CHAPTER 6: Treatment Settings and Treatment Planning Substance Abuse Counseling: Theory and Practice Fifth Edition Patricia Stevens Robert L. Smith Prepared by: Dr. Susan Rose, University of the Cumberlands

Overview of Chapter What is a Treatment Setting? Types of Treatment Settings What is Treatment Planning?

What is a Treatment Setting? Treatment setting: the place or environment where substance abuse treatment services are provided Restrictive: the degree of physical and social structure provided by the professional staff for the recovering substance abuser Severe: used for individuals in restrictive settings that have been classified with a substance use disorder Moderate: a less restrictive setting where clients generally reside in their homes and attend schedule meetings Effective Treatment attends to multiple needs of the individual, not just his/her drug use Treatment must address medical psychological, social, vocational, and legal problems

Most Common Treatment Settings Medical Detoxification and Stabilization Detoxification: the safe and complete withdrawal of incapacitating substances Dual Diagnosis Hospital Inpatient Usually based in psychiatric hospitals, dual-diagnosis programs are designed to treat clients with the presence of both serious psychiatric illness and substance abuse/dependency Free-Standing Rehabilitation and Residential Programs Rehabilitation Programs: usually free-standing, nonhospital-based facilities Residential Program: usually used as a bridge between the more restrictive dual-diagnosis inpatient and rehabilitation programs and the less restrictive outpatient programs Intermediate-care facilities that allow individuals to live within a residential setting, be employed during the day, and receive comprehensive treatment

Most Common Treatment Settings Partial Hospitalization/Day Treatment Temporary Recovery/Halfway Homes: community based home near a rehabilitation or residential facility Intensive Outpatient: Consists of substance-free treatment that can range from daily all-day activities to once-a-week meetings Outpatient DUI/DWAI/DUID Programs: usually court ordered treatment; considered the least restrictive treatment setting

Types of Treatment Settings Medical Detoxification and Stabilization Detoxification: the safe and complete withdrawal of incapacitating substances Medical model: Utilizes medical staff to administer medication to safely assist people through withdrawal Establishes medical necessity before admission and refers to the risk of medical problems or psychiatric difficulties the client exhibits Length of stay is usually less than two weeks Detoxification is only beginning of treatment Treatment Plan includes detox and continues treatment

Types of Treatment Settings Dual-Diagnois Hospital Inpatient Designed to treat clients with both serious psychiatric illness and substance abuse/dependency Each condition must be assessed independently and in relation to the other presenting conditions or symptoms. Length of stay in these hospital units is from several days to several weeks. Figure 6.1 (Page 160) defines common staffing patterns for inpatient and partial treatment settings.

Types of Treatment Settings Free-Standing Rehabilitation Programs Minnesota Model of addiction treatment Hazelden, a treatment facility,pioneered the Minnesota Model Two long-term treatment goals: Total abstinence from all mood-altering substances An improved quality of life Objectives for the individual: To grow in transcendental, spiritual awareness To recognize personal choice and responsibility To develop peer relationships

Types of Treatment Settings Minnesota Model of addiction treatment cont. Success of the process is characterized by: Relief Peace Increased sense of self-worth Acceptance by self and the group The existential restoration of meaning to life The importance of self-help and peer support are the foundation of the Minnesota Model

Types of Treatment Settings Free-Standing Residential Programs cont. Used as a bridge between the more restrictive dual-diagnosis inpatient and rehabilitation programs and the less restrictive outpatient programs. Intermediate-care facilities Average stays range from 4 months up to a year Key components of effective treatment programs: Behavior Modification Academics Activities Personal/Emotional Development Family Involvement

Types of Treatment Settings Partial Hospitalization Occasionally referred to as day treatment Offers comprehensive substance-abuse treatment in a semirestrictive program Patients go to sessions for 3-12 hours per day and 3-7 days per week for less than six weeks After partial program is completed, patient attends weekly meetings

Types of Treatment Settings Temporary Recovery or Halfway Homes Usually a community-based home or a building near a rehabilitation or residential facility Requirements for residence typically are: Abstinence Employment Attendance of 12-step recovery meetings Possible urine testing to evaluate recovery progress and maintain a safe, sober house

Types of Treatment Settings Intensive Outpatient Consists of substance-free treatment that can range from daily all-day activities to once-a-week meetings Completion is usually determined by documented behaviors such as: Length of abstinence Attendance in groups Keeping scheduled individual and family counseling appointments Length is typically 90 to 120 days

Types of Treatment Settings Outpatient DUI/DWAI/DUID Programs Majority are court ordered Considered least restrictive treatment setting Basics of treatment: Describing physiological effects of alcohol and drugs Describing possible psychological consequences of use/abuse of drugs Defining the legal limits of blood alcohol levels Presenting current theories of alcohol and drug abuse and addiction Developing alternatives to impaired driving

Types of Treatment Settings The Importance of Matching Treatment to Client Needs Circumstances that affect treatment-setting choice include: Ability to pay Method of payment Geographic availability of specific services Current employment, housing, and family conditions Previous treatment experiences Reliability of assessment information Availability of space in existing settings Level of self-care Current emotional and behavioral state

What is Treatment Planning? Treatment Plans: written documents that detail how problems are defined and treatments are formulated for the substance abuser. Treatment Plans must be updated to reflect any changes occurring during treatment such as: Addressing problems present along with drug abuse Exploring solutions for problems Expanding the patients worldview Projecting long-term goals Using measurable objectives Using a variety of resources and interventions

What is Treatment Planning? How to Develop a Treatment Plan Foundation of Treatment Plan is the data gathered in a thorough assessment Perkinson and Jongma’s The Addiction Treatment Planner Categories/Elements of Treatment Plans Diagnosis and initial structured treatment plan Medical treatment (effects of drugs on the body and brain) Psychological considerations Relationship factors: family, peers, friends Readiness for change: denial and spirituality outlook Client cooperation and setbacks (relapse possibilities) Context of treatment (setting) Context of living conditions while in treatment Home environment after and during treatment

What is Treatment Planning? The Elements of a Severe Substance Use Disorder Treatment Plan Plan Identification (early treatment, comprehensive treatment, modified) Diagnosis of the problem Symptoms/Behavior Treatment/Individual goals Treatment objectives Intervention/Action (kind and frequency) Contract (Signatures of participating parties) Examples on Pages 171 – 175

What is Treatment Planning? External Reviewers of Treatment Planning: Health Care Accreditation Organization and Managed Care When evaluating SATP functions, accreditation visitors/surveyors examine the structures and processes in six areas of performance.