Drug Rehab in Virginia
Opioids, according to the Centers for Disease Control and Prevention, are the main cause of drug overdose fatalities. In 2016 alone, 42,249 people in the US died from opioids abuse.
West Virginia has the dubious distinction of having the most drug overdose deaths per 100,000 population at 52.0, this was followed by Ohio at a far second with 39.1 per 100,000, and New Hampshire at 39.0 per 100,000.
However, its sister state, Virginia, didn’t fare too well either.
It’s no wonder that Virginia was red-flagged by the Centers for Disease Control and Prevention for the stark 34% increase in overdose deaths between 2015 and 2016. The most commonly abused drugs here are controlled prescription opioids, fentanyl, and heroin.
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Counties With Alarming Numbers of Deaths Related to Drug Overdose
In terms of counties, Fairfax (189), Virginia Beach City (144), Richmond City (107), and Prince William (104) all hit triple-digit overdose deaths in 2016. Most of the deaths (are attributed to opioids use but street drugs are really rampant, especially in Richmond City.
Richmond is drawing comparisons to Chicago in terms of a deteriorating peace and order situation. More than 10 residents per 1,000 population become victims of violent crimes here, another 55 people will fall victims to property crimes annually. Richmond is one of the worst cities in the US in terms of peace and order.
Unlike other states, or even its sister state West Virginia, fentanyl is the drug of choice here, registering a 175% increase in drug overdose deaths. According to The Washington Post, 1,420 deaths were caused by drug overdose in 2016. What’s more amazing about that statistic was it was more than the fatalities claimed by violence and motor vehicle incidents.
The number doesn’t even illustrate how Virginia seems to be losing in face of the drug epidemic where three people are killed daily due to overdose. Emergency rooms also accept more than 24 cases per day on drug abuse-related cases. From January to September in 2016, the number of heroin overdose jumped 89% against the figures for the same period in 2015.
It even prompted Gov. Terry McAuliffe to declare a health emergency in the state due to the opioid epidemic in the state. In response, the state decided to make Naloxone, the drug which reverses the effects of overdose and save the patient, widely available.
While Naloxone, which works to stop the opioid receptors, can be bought from the pharmacy, it still needs the prescription from the doctor. With the order by Health Commissioner Marissa J. Levine back in 2016, anybody can buy the drug from the pharmacy even without a prescription as long as it’s used to save a life.
Fentanyl As The Drug Of Choice
As in the case of the rest of the country, opioids present a far bigger problem than illicit drugs like heroin.
According to Richmond Times-Dispatch, fentanyl is attractive among users for several reasons.
In its May 2017 article, the newspaper said that fentanyl was more deadly that controlled prescriptions and heroin since 2013. Of the 1,133 overdose deaths in 2016, more than half or 618 were caused by fentanyl. Opioids, meanwhile, were responsible for 469 deaths while heroin caused 448 deaths during the same period.
The Richmond Police Department said that fentanyl is much cheaper compared to heroin and opioids, which is why it’s so attractive. Drug dealers can earn more by passing off the contraband as heroin. This could possibly be the reason why there were more fentanyl-related deaths in the state compared to any other because the users were not aware of the product they were abusing.
The change in the fentanyl characteristic being sold in the streets contributed to the deaths. Before, the administration of fentanyl was solely the domain of the medical doctors. However, manufacture of the drugs—with chemicals coming from China and Mexico—changed the structure of the drug. Now, drug traffickers are peddling fentanyl laced with heroin, a very potent cocktail that has been the cause of many drug overdoses.
The Virginia Department of Health reported that fentanyl and heroin are responsible for overdose deaths more than any other opioids. In 2016, both drugs were responsible for 803 deaths with a mortality rate of 9.3. In contrast, other opioids were responsible for 465 overdose deaths or a mortality rate of 5.5.
What Is Fentanyl?
Outside of those who abused this synthetic opioid, however, nobody knows much about fentanyl. Lately, however, the spotlight has been shone on it because this was the drug that killed Prince. Tom Petty was another artist who succumbed to its deadly properties.
The US DEA warned that 1 in 10 teens has admitted to using prescription pills to achieve a high at least once. The data confirms that survey since the number of kids younger than 20 years old who were sent to the emergency room ballooned by 45.3% between 2004 and 2010.
What makes fentanyl dangerous is that users quickly develop some kind of immunity to it. They have to take in more and more before replicating the high they experienced the first time. The problem is that there are too many synthetic and contaminated products being sold in the streets. These are what are responsible for the number of overdose deaths.
Because it’s very cheap to produce, traffickers are passing fentanyl off as Xanax, heroin, OxyContin or hydrocodone to boost their profit margins.
In 2016, however, more than 20,000 people have overdosed on fentanyl all across the US. One simple way to describe this opioid is that it’s like morphine, only 100 times more potential for danger. It’s also 50 times stronger compared to heroin. If the patient no longer responds to morphine, the doctor may amp up the prescription for fentanyl.
Doctors generally don’t prescribe fentanyl knowing how dangerous it is. If they ever do, the prescription is measured in micrograms instead of the usual milligrams. The potential for abuse, however, is so great that large volumes of the drugs end up on the streets.
Besides, there’s so much potential for the drug considering that one gram can be sliced into more than 7,000 doses.
However, with street names such as Flatline or Drop Dead, it’s hard to trust your friendly neighborhood dealer to be the expert in the intake of fentanyl.
Counteracting the Effects of Drug Overdose
Health Commissioner Marissa Levine had to declare a statewide emergency due to the number of overdose deaths. As a result, it allowed the availability of Naloxone, which works to block the opioid receptors, in order to save lives by reversing the effects of the overdose. The order mandated about 2,000 pharmacies in the state to dispense the drug even without prescription as long as it’s going to be used to save lives.
Levine had to issue the order after authorities found out another menace in the streets—Carfentanil. The opioid was said to be 100 times more powerful compared to fentanyl and 10,000 times more deadly than morphine.
The Centers for Disease Control and Prevention flagged eight counties in Virginia which are on the precipice of an HIV outbreak. These are Dickenson, Buchanan, Wise, Lee, Patrick, Tazewell, Wythe, and Russell.
The Virginia Department of Health, in its Opioid Addiction report, revealed that there were 863 new cases of HIV in the state in 2016. About 44% of the new cases belong to the demographic age of 15 to 34 years old.
Because of the long dormancy of the disease and the lack of reporting due to the stigma, the number is theoretically exponentially higher.
There were associated health risks, as well. Hepatitis C cases in Virginia ballooned because of injection drugs. Users were sharing the same needles over and over again, which resulted in the contamination. In 2016, there were 10,600 cases of Hepa-C compared to 6,675 in 2014. What’s more alarming is the rising HIV cases due to the sharing of needles.
What Accounts for the High Rates in Virginia?
As if controlled prescriptions and heroin are not enough, methamphetamine is also a growing threat. The good news is that the use of crack and cocaine has steadily gone down since 2010. However, the bad news is that there’s a new supply chain of methamphetamine coming from Mexico that floods the local market with cheap drugs.
The busy interstate of Virginia stretching more than 1,000 miles has been a haven for drug traffickers. According to the US Drug Enforcement Agency, the high rate of drug abuse in the state can be attributed to the sizeable number of menial jobs, as well as specialized jobs in mining, manufacturing, and timber.
Although doctors and pharmacies have been doing their part now, there used to be a time when the default prescription to injuries suffered by workers in the state was opioid painkillers. The euphoric feeling and the need to kill the pain, along with the ignorance of the true dangers they pose, result in addiction.
Virginia Drug Laws
Because of its drug problem, it’s understandable that Virginia should also have draconian laws when it comes to violators.
Sec. 18.2-250 of the law covers Possession of Controlled Substances.
- Possession of Schedule I and II controlled substance is considered a Class 5 felony and will result in 1-10 years imprisonment if found guilty. A fine of $2,500 along with court fees will also be slapped against the violator.
- Possession of a Schedule III controlled substance is considered a Class 1 misdemeanor, which will result to up to one year in jail and a maximum fine of $2,500.
- Possession of a Schedule IV controlled substance is considered as Class 2 misdemeanor, which will land you up to six months in jail along with $1,000 in fine.
- Possession of a Schedule V controlled substance is considered a Class 3 misdemeanor, which will earn a fine of up to $500.
- Possession of a Schedule VI controlled substance is considered as Class 4 misdemeanor, which will earn a fine of up to $250.
Section 18.2-248.01 covers Transporting Controlled Substances into Virginia.
The individual who’s going to be tried under this law is the one who traffics the contraband with the full intention of selling or distributing it for profit. You can be tried if you are caught in the possession of one ounce of Schedule I and II controlled substance and cocaine, along with five ounces of marijuana.
- Anybody convicted of transporting the listed illicit drugs will face from five years up to 40 years in prison.
- He or she will also pay a maximum fine of $1 million
- He or she needs to serve three years in prison before being eligible for parole
- For those who were already convicted of the same crime, they will serve a minimum of 10 years before being eligible for parole
Marijuana Laws in Virginia
Although possession of marijuana in the state is considered a misdemeanor, you will not immediately be off the hook.
- Possession marijuana will land you up to a month in jail, along with a maximum $500 fine
- You will also shoulder the cost of litigation and attendant fees
- Subsequent offenses are considered as Class 1 misdemeanors
Selling of Marijuana
Selling even half an ounce of weed is considered a Class 1 misdemeanor. This will be bumped up to Class 5 felony if you are caught with five pounds of weed with the intent to sell. Over 2.5 kilos will land you from five years up to 30 years in jail. There are aggravating circumstances, which will net harsher punishments, like if you sell within 1,000 yards from a school, for instance.
Section 18.2-257 covers Attempting to Commit a Drug-Related Offense
- Drug-related offenses are considered as a felony and will land you between 12 months and 10 years in prison
- For misdemeanors that are drug-related, the case is elevated to Class 2 misdemeanor which will involve a punishment of a maximum six-month jail sentence, along with a $1,000 fine
- The court or the jury may choose to slap the lesser penalty of the felony or misdemeanor charge
Section 18.2-255 covers Selling Controlled Substances to Minors
Selling illicit drugs to minors is considered an aggravating circumstance which will earn a harsher punishment from the court.
- The suspect must be 18 years old and above
- He or she intentionally sold drugs to a minor who is three years younger
- He or she solicits the help of the minor to distribute the drugs
- The penalty can range between 10 and 50 years imprisonment and a maximum fine of $100,000
If the suspect sells more than one ounce of marijuana to a minor, he or she will serve five years in prison. The same goes if he sells any of the drugs listed under Schedule I and II controlled substances. For weed weighing less than one ounce sold to minors, the individual may be sentenced to two years in prison.
Other aggravating factors that will result in harsher penalties are:
- If you sell controlled substances and illicit drugs in properties near child day care, primary, middle and secondary schools, including colleges and university campuses
- If you sell near school bus stops. However, only if there are children waiting at the bus stop at the time of the transaction or if the kids are being dropped off
- Public areas where the people converge such as a public library, recreation center, gym, community center, etc.
Steps of the Rehab Treatment Process
Before anything else, the drug addict will have to undergo an assessment. Strange as it may sound, this process is what most individuals fear about—even more than detox. This because they need to be honest with their evaluation of themselves and the truth can get ugly very fast.
As those living with persons dealing with addiction, honesty is a very valuable commodity for addicts. They are in constant denial about their problem. And when you confront them, they lash out. In fact, they tend to choose to be alone and alienated from their families rather than face a full confrontation.
However, the assessment process is necessary and no treatment option can proceed without it. The main goal is to determine the type of substance abuse, if there is dual diagnosis, as well as the extent of the problem. This is also where the interviewer will determine if the person is ready to commit 100% to the rehab process.
During this session, the family can ask any question they may have. They may also discuss payment options. All the information during this session is covered by the strictest confidentiality.
If you are enrolling in the treatment facility, expect to talk to different people. These professionals have different expertise and everybody there are out to help you. The important thing is to be honest and transparent.
Assessment is just but a part of the intake rehab process. You can also tour the facility and meet the staff there. Typically, the residents of the facility are not allowed to meet those who have yet to commit to entering the treatment program for privacy’s sake.
The individual will be briefed on what to expect during the whole treatment program. You will also know the house rules and each violation will result in a corresponding punishment, which may even include kicking you out of the program.
You will understand how detox works. For harder opioids like fentanyl, you will more than likely undergo detox, which will medically flush out all the toxins in your body. You will undergo a drug test to determine if you are free from any chemical substance during the assessment process. While inside the facility, you will be subjected to random drug tests.
The patient can’t be enrolled in the treatment program without first passing the intake process.
To put it simply, the intake process is the time where the patient and the rehab center will find out if they are a good fit for each other.
Common Questions Asked During the Intake Process
Just to give you an idea what happens during the interview process, here are some of the most common questions that you are expected to answer:
- What type of drugs are you taking?
- How long have you been abusing the drug?
- How much do you use and how frequent?
- Do you have a prevailing injury that necessitates opioid intake?
- How are you money-wise?
- What are the symptoms you feel when you don’t take drugs?
- Is this your first time to enter a treatment center?
- If this is not your first time, did you finish the program in the first facility? If you failed to finish, why not?
- Describe your current relationship with your family and friends
- Do you have a job now? If no, why not?
- Can you commit to following the treatment program?
Some of the questions may seem personal but it’s the only way for the facility to come up with a treatment plan that is tailor-fitted to your requirements.
What to Bring to the Facility
During the intake process, you will be given a list of things that you can bring to the treatment center while the rehab is ongoing.
Every facility is different although the list of prohibited items is very clear. Below are just some of them:
- Prescription medicines that have been opened
- Guns and bladed weapons
- Pornographic materials
- Gadgets and other electronic devices
- Food and drinks
- Large bundle of cash
- Sexy clothing
- Jewelry (women are also not allowed to wear excessive makeup)
- Radio, guitars and other musical instruments
You will only bring the clothes that you use during the rehab period. You should also bring your prescriptions for any maintenance medicine, hygiene kit, and razors (not the blade but the electric kind).
Not all patients who passed the intake process will proceed to the detox. If you entered the facility sober, then you will advance immediately to the rehab proper.
Detox is generally considered as the first stage of sobriety. This is where medical personnel will try to flush out all those chemical substances that your body has gotten used to over the years. There’s no single procedure that rehab facilities follow. It’s case-to-case basis, depending on the individual’s needs and the facility’s own protocol.
It’s generally recommended for the detox program to be carried out within the safe confines of the treatment facility where the patient is under 24/7 monitoring. If the patient is much more comfortable if the detox is done at home, it’s possible but this will have to be evaluated because it can be dangerous without proper medical supervision.
What to Expect During Pre-Detox?
There’s no mystery surrounding the detox process. It’s like any treatment program you will undergo if you check in at the hospital for an illness.
At the start of the detox, you will meet your doctors, staff, and nurses. They will become your core support group during the whole process. You will be assigned a counselor who will handle your case. He will build up your background based on the interview you’ve had earlier. The counselor will also be responsible for creating a treatment plan for your specific situation.
If you’re staying at the rehab center as part of an inpatient drug treatment program, you’ll get to see your room and get settled in. You’ll also take a tour of the facility. Even if you’re doing an outpatient detox program where you’re living at home, you’ll need to know where everything is.
The doctor will conduct an extensive checkup and then run some lab test to determine the state of your body. Although you likely answered the same questions during the initial intake interview, your doctor may run through the same ones, along with a few others, at this point. Again, you will only be doing yourself a disservice if you are not honest with your answers.
Your doctor will be able to determine the right medication to counteract the effects of the substance abuse. Patients are always surprised to know that they will have to take some drugs during this procedure. But this is normal in some cases because going cold turkey will wreak havoc on your system. In the next few weeks, your diet will be strictly monitored for optimal results.
How Long is the Detox?
The detox period will range from three days to one week. You can have a choice of a three-day, five-day, and seven-day detox. The length will depend on your addiction of choice. Some opioids will be flushed from your body quicker than others. For instance, heroin may take one week of detox. There are drugs that will not manifest some withdrawal symptoms such as LSD so you go straight to therapy or counseling.
Fentanyl is a very potent drug and it will take seven days before the withdrawal symptoms will taper down to negligible levels. Because it’s very powerful, going cold turkey is not advised because the withdrawal could be very painful.
The National Institute on Drug Abuse, fentanyl will latch on to the opioid receptors which will then elevate the dopamine levels for that feeling of euphoria and intense relaxation. The problem is that fentanyl will arouse the area of your brain which controls breathing, and too much use will cause your breathing to stop.
With fentanyl you can expect the following withdrawal symptoms, which range from uncomfortable to distressing:
- Excessive sweating
- Muscle and joint pain
- Intense headaches
- Nausea and vomiting
- Difficulty breathing
The latter symptom will result in panic to some patients, which is why it’s dangerous to do self-detox at home without the benefit of 24/7 monitoring by competent staff. The first 48 hours are crucial to managing the symptoms.
The Case Of Amy Winehouse
Amy Winehouse was a multi-awarded English songwriter and singer known for her raspy vocals and edgy lyrics. Her battle with alcoholism and drugs was also notorious. She died at the age of 27 on alcohol intoxication.
However, what many people don’t know about what that Amy Winehouse was attempting to self-detoxify prior to her death.
Even if you are not a celebrity like Amy Winehouse or Nelsan Ellis, who played Lafayette Reynold on the HBO hit series “True Blood,” self-detox is a very attractive proposition because you don’t spend money on the treatment facility and you avoid the social stigma. Most alcoholics do not admit they have a problem, and they think that they can stop anytime they want.
Accordingly, as much as 25% of the people who suffer through the withdrawal symptoms from alcohol addiction die. The alarming stat, however, is that less than 10% of alcoholics seek the assistance of treatment centers.
Amy Winehouse’s father said that his daughter may have suffered from a seizure at home while self-detoxing, and there was nobody around to bring her to the hospital.
What most people probably don’t know about is that alcohol is much more dangerous than hard opioids when it comes to withdrawal fatalities. While in some drugs, you will wish that you were dead because of the painful withdrawals, it’s only with alcohol that you will actually die.
While Amy Winehouse’s case was for alcohol, the danger remains the same when you opt for self-detox without first consulting a doctor.
It is recommended that you finish the detox program as outlined by the doctor. Cutting it short for one reason or the other will only exacerbate your situation.
What Types of Detox?
Different treatment facilities administer different types of detox depending on the individual’s needs.
Cold turkey – This type of detox procedure means that you immediately stop taking medication, even those which are essential to reduce the withdrawal symptoms. It’s essential that you don’t go cold turkey on your own. This should be done in a controlled setting where you will be monitored constantly.
Maintenance detox – In this procedure, you will be given prescription medication, which likely mimics the effects of your opioid addiction, to ease the effects of withdrawal. The concept is to slowly wean your body away from substance dependence. As you can expect, you don’t bear the brunt of the effects of going cold turkey. For most people, they prefer this method.
Rapid detox – During this procedure, the patient will be given an opioid antagonist to stimulate the withdrawal process. Meanwhile, the patient will be sedated during the whole process even if he’s conscious all throughout. Every now and then, the doctor will administer medications like clonidine to alleviate the withdrawal symptoms. Another variation of this procedure is giving the patient general anesthesia. The concept is that the body will flush out all the toxins while the individual is sleeping. In effect, he doesn’t feel any discomfort or pain. However, not all treatment facilities offer this kind of procedure. Some have called for more research and studies on the safety and effectiveness of the procedure.
Even outside the treatment facility and into the operating room, the risk of undergoing general anesthesia is high. This is why anesthesiologists are paid handsomely for their specialties. Post-traumatic stress for patients with prior histories can lead to deaths, although these cases are extremely rare.
What Happens During Detox?
The first few days of your detox are going to be tough and it’s probably not going to be pain-free despite what you will be told. During the drug detox program, your body will be slowly introduced to methadone or buprenorphine to lessen the symptoms of withdrawal and cut your dependence on opioids. This is a closely supervised setting and the administration of these drugs typically won’t last more than 10 days.
During the detox process, it’s probable that you won’t see your family and friends to allow you to focus on the process.
The idea that you will be isolated is just a myth. You will stay in the detox area but you will still join the activities in the treatment facility, interact with other patients and go through counseling with your therapist. As all treatment centers know, detox is just but a small part of the recovery process.
After your body is cleared of all the toxins, you will feel better than ever. And you may think that you are already totally cured and not go back to avail of the other treatment options. This is the fastest way toward relapse.
Diet During Detox
During detox, you will have access to the nutritionist who will create a diet plan to help accelerate the process. The goal is to replenish the nutrients that you have lost while you were on drugs or alcohol. The diet is then customized to achieve this purpose.
For instance, alcoholics are typically anemic because they will shed off vitamin A, B2, B1 and B6, as well as folic acid due to the poison they ingest. They will also need a lot of vitamin C and iron in their diet. Female alcoholics are at risk of osteoporosis so their food should have plenty of calcium. For vitamin C, you need bell pepper, papaya, orange, strawberry, and pineapple.
People who are addicted to opiates will likely wreck their digestive system. Constipation is a big issue for them. The nutritionist will recommend a high-fiber diet for these residents so that means beans, whole grains, and green leafy vegetables. For fiber, you will eat beans, potatoes, and whole grain bread. They will not only help you in digestion but they will also give you a bolt of energy to perform the day’s activities.
The first thing that your body needs is plenty of fluid. Addicts are oftentimes dehydrated. Apart from water, you will also drink coconut water or Gatorade that has plenty of electrolytes. Fruit shakes and juices are also an option.
You will also have a healthy dose of protein in your diet because it’s an essential element to repair cellular damage. Chicken, red meat, turkey, and tuna offer plenty of iron and calcium.
One shortcoming of opting for outpatient care is the temptation of not following the recommended diet. If you are staying in the residential facility, however, you have no choice but to eat what’s given you.
Different Substances and Their Withdrawal Symptoms
Those who abuse opioids, such as fentanyl and morphine, will likely experience:
- Muscle aches
- Joint and bone pain
- Gastrointestinal issues
- Heightened pain stimuli
- Nausea and vomiting
- Cramps, particularly in the abdomen area
- Elevated heartbeat
Those who abuse alcohol will likely experience:
- Nausea and vomiting
Those who abuse crack cocaine and methamphetamine will likely experience:
- Intense craving
- Shaking and tremors
- Heart palpitations
- Nausea and vomiting
- Extreme sweating
Those who abuse marijuana will likely experience:
- Mood swings
- Intestinal pain
Babies Born Addicted to Opioids
For pregnant women taking substantial quantities of opioids, there’s a very high possibility that their babies will also exhibit withdrawal symptoms.
These symptoms include:
- Profuse sweating
- Muscle aches
- Nausea and vomiting
- Chills and goosebumps
- Sleep disturbance
The reality is made more tragic considering that the babies could not voice out what they are feeling so they suffer alone. The condition is also misdiagnosed especially if the mother doesn’t come out to admit her opioid addiction. They stay on 24/7 monitoring at hospitals until the doctors have flushed out the toxins from their bodies.
According to Reuters, an addicted baby is born every 19 minutes in the US. There’s supposed to be safeguards where the doctors will alert social welfare that the mother is an addict before releasing the baby from the hospitals. Too often, babies die due to negligent parents who are more interested in getting their fix than caring for their kids. Between 2010 and 2015, there were 110 opioid-addicted infants who were killed deliberately or due to negligence. The last time data was available was in 2013 and at that time, there were 27,000 baby addicts.
In fact, NBC reported in 2017 that there are more and more infants addicted to opioids now more than ever in America’s history. However, there’s no government and non-profit project that will effectively track down these infants which means there’s a big gap in the programs that should have addressed the issue.
Understanding Drug Detox Kits
Drug detox kits are being sold in pharmacies and retail stores like Walmart or CVS. You can choose a liquid form or a pill form. There are also hybrid products. They are a very attractive option if the user wants to clear his or her system of drugs prior to a job interview, for instance, where a drug test may be administered.
The question, however, is do they work as an alternative to the detox program offered by treatment facilities?
It’s hard to determine the efficacy of these kits because the users report of different experiences. There’s no single study that compares the different products as to whether they perform as advertised. Despite the name, they actually bill themselves as a temporary and emergency solution to cheat the drug test.
The problem, meanwhile, is the misconception about how the detox kits work. Some people believe that it’s a good alternative to the medical detox. Another benefit is that they get to save money, or so they thought, because these kits are much cheaper.
The very purpose of purchasing these kits is privacy. It’s highly probable that they will do the detoxing in the comforts of their home. It’s also highly likely that they will do so alone, and without the supervision of a medical professional.
The placebo effect is very much a risk here. Because they think that the toxins are already cleared having passed the drug test, they are just going to repeat the process over and over again. Meanwhile, they are not really setting themselves up for recovery. They thought they found the panacea to their drug addiction but instead their system continues to deteriorate because of the consistent drug use.
Inpatient treatment facilities will provide a safe environment where you deal with your addiction with help of qualified professionals and staff. Their services are not limited to alcoholics and drug dependents since some of them also treat depression, post-traumatic stress syndrome, and mental health disturbances.
There’s a strong link between mental health and addiction. Residential treatment will offer customized programs that are tailor-fitted to the individual’s needs. The patient will undergo an extensive interview process to try to determine the extent of the problem. Detox is a large part of the overall therapy, along with behavioral modification, counseling, and group therapy sessions. The main aim is to try to get to the bottom of the problem.
A person who undergoes detox without behavioral modification is almost always a candidate for relapse.
Residential facilities have different protocols. Some of them insist on totally shutting out the patient from the outside world, which means family visits are not allowed, while the treatment is ongoing; while others allow scheduled visits. One method is not better than the other.
Most therapists would tell you that the inpatient treatment program is the better option because you are always going to be monitored 24/7, and you are away from temptations, which would lead you back to your bad habits that caused you to be dependent on drugs or alcohol in the first place.
For the most part, rehab centers offer a short-term program of 30-45 days but it’s not uncommon for some residents to stay in the facility for up to one year.
There are so many factors to consider in the treatment which explains the large difference in costs.
These factors include:
- Location and size of the facility
- Extent of the addiction
- Amenities and services
- Insurance coverage
Pros and Cons of Inpatient Treatment
The advantages of getting inpatient treatment from rehab centers are clear:
- You will get supervision 24 hours a day, seven days a week
- You will get access to the therapist anytime. Studies have proven that detox alone will not help the resident beat the addiction. This should be coupled with behavioral modification therapy
- You will participate in physical activities such as exercises or meditation and yoga. Sweat doesn’t’ really help flush out the toxins but they are a good excuse to stretch those muscles
- You will follow a strict nutritional diet plan to speed up detox recovery
- You will be monitored for co-occurring mental conditions
- You will get support from your fellow residents because they understand what you are going through. When you are at your lowest emotionally, they will be there to pick you up.
- You are away from all the temptation because you are somewhat isolated inside the home. Any external stimuli are strictly controlled and regulated.
The disadvantages of inpatient treatment may depend upon the viewpoint of the resident.
- For instance, the patient doesn’t enjoy the same types of freedom inside the facility because of the strict regimen and schedule.
- You are going to be away from your family during the duration of the treatment
- You will have to take a long leave of absence from work. In some instances, employees are fired by their companies which couldn’t afford to lose one staff.
- Your individual needs, although they are going to be addressed, will take a backseat to the benefit of the group.
- Insurance will not cover most of the costs of inpatient rehab, which means you end up paying more
Again, it all depends on how the patient will view his time inside the rehab center.
Perhaps one disadvantage which should be highlighted is the fact that the treatment process is pretty much isolated. What that means is that the patient is able to deal with his addiction within the four corners of the facility, away from the temptations of the outside world. Some recovering addicts really struggle with the transition, especially if they stayed in the facility for long periods of time.
You need to weigh the pros and cons before arriving at a decision.
Not everybody is a candidate for outpatient treatment. Those who are well-adjusted may probably have a high success rate on this kind of method, as well as those who have not been dependent on chemical substances for long. As you can see, it’s not going to be easy to deal with all those cravings when you still have access to the same stimuli.
The outpatient treatment program includes:
- 12-step program
- Holistic therapies
- Support groups
- Individual behavioral therapy
As the name suggests, you are not going to stay inside the facility during the duration of the treatment. You can go home and be with your family. Some families prefer since, understandably, it’s much harder to raise children or deal with day-to-day problems on your own. The whole duration of the program will last from 30 days, 60 days, 90 days, and more depending on your progress.
Across the United States, there are about 14,500 drug treatment facilities that offer both inpatient and outpatient programs. The number doesn’t include community centers that also help indigent addicts get the assistance they need.
There are three types of outpatient treatment:
- Intensive outpatient program – The main goal of the therapies, counseling and group support is to prevent relapse. Under this program, the patient will meet with the counselor at least three times a week. Each session will last between two to four hours, or even more. You can choose the schedule to ensure that your school work or your employment hours won’t be affected. However, you will be held accountable for the absences.
- Group therapy and individual counseling – It’s not uncommon for patients who graduate from inpatient programs to transition to outpatient treatment. The main purpose is to find the root of your problem, which led you to become addicted. Family therapy is a large component of this method because it’s the only way for you to thresh out your issues, or vice versa, for relapse prevention. This also allows the family to better understand your situation.
- Partial hospitalization – Partial hospitalization is another major component of outpatient treatment. While you go on with your life, you will meet with your counselor or doctor for the procedure for at least a week. The sessions may last up to six hours. This is not the same as detox. In fact, the candidate is typically somebody who has already graduated from a residential treatment but is having a hard time coping up. He may also be exhibiting a co-occurring disease, which needs medical attention.
Most of the programs are just a variation of these three. Again, you can’t say that one method is better than the other. The best method is always the one that works for you.
Pros and Cons of Outpatient Treatment
Just like the inpatient treatment program, the outpatient option has its own benefits and drawbacks.
Advantages of outpatient treatment are:
- You still enjoy your freedom as opposed to your schedule being outlined for you inside the residential facility
- The schedule of counseling will depend on your timetable. This means that you won’t miss time at work or school.
- You still enjoy your privacy. Some people are still anxious about the stigma of being in rehab. In this way, nobody really knows that you are seeking treatment for addiction unless you tell them.
- The outpatient program is much more affordable than residential rehab
- Insurance will cover most of the cost of treatment
The disadvantages of outpatient treatment are:
- You will still be exposed to the same temptations when you are in the outside world. Friends who are none the wiser will continue to invite you out for a drink, for instance.
- There will be a lot of distractions which will cause you to miss your appointments.
- When you are outside, you will find a lot of excuses not to follow through with your treatment. For instance, when you need to finish that report or when you have to go on overtime at work
- You are going to battle with your demons alone. Although there are community support groups outside that will be recommended by your counselor, it’s not easy sitting with strangers talking about your personal life. In contrast, in residential centers, you don’t have a choice but to join the group activity.
- Outpatient treatment doesn’t include the option of medical detox. Flushing out all the toxins from their body and trying to stem the intense cravings through willpower alone may become a losing proposition.
- You are not always monitored by residential staff, which means nobody will call you out before you even start touching the bottle or the pill.
Are you a candidate for outpatient rehab?
You will have to talk to your doctor about this. But historical data reveal that those who transition from inpatient care to outpatient programs have a bigger chance of succeeding. Here are some guide questions that may help you:
- Have you tried outpatient rehab before and relapsed?
- Have you tried going cold turkey from your alcohol or drug of choice and failed?
- What kind of drugs are you addicted to? Opioids, barbiturates, opiates, depressants, painkillers or marijuana?
- How long have you been an addict?
- Do you have easy access to alcohol and opioids?
- Have you tried detox before?
Will Insurance Cover Rehab Treatment?
It really depends on the type of insurance you have. Medicare and Medicaid will reimburse a certain percentage of the cost of rehab so co-payment is required. Private insurance will cover a bulk of the cost but totally free is out of the question. For instance, platinum plans will shoulder as much as 90% of the treatment cost.
The US Veteran Affairs, however, has a program to send service vets to drug rehab facilities for free, especially if it’s proven that their substance abuse problem is a result of PTSD or any other mental health issue.
The Affordable Care Act also penalizes insurance companies if they will reject an applicant due to preexisting drug or alcohol dependency. Prior to the law, insurers don’t really cover alcoholics and drug addicts on their list. Even if they did, there was a very low ceiling, which means the patients ended up leaving the facility in just a few days and without finishing their treatments.
You can also take out a loan through your IRA savings or your 401(K). You can also refinance your mortgage and use part of the money for rehab.
Nevertheless, rehab centers should have financing options for incoming patients. As you can see, recovery is a very expensive endeavor but then again, substance abuse is also an economic luxury that most people could not afford. Think of the expenses as an investment to get your life back.
Low Cost to No Cost Rehab
Indigents may be eligible for no cost rehab offered by most states. To be a candidate, you must be included in the low-income bracket as required by the government program. Federal and state agencies also have their own inpatient and outpatient programs. They may have their own treatment facility through government-run clinics or you will be referred to their partner rehab centers.
Non-profits also run their own drug and alcohol rehab programs. The Salvation Army is one good example of since instead of money, the patients will offer sweat equity. They have to work in one of the group’s warehouses or offices for as long as 40 hours a week in exchange for the treatment services, along with the lodging and food.
Sober Living Program
What is the Sober Living Home?
At the turn of the 19th Century, groups like the Salvation Army started what was then known as dry hotels for recovering alcoholics. Remember that back then, nobody really knew about the dangers of cocaine and morphine and these were largely used by doctors for pain management.
Think of these homes as halfway houses where the addicts who have no resources can face their problems head-on. These facilities are run either through philanthropic efforts of individuals, the local chamber, charity organizations and religious groups.
The rules are very strict so this may not be for everybody. Each patient will be subjected to random drug tests, will have to go to bed at the scheduled time and also rise up early to do chores. Guests are not allowed inside. However, as the time goes by, when the patient proves that he can be trusted and he’s committed to recovery, he will gain some of his freedoms back.
The patient may also pay a token rent to ensure that he will also have a stake in his recovery.
What you need to understand is that Sober Living is not the same as a treatment facility. They don’ t run detox or therapy sessions inside. You will have to do that in any of the government-run facility. What they do, instead, is to provide a refuge for people so they don’t go near temptations.
Among the rules that residents have to strictly follow are:
- Participate in the 12-step program
- No alcohol or drug use while inside the home
- Follow the curvey
- No fighting with the other residents
- No sex allowed inside the facility
The punishment for rule-breakers is dire. It’s not uncommon for residents to be evicted from the facility and banned from coming ever again.
For more information about the government services, you can contact your local health agency or city hall.
Philosophies of the Drug Treatment Program
Although there are some variations in their methods, most treatment facilities in the country adopt certain principles as outlined by the National Institute on Drug Abuse.
The following are some of the tenets of rehab centers:
- No two individuals require the same treatment. Each program should be customized to fit each patient’s needs.
- The earlier the intervention, the higher degree of success
- Treating the addiction itself doesn’t result in long-term success without also addressing the underlying causes
- Addiction can alter the brain’s properties
- Mental health can be the cause and effect of substance abuse, and this should be addressed as well
- Pharmaceutical option in conjunction with therapy may oftentimes be necessary
- Treatment facilities can only do so much if the patient is not 100% committed
- Behavioral therapy (which will come in group sessions or one-on-one consultations) is crucial to treatment
- Relapse is real and affects a high number of recovering addicts. Follow-through is necessary to minimize the likelihood of relapse
- The treatment plan undergoes a lot of evolutions during the duration of the rehab. The changes seek to address the response of the patient
The importance of aftercare following the inpatient or outpatient treatment could not be stressed enough. This is basically the subsequent treatment you have to undergo after you have completed the alcohol or drug treatment program.
The fact is, a number of treatment facilities out there are still using outdated methods and protocols. In fairness, more and more centers are adopting what is dubbed as an evidence-based treatment (EBT) protocol. Included in this are motivational interviewing, cognitive behavioral therapy, medication, and contingency management.
The aftercare treatment will fill in the gaps and ensure that the patient doesn’t relapse.
Aftercare programs include:
- Sober living
- 12-step programs
- Holistic methods like yoga, meditation, acupuncture
- Group counseling
- Individual sessions
In 2017, the Scientific Research Publishing released the “Addiction Treatment Aftercare Outcome Study” which proves the efficacy of aftercare coupled with inpatient and outpatient care.
According to the survey of nearly 300 patients, 11.7% of those who went through residential treatment were sober for about a year, 16.8% of patients receiving outpatient care were sober for one year, while those living in sober living homes had a 23.8% success rate.
It should be noted that the higher rate of success of outpatient care doesn’t mean that it’s more effective compared to the inpatient care. However, as already pointed out, those who opt for outpatient care are less severe in terms of their addiction, environment, and cravings.
Meanwhile, 74.6% of the individuals who tried all treatments simultaneously remained sober for one year.
Clearly, aftercare is an important factor in abstinence and preventing relapse.
What is Relapse?
Relapse is generally understood as the state where the recovering addict reverted back to his old habits. Here are some of the statistics that you should know when it comes to drug or alcohol relapse:
- More than 8 in 10 people relapse within 12 months after getting out of rehab
- 4 in 10 people who complete drug and alcohol treatment programs within 30 days after detox are less likely to relapse
- 2 of heroin users suffer a relapse
- 4% of alcoholics suffer a relapse
- 9% of cocaine users tend to a relapse
- 2% of crystal meth suffer a relapse
What you need to understand is that relapsing is not an outlier, but rather a norm. Recovering addicts should expect relapse rather than be surprised about its possibility. The good thing is that there are some warning signs when you are about to fall off the wagon. Relapse can be mental, physical and emotional.
Red flags that tell you that you are about to relapse:
- You tend to isolate yourself more and more
- You miss a lot of group and individual sessions
- You don’t about your issues if you do go to the meetings
- You sleep and eat a lot less
- You think about your dealer or the places where you used drugs with your friends a lot more often
- You lie about your true emotional state
- You look at your past drug use with nostalgia
- You think that you can manage your addiction this time around
Another thing about relapsing that nobody is really talking about is that how dangerous it is for the individual. The recovering addict is must prone to overdosing during the relapse phase, and that’s because they revert back to the peak volume they were taking prior to getting treatment. Their bodies developed immunity over time and sudden intake of large quantities will overload the system.
However, it must bear stressing that a relapse is part of the recovering process. While the relapse rate for heroin and alcohol is high, a large number of those actually remain sober for good after relapsing.
How Long is Aftercare?
There’s no yardstick as to the length of the aftercare treatment. Each individual will respond differently to the program. Some people will only require weeks. Others will need a lifetime of monitoring and support. It’s a mistake to compare your progress with those of your peers. Just because you are still doing aftercare after more than a year doesn’t mean that you are weaker. Again, there are many factors to consider.
The Sober Living Home is the very definition of an Aftercare treatment. You can consider it as a halfway house that will make it easier for them to transition back to main society. They will understand the need for structure in their path toward full sobriety.
What should be ingrained in the minds of the recovering addicts is that opioids and even alcohol change the chemical structure of the brain. This results in a change in behavior. Willpower or weakness has nothing to do with it. For the most part, they are not conscious of what they are doing. What is abnormal behavior to most people seems normal to them. That’s why aftercare is essential in making sure that you don’t revert to your old habits.
The best aftercare program seeks to address the recovering addict’s issues on the following:
- Relationship with family and close friends
- Financial status
- Medical issues and mental health
Most of the recovering addicts are embroiled in some legal difficulty. This could be the crimes they might have committed when they were under the influence, child custody issues or paternal support. Legal representation is not cheap and you have to add to that the stress of the litigation and mediation process. It’s enough to send a sober individual back to the bottle or the syringe.
If the recovering addict is an emotional time bomb, any of those factors can become a trigger.
There about 20 million Americans who have a substance abuse problem and 7.7 million of those have a co-occurring mental illness or also called dual diagnosis. If you treat the chemical dependence alone without touching on the mental health, relapse is almost a guarantee.
The Four-Step Process of Drug Addiction
Most drug addiction starts off as a curiosity. The teens, especially, are prone to risky behavior. It’s not their fault really because risk-taking is imprinted in their DNA. Peer pressure peaks at 14 years old for teenagers so during this period, they are liable to being influence into drinking or taking drugs. They also don’t have all the tools to evaluate risks from all angles.
With that said, here are the four steps of addiction:
Step 1: Experimentation
The experiment stage is devoid of peer pressure but rather stimulated by intense curiosity. There are many factors that lead to this stage but one of the more prevailing ones is the easy access to the drugs or alcohol. Children with parents who are addicted to opioid painkillers have a higher risk compared to the average teenager. Experimentation, however, doesn’t necessarily lead to addiction. A good number, in fact, discontinued the use after one or two tries.
Step 2: Habitual Use
From experimentation, the use of the substance has become a habit. Again, it doesn’t mean that they are already addicts just because they are habitual users. At this stage, some people can still stop using drugs anytime they want without exhibiting the withdrawal symptoms. They also don’t have intense cravings. However, the risks accelerate for these users to develop an addiction.
Step 3: Drug Abuse
It can be argued that the habitual user is already abusing the drugs. But there’s a slight distinction in the definition. Habitual users may be able to control their use when there’s a very real negative outcome. Drug abusers, however, do not care about the social consequences as long as they have their fix. Now, their time is really preoccupied about when they can take the drug or alcohol and how they can do it without anybody noticing. Cravings are getting more intense.
Step 4: Drug Addiction
Now, there’s no line that will separate the drug use and the everyday routine of the individual. In fact, his life now revolves around his addiction. Eating, working and spending time with the family take second place because the priority is drinking that bottle or injecting that needle to satiate the craving.
Choosing Your Treatment Center
With 20 million people in the US with some form of substance dependency and only 14,500 treatment centers, the demand is at an all-time high. It’s very easy for rehab centers to fall into the trap of serving as many individuals as possible to increase their profit margins. While there’s nothing wrong with helping people, it should not be at the expense of quality.
It’s a mistake to pit one treatment center against the other. There’s no single benchmark that will declare one rehab facility as the best. The important thing to consider before enrolling in the program is to know whether or not the facility is invested in continuing care for the individual.
That’s one way to know that the center is not only there to turn a profit.
But what is continuing care?
- The facility still monitors the individual even after the detox and inpatient or outpatient rehab treatments are already completed
- Helping the individual transition to life outside of the confines of the facility
- Linking the individual to community support groups or aftercare facilities
Understand that these rehab facilities don’t possess the magic bullet that will cure your addiction. Anyone claiming to do so is probably exaggerating, if not lying. Unfortunately, some people just possess the DNA or what is termed as an “addiction gene” that makes them susceptible to dependence. It’s the same reason why some people can stop anytime they want to.
This addiction gene is not limited to drugs and alcohol either. There are individuals who are addicted to food, gambling, shopping, sex, Internet, games, body modification, exercise, plastic surgery, cutting, and even risky behavior.
And with social media as popular as it is, there is now a growing number of people who are addicted to the “likes” they get from Facebook. They even blame themselves if their social media post doesn’t get the attention they think it deserves.
Being passionate is one thing but when they already cross over to risky behaviors in order to feed their addiction, it can end up badly for everybody.
Success in the field of drug and alcohol treatment is relative. Would you say that a particular facility is unsuccessful because it’s only able to help two people manage their addiction as opposed to another one that is able to help three?
The patient will have a lifetime to deal with the problem. Some are lucky enough not to suffer a relapse when they finish the rehab. Others are ticking time bombs that will revert back to their old ways without warning.
Of course, your local health agency should be able to point you to the best facilities in your area. At the very least, you will be referred to a legitimate facility which has all the permits and certifications. They are regulated and their programs are monitored for efficacy. That means you will not be wasting your money for an unproven treatment protocol.
The treatment center will help you manage your cravings, deal with relationships, and cope with everyday stress so you won’t go back to the bottle or the needle by default. You will also be introduced to community charity and non-profit groups that will be able to provide emotional support when your days are at their bleakest. But you will still deal with your own demons when you are lying in your bed, the lights are turned off, and you are alone in your thoughts. During those times, it’s good to know that you can call somebody for help.