
University of Utah

When it comes to our loved ones, whether it’s treatment for cancer or treatment for addiction, we only want the best.   Most communities in Utah have several agencies that offer substance abuse treatment services. Furthermore, if you ask each agency if they provide the best treatment services, it would be remarkable if the answer was anything but yes.  So how does one go about finding a good substance abuse treatment agency? Below is list of questions to help guide you.

1. Are you licensed by the State to provide substance abuse treatment and do you accept my insurance?
These are the basics.  Agencies must be licensed and financial considerations are a reality.  Many agencies have sliding scales and are willing to work with individuals who do not have health insurance.  Agencies that are the most expensive do not necessarily offer the best services.

2. What philosophy of treatment do you use?
There is no superior philosophy.  However, agencies should not have difficulty answering this question.  A philosophy of treatment that includes caring about individuals who have addictions and working with them during fluctuating motivation is critical.  If clients feel comfortable in treatment, they stay in treatment. If they stay in treatment, they improve.

3. How long is treatment?
Research shows that treatment needs to be at least three months in length.  When there are complicating factors such as another mental health disorders (e.g., depression, anxiety, etc.) or the lack of other external resources (i.e., unemployed, homeless, etc.) treatment will need to be longer.  The treatment agency should constantly be evaluating the progress of their clients and increasing or decreasing the level of care, as well as the length of treatment, as necessary.

4. Will my loved one have access to both group and individual therapy?
Agencies should offer a variety of treatment, including psychoeducational classes, group therapy and individual therapy.  If clients only receive group therapy, it is difficult for the agencies to truly evaluate their clients’ progress in treatment; and almost impossible to address the personal issues that lead to urges, cravings or relapses.

5. Do you have someone who can provide medication management if necessary?
Mental health problems often go hand in hand with addictions.  Many people begin using drugs or alcohol in an attempt to mask distressing feelings.  In addition, the results of long term drug or alcohol use can precipitate mental health problems.  Simultaneously addressing the mental health issues and the addiction is the best practice, and sometimes there is a need for medication in addition to therapy.  Thus, agencies which employ or have access to prescribers, can provide more comprehensive treatment.

6. How do you deal with relapses or continued use?
Outpatient agencies should not terminate individuals from treatment because of continued use.  If the expectation is that the individual should be completely abstinent while engaged in treatment, then look elsewhere.  The exception to this is residential treatment where the use of alcohol or drugs by one individual affects the entire therapeutic community.  Still, residential treatment agencies should examine each situation on a case by case basis rather than implementing a global policy to immediately discharge someone who has relapsed.  Agencies should express awareness that addiction can be a relapsing disease.  They should indicate they explore relapses, help their clients learn from them, and bolster coping strategies for future high risk situations.  Termination from outpatient treatment should be based on a sustained period during which the client has not participated in treatment.

7. Will you work with my loved one even when he/she isn’t very motivated?
It is normal for motivation to fluctuate during treatment.  It is easy to work with clients when they are highly motivated, but it takes more skill and different tools to work with clients whose motivation has hit a low.  Agencies should believe in the importance of keeping clients engaged, including calling them when they have missed appointments and providing continued support during the more difficult times, since that’s when they need it the most.

8. Will you encourage my loved one to sign a release of information just so I know they are showing up for treatment?
Therapy is a very private experience and it is unnecessary and often counterproductive for you to know what is being discussed in treatment.  However, when your loved one is an adult who lives in your home, or whose treatment you are paying for, having knowledge of their participation will help you set the appropriate limits, make the best decisions you can, and help you determine the best way for you to support your loved one.

9. Will you involve me in the treatment process?
Treatment should involve the participation of those who are closest to the individual struggling with addiction.  Groups, classes, couples counseling or individual time spent educating loved ones about addiction and how they can respond in a supportive manner which is respectful of their own personal boundaries is important and should be available in treatment.

10. Do you offer recovery services such as aftercare groups?
Recovery services are critical for sustaining abstinence.  Agencies should either offer their own services or should encourage client participation in other services such as community support groups (e.g., AA, NA).  Ideally, the agencies should develop an aftercare plan with their clients and encourage attendance in recovery services prior to their actual discharge from treatment.  This allows the opportunity for clients to explore their feelings about the transition with their therapist, and for the therapist to support and encourage clients to continue to engage in recovery services; both of which increase the likelihood of continued participation in aftercare.

This article was originally published on April 2, 2007.