The Ultimate Comparison Guide to Drug and Alcohol Addiction Treatment

How do you select an alcohol & drug addiction treatment center? Selecting a treatment program that best suits the values, needs and personality of your loved one who is struggling with an alcohol or drug addiction can take hours of research and thoughtful consideration.

First, it’s stressful because we’re talking about the quality of life for your loved one and the reality that substance abuse claims lives every day.

Second, it’s stressful because substance abuse treatment models vary widely and can be confusing to know which is the best option. For example,

• What are the pros and cons of inpatient or outpatient rehab?
• What is included in 28 or 90 day alcohol or drug rehab?
• How are support groups such as LifeRing or S.M.A.R.T different from traditional Twelve Step ones?

To help you get started with your research and better know how to help someone struggling with substance abuse, we’ve compiled information on three key treatment options, complete with comparison charts:

• Treatment Plans (i.e. outpatient vs inpatient)
• Length of Stay (28 days? 90 days?)
• Support Group Comparison

Inpatient (Residential) vs Outpatient Treatment Programs

A major way to narrow down your treatment choice is to decide if your loved one needs a residential or outpatient program.

Residential

Residential programs, the most commonly considered type of addiction treatment programs, are often conducted for several weeks to several months in a live-in facility with 24 hour supervision. Specialized residential programs may be tailored for specific populations, such as adolescents, pregnant women, or cultural groups.

Disadvantages of Residential Programs

Although residential rehab is often the preferred treatment model, many people avoid this method because of cost, time, and the fear of what time away from their life will cause.

• Cost. The cost of rehab is different for every person, depending on facility, insurance, and eligibility for financial assistance.
  • Private: Cost for private residential programs range between $10,000 and $40,000 for standard treatment centers and between $40,000 and $100,000 for luxury rehab centers. Your insurance plan may help to offset the costs, but most people will end up paying a significant portion out-of-pocket.
  • Non-Profit: Non-profit organizations such as Project90 and publically funded organizations such as some of the ones listed here provide financial assistance based on your ability to pay. They are considerably more affordable, although participants must meet certain criteria and may be placed on a waiting list.
• Time. Since the minimal length of residential treatment is often 28 days (long-term treatment is considered 60 or 90 days), those who choose residential treatment must be willing to commit for that length of time and have someone back home who can oversee household and familial responsibilities.
• Employment and Stigma. Although most employers have policies to encourage treatment for substance abuse, the fear of getting fired or the feasibility of leaving work for four weeks—not to mention the stigma associated with going to rehab—prevents many from considering residential programs.

Advantages of Residential Programs

Despite the sacrifice of time and money, residential treatment programs (especially long-term programs) continue to have some of the lowest relapse rates of the various treatment models for the following reasons:

• Intensive Care. Residential programs provide an intense level of care, with a structured routine of learning, counseling, therapy, and activities that promote physical healing. Most residential programs offer advanced programs and additional aftercare benefits, and alumni become part of a lifelong community of support and encouragement.
• Safe and Structured Environment. People who are trying to recover often need a complete break from stressful relationships, certain areas of town, or friends who are still using or drinking. The safety and distance of a different environment allow guests to focus on their recovery without returning to the stress and temptation of everyday life. Detox is usually provided, and guests can have access to therapists and medical staff on a daily basis.
• Reconnection.  A big part of recovery is about connection and support, and there are few places that provide the environment to build lasting relationships like residential rehab. The time spent learning, growing, eating and socializing together forms the foundation for lasting friendships.
• Better Outcomes for Long-Term Abuse. Evidence shows that residential programs generally have better outcomes than outpatient programs. Because of this, residential rehab is highly recommended for people with a long history of drug abuse or for people who have tried outpatient programs and relapsed.

Outpatient Programs

Another popular addiction treatment alternative is outpatient programs. Offered by 81 percent of treatment facilities who participated in the National Survey of Substance Abuse Treatment Services, it’s the most pervasive type of treatment model for addiction today.

Outpatient programs fall into two categories: traditional outpatient and a more intensive outpatient program.

• Traditional outpatient offers individual, family or group services that meet at least once a week for a couple of hours at a time.
• Intensive outpatient programs provide education and counseling session that meets a minimum of 2 hours per day for 3 or more days per week. These programs typically last from 8 to 16 weeks.

Depending on the facility, intensive outpatient programs can go on all day with guests returning home only for the evenings.

Disadvantages of Outpatient Addiction Treatment

Outpatient treatment is generally recommended as a transitional stage from residential treatment to home life and is often used in conjunction with support groups such as Alcoholics Anonymous. Alone, however, it does not offer the security or comprehensive experience of residential programs. Some disadvantages of outpatient addiction treatment include

• Risk of Relapse. Instead of living in a protected environment, guests remain “in the real world” and therefore have to return to their old environment. While this model allows for immediate integration of theory with practice, some people may not be ready to cope with triggers and renewed levels of responsibility, thereby increasing the chance of relapse. It if for this reason that people with a long history of addiction or relapse are not advised to attend outpatient treatment.
• High Dropout Rate. Although everybody works the program differently, outpatient treatment, especially traditional outpatient treatment, has a higher dropout rate than short term residential treatment. According to the latest data by SAMHSA, almost a third of participants leave traditional outpatient programs prematurely.

Advantages of Outpatient Addiction Treatment

Despite high dropout rates, outpatient addiction treatment can be effective for many people. In general, people in residential programs will relapse at a lower rate, but it is quite possible for someone to learn and apply the tools learned in outpatient just as effectively as the tools learned in residential treatment. As with all programs, it’s how one decides to use the tools that really matters.

Advantages of outpatient treatment include

• Low Cost. Outpatient programs rarely cost more than $10,000. Insurance is more likely to cover the costs, and some programs even accept Medicaid.
• Ability to continue home or work responsibilities. Depending on the intensity of the program, outpatient programs allow clients to keep commitments to family, work, or educational responsibilities while maintaining privacy and anonymity.
• Adequate learning experience (for some). Most intensive outpatient programs work under the same principles as residential programs, and guests will receive similar, though not as extensive, treatment: educational lectures, group therapy, one to one counseling and relapse prevention. Though the classes and therapy sessions may not be as comprehensive or numerous, the program may be enough for self-motivated patients with a supportive home environment.

Does my loved one even need formal treatment? Can’t they recover at home?

Although some people can break out of a life of substance abuse without a formalized treatment program, this doesn’t happen very often. Many people also mistakenly equate quitting or “getting dry” with getting sober. In reality, quitting is the first step. It doesn’t take away the urge to use or deal with the underlying problem that led to the addiction in the first place. Staying sober, and liking it, is another thing entirely—a state of living that takes time, training and tools.

Addiction also affects the entire family system, and it is difficult to recover when those around you have dysfunctional behaviors. The whole family requires healing, and that takes time. Some type of counseling, for both addict and family, is usually necessary.

There’s a huge difference between trying to quit drinking on your own and having the tools and program in place to help you stay sober. –Pam, former Duffy’s Guest

Does this mean that they can’t recover on their own at all? Can they at least detox at home?

Depending on the severity of the addiction, the process of detoxing from substances can be extremely dangerous and in some cases, impossible, alone. For example, withdrawal symptoms for alcohol and benzodiazepines can lead to life threatening conditions, and detox should always be conducted under medical supervision.

Even after detox, the early few weeks of sobriety is one of the most difficult and painful experiences in the world. Without the proper tools and boundaries, it becomes easy to  surrender to not only the physical but mental cravings. Addiction is a powerful disease, and the dependency runs deeper than just the physical.

Not everybody needs treatment programs to recover, but everyone does need some method of support such as personal coaches, support groups, self-help books, anti-craving medications, etc. Very few, if any, people recover at home, alone and without any outside help.

Even though the idea of recovering for free in the privacy of one’s own home is alluring, it is not the best option. Recovery at home is especially not recommended for those with a long history of addiction, heavy drug use, or relapse.

Short-term vs Long-term Rehab

Treatment is, in essence, all long-term. Addiction is a lifelong disease, and treatment requires a continuum of care, ranging from detox and rehab to Sober Living Homes and aftercare. However, the intensity of the initial treatment plan may vary, and guests have the option of extending their stay depending on their needs.

The treatment contiuum timeline:

In this section, we will focus primarily on the two most common residential treatment programs: standard programs that lasts 28 to 30 days and extended care programs longer than 30 days (i.e.  60 or 90 day programs).

Some plans may be shorter (such as 7-day treatment plans) or longer (120 day stays), but the most common programs are the 28 (or 30) day program and 60-90 day program.

What’s included in the 28-day program?

A 28 or 30 day program lays a solid foundation for lifelong sobriety. More effective than shorter stays and less costly than an extended program, this is the most popular treatment model. Most 28 day programs include

• Detox
• Learning workshops
• Group sessions
• Private and family counseling
• Recreation and fitness, and
• Aftercare benefits.
• Relapse prevention

The focus on 28 day rehab is to understand the disease, creating a recovery plan and developing the living skills for a lifetime of sobriety.

What’s different about the 90-day program?

Most people prefer the 28 or 30 day program, but research from the National Institute of Drug Abuse indicates that 90 day programs correlates with the lowest relapse rates, with the sweet spot falling around 90 days. Today, the 90 day treatment considered the gold standard for addiction treatment.

What’s included:

Each facility builds their programs differently, but 90 day programs generally expand upon the 28 day program to include further education, counseling, and training. Look for treatment centers that have unique, different, or more in-depth material, lectures, and workshops for their extended care programs.

How much more does 90-day program cost?

As expected, a longer stay is going to cost more than a shorter one.

• Estimated cost of short-term residential treatment: $10,000 – 40,000
• Estimated cost of long-term residential treatment: $30,000 – 60,000

Insurance usually covers at least a portion of that amount, making longer stays more manageable. At the end of the day, answering the question “Is it worth the cost?” depends on what your loved one needs to live a healthy life.

How do I know if my loved one needs longer treatment?

A longer stay is highly recommended for those who have

• used drugs by injections
• a long history of addiction
• a history of treatment and relapse

“The best single predictor of treatment outcome across all modalities is length of time in treatment.” -NIDA

What are Sober Living Environments?

Sober Living Environments (SLEs) are apartment-like facilities that are not designed to replace residential treatment but rather to help people transition from the rehab world back into their lives. Usually privately owned, SLEs provide structure and peer support without the restrictions and cost of residential rehab. SLEs are a wise way to extend “the runway” of a good residential treatment program.

Twelve Step Programs vs Non-traditional Support Groups

Self-help programs are integral components of the recovery process. They can complement counseling or therapy, provide lifelong support after rehab, or begin the pathway to recovery.

Alcoholics Anonymous and other Twelve Step Programs are the most common support groups, but there are multiple other options available, both online and locally. Below is a summary and comparison of seven most common self-help programs in the U.S.

• Twelve Step Programs (Alcoholics Anonymous, Narcotics Anonymous, etc.): The most accessible and well-known recovery support group in the world, these anonymous programs are based on an enduring philosophy of community support, spirituality, and helping others. People are drawn to the engagement, diversity, and strength of the Twelve Step Fellowship. You can learn more about why 12 step meetings work and how Duffy’s integrates it into our treatment philosophy here.
• Rational Recovery: Based on the Addictive Voice Recognition Technique (AVR), Rational Recovery promotes independent and immediate recovery through a decision to “never drink again.” There are no meetings, and all the information is on their website.
• Self Management for Addiction Recovery (SMART Recovery): As the leading self-empowering addiction support group, SMART offers free online and local meetings to practice tools and skills for each of its four program points (motivation to abstain, coping with urges, problem solving, and lifestyle balance). Although spirituality is not discouraged, reason and scientific knowledge are the final authority.
• LifeRing Secular Recovery (now known as just LifeRing): A strength-based sober support network, the LifeRing works through positive reinforcement to achieve and maintain abstinence. Recovery is a choice, and LifeRing acts as a “permanent workshop” for one to build his or her own personal recovery plans.
• Moderation Management (MM): With an emphasis on early recognition of risky drinking behavior, Moderation Management is a supportive mutual-help environment that empowers individuals to accept personal responsibility for their own path, whether moderation or abstinence.
• Women for Sobriety (WFS): The first national self-help program for women alcoholics, WFS is a primarily online support group that focus on developing personal growth, self-esteem and abstinence through its “New Life” Program.
• Secular Organizations for Sobriety (SOS): SOS is an abstinence-based recovery support group based on self-empowerment and personal responsibility. As one of the oldest Twelve Step alternatives, SOS believes that sobriety is a separate issue from religion or spirituality.