1. 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

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

3. 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

4. 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

5. 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

6. 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

7. 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.

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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.