Types of Addiction Treatment Programs in the United States

In the U.S. alone, over 20 million people suffer from at least one substance use disorder (SUD).1 Substances are drugs that have an addictive potential, such as alcohol, caffeine, cannabis, opioids, and tobacco. Substance use disorders exist across a large range and can be classified as mild, moderate, or severe.

Dependence occurs when the brain becomes reliant on certain substances to maintain a preferred level of functioning. Any substance use disorder is generally considered an addiction. Not everyone with a substance use disorder identifies the negative consequences or identifies as having a problem that they want to address. Some do understand the negative consequences, but their physical and psychological dependence on the substance prevents them from stopping. Depending on what level of addiction or substance use a person might be suffering from, there are different types of treatment programs that can help.1

In this guide to the various recovery programs offered in the U.S., we’ll explore the pros and cons of each to help you determine the best option for you or your loved one.

In order to determine the most suitable treatment program for you or your loved one, it’s essential to understand the effects of addiction on the brain and body. An individual struggling with addiction experiences a combination of physical and psychological dependence on a specific substance. The table below explains the aspects of each.

Treating addiction is a very personal process. While substance use disorders are fairly common in the U.S. (19.7 million Americans over the age of 12 reported having a SUD in 2017), no two individuals’ experiences are the same.12 This means that recovering from addiction looks different for everyone.

For some people with substance use issues, their addiction is less severe, and they require fewer interventions. For others, they might need multiple levels of care to fulfill long-term recovery. Regardless of the severity, recovery is possible with the right tools and support in the correct settings.

The three main forms of treatment are:1

• Detoxification
• Cognitive and behavioral therapies
• Medication-assisted therapies

Below, we’ll delve further into the details surrounding each of these treatment forms.

Detoxification

Depending on the severity of the SUD, the first step in the treatment process is detoxification. This process is a medically managed stage of treatment where doctors and medical professionals monitor the patient as they go through symptoms of withdrawal.2

Sometimes patients have other comorbid mental or physical illnesses that can impact detoxification or vice versa. It’s important to detoxify in a medically managed environment so that medical professionals can monitor the patient for potentially complex symptoms. Some common examples of co-occurring conditions include:3

• Gastrointestinal disorders
• Hematologic disorders
• Cardiovascular disorders
• Pulmonary disorders
• Neurological systems
• Infectious diseases

According to the Substance Abuse and Mental Health Services Administration, there are three main steps in the detoxification process:3

1. Evaluation: The general evaluation process includes measuring levels of substances in the blood, screening for comorbid conditions, assessing the patient’s physical, mental, and social health, and determining the appropriate level of treatment necessary.
2. Stabilization: Either with or without medication, the patient is assisted through acute intoxication and withdrawal. The patient is made familiar with what to expect throughout treatment, and their family or other significant people in their lives are contacted by practitioners.
3. Fostering the patient’s entry into treatment: It’s important to note that detox alone is not considered substance use treatment. With that in mind, the patient is prepared for entry into an SUD treatment program by emphasizing the importance of completing and following through with the complete process of recovery. Written treatment contracts (not legally binding) may prove beneficial for some patients.

Cognitive and behavioral therapies

Psychotherapy, otherwise known as talk therapy, can be an effective way of treating addictions. Mental health professionals have found different types of psychotherapy useful when treating patients with addictions. Some examples include:1

• Cognitive behavioral therapy (CBT): CBT is when a mental health professional helps you understand how your thoughts affect your actions. This form of therapy helps patients unlearn negative thought patterns that contribute to addictions.
• Dialectical behavior therapy (DBT): This form of therapy helps patients regulate and manage their emotions. It’s been shown to be effective for SUD and other mental health concerns.
• Assertive Community Treatment (ACT): This form of therapy is highly individualized and focused on strengths, goals, and needs for the future, but it occurs in a community environment rather than a residential or hospital setting.
• Therapeutic Communities (TC): A TC is a long-term residential treatment that helps people with substance use disorders develop healthier values and behaviors related to substances.
• Contingency management (CM): This form of therapy encourages healthy behaviors in exchange for some sort of reward. An example is receiving a gift card in exchange for a negative drug test.
• Motivational interviewing (MI): First developed in the 1980s, therapists who use MI are focusing on motivation as a process to be strengthened in an individual, rather than a trait that a person either has or doesn't have. The emphasis on it being an interview helps a patient to feel more autonomous and participatory in shaping the approach, rather than potentially feeling confronted by an authority. Patients create their own goals, encouraged by the therapist. Through this technique, therapists often witness their patient's motivation to remain sober grows stronger.

Medication-assisted therapies

Another way to treat substance use is through medication, which can help with cravings and withdrawal symptoms. Using medication in combination with counseling or other behavioral therapies can provide a “whole-patient” approach to SUD treatment.13

Here are some examples of medications that can help treat addictions:1 13

• Methadone, buprenorphine, and naltrexone can be used to treat opioid use disorder, and naloxone can be used to prevent overdoses.
• Common alcohol use disorder medications include acamprosate, disulfiram, and naltrexone.
• For tobacco or nicotine, patches, sprays, gums, or lozenges can be used, or your doctor might prescribe medications like bupropion or varenicline.
• In addition to bupropion being used for smoking cessation, psychiatric medications such as antidepressants can also indirectly help treat substance use disorder by addressing underlying, coexisting mental health conditions, thereby reducing the likelihood of relapse.

There are a wide variety of treatment centers in a range of locations and settings where the above treatment programs can be carried out. Depending on your needs, you could benefit from more than one. Below, we’ll explore some of the most common treatment settings.

Inpatient or residential rehab

Once a patient has gone through detoxification, the next step of the treatment process is often residential. Residential programs are live-in programs where patients stay in a house or facility and attend regularly scheduled meals, groups, and therapy sessions. Inpatient programs have 24/7 monitoring with access to medical professionals who specialize in treating SUDs.2 There are long-term residential programs that span a couple of months and short-term residential programs that last several weeks. Inpatient programs can be an effective way of treating addiction, depending on if it suits your needs.

Pros of inpatient residential programs:4

• Stays are normally at least 28 days long. Though they can rarely stretch as long as two years, that length of time is extremely rare; one to three months is a much more standard amount of time for inpatient programs. This typically gives the patient ample time to cultivate long-term recovery.
• The days are structured, which can aid in the recovery process.
• Constantly available support from practitioners and a community to lean on.
• Temporarily removes the patient from their familiar drug environment to establish a baseline recovery.

Cons of inpatient residential programs:4

• Even though longer stays could be better for the patient, some might consider a longer stay to be a downside.
• It can be expensive and isn’t always covered by insurance.
• Residential life is not the same as the real world. The longer you stay in a program, the harder it can be to integrate back into society while maintaining recovery.
• The patient may need to quit work and/or arrange for alternative childcare accommodations, which isn’t always feasible.

Partial Hospitalization Program (PHP)

Sometimes used as an alternative to inpatient programs, PHP is a step down from inpatient care in that the patient spends the day in care and then returns home at night. This provides more structured time than typical outpatient treatment programs but is less intensive than inpatient care.

Outpatient Treatment

The next step in the treatment process is called outpatient. Sometimes patients go straight to this level of care. Other times, patients start outpatient treatment after completing the necessary amount of inpatient or PHP treatment.

Outpatient treatment offers patients access to groups, therapy sessions, and other treatment resources without having to live in a treatment facility. This level of treatment gives patients the ability to get the support they need while staying in the comfort of their own homes. There are two levels of outpatient treatment:2

Pros of outpatient treatment:5

• Great transitional treatment option for those exiting residential treatment.
• Works well for patients who don’t need constant supervision and support.
• Helps patients integrate substance-free living into daily life.
• Ideal for patients who need to keep working or have childcare needs.
• Outpatient options are often more affordable.

Cons of outpatient treatment:5

• Patients must manage daily stressors themselves while attending treatment.
• Less hands-on support and accountability.

Individual and group counseling

Sometimes those dealing with addictions choose to not go to a residential or outpatient program and instead opt for individual or group counseling. Other times, patients continue with individual or group counseling after completing residential or outpatient treatment. This depends entirely on the individual, the severity of their SUD(s), and the circumstances they must navigate to access services.

Individual therapy is an opportunity for an individual to work with a licensed mental health professional on their thoughts, behaviors, patterns, and emotions. This form of treatment helps patients identify the root of their substance use and develop an individualized treatment plan. Most residential and outpatient programs require a combination of individual and group therapy sessions as part of the daily structure.5

Pros of individual therapy:2

• Confidential, one-on-one attention
• Intensive and individualized analysis and treatment
• A strong therapeutic alliance
• Flexible schedule
• Helps treat a wide range of mental health disorders

Cons of individual therapy:2

• It can be expensive
• No peer interaction
• Patients need to have personal motivation and be committed to attending

Group therapy occurs when more than one individual is being treated at a time. It’s a great way to access peer support, feel less isolated, and use community strength to achieve and maintain recovery. Group therapy offers patients accountability, support, gratification, and identity and helps patients feel a part of something bigger than themselves.6

Here are five common types of group therapy:6

Pros of group therapy:2

• The assurance that you are not alone.
• A chance to receive and give support.
• A broader therapeutic alliance.
• Development of self-awareness and the opportunity to practice listening skills.
• A feeling of safety in numbers.
• Learn through watching others model addiction-free behavior.
• Often more affordable than individual therapy.

Cons of group therapy:2

• Not individualized.
• Less confidential and less flexible.
• Some attendees might not be accountable to the group.
• Not always the right group for you.

Long-term therapeutic communities

The last main form of treating addiction is through participating in a long-term therapeutic community. A long-term therapeutic community, otherwise known as a TC, is a community that commits to living a sober lifestyle and supports each other in sustaining that lifestyle. Historically, these communities were created and run by individuals who were also in recovery. Presently, some TCs have incorporated medically trained professionals onsite. It’s a self-supporting and democratically run residence that supports a sober lifestyle.7

Pros of therapeutic communities:7

• Build a sense of community.
• 24/7 peer support.

Cons of therapeutic communities:7

• Can be hard to get into a TC.
• Not always available in your location.
• A group environment doesn’t work for everyone.
• High level of commitment.

According to the National Institute on Drug Abuse, around 65% of the United States prison population had an active substance use disorder when they were arrested. Treating substance use issues while a person is incarcerated can greatly reduce both drug use and criminal involvement after release.8

To provide effective treatment, patients need access to comprehensive treatment approaches. These include:8

• Behavioral therapy; access to cognitive behavioral therapy and contingency management therapy.
• Medications such as methadone, buprenorphine, and naltrexone.
• Wrap-around services after release including employment help and housing assistance.
• Overdose and substance use education.

If patients are not treated for their substance use issues, there are proven negative results. Without proper treatment, many individuals will go back to substance use and criminal activity. This return to substance use greatly increases their chance of overdose and continued criminal involvement.8

Some programs are currently being utilized across the U.S. in the prison system to treat those with substance use disorders while incarcerated. These treatment programs include:8