Note: Some people may need to go directly to a residential rehab program; the ideas presented below may only delay the inevitable and necessary admission into such a program. However, for a few people, especially those that are strongly ready, willing, and able to begin a clean and sober life (and don’t have a significant history of relapse), the following ideas might save your family more money than any other online article on this subject:
Voluntary admission to a local ‘outpatient,’ community-based program
Ever abundant DUI’s and drug possession crimes have created a very large market of state-licensed local services (available almost everywhere in the United States) that specialize in court-ordered education and group therapy programs with adjunctive services including random drug and alcohol testing and Antabuse (and Naltrexone) monitoring. If the person abusing alcohol and/or drugs is seriously ready to make a change, it is actually easy to set up a ‘custom-tailored’ program. These services will help the participant and his family (or employer, if necessary) monitor recovery and provide extrinsic motivation for relapse prevention. Your local phone directory, yellow pages, or online directory can provide listings under “addiction” "alcoholism" or "drug abuse."
Any outpatient program will have a reasonable fee schedule for its services. Typical fees for random drug testing: per urinalysis $10-$20; breathalyzer $5-$10 each. The usual procedure for random drug and alcohol testing: participant calls the outpatient facility every single day (although many are closed Sundays and Holidays), to find out if he is required to come in that day to submit breath and/or urine for testing. You can set up drug and alcohol testing for multiple times a week, once a week, twice a month, or once a month.
Antabuse (Disulfiram) and Naltrexone monitoring (both for alcohol abusers only, see below under “Antabuse and Naltrexone”) is usually around $5 per visit. Once the participant receives the prescription from the pharmacy (Antabuse and Naltrexone must be prescribed by a physician), he gives it to the 'outpatient' program. Several times during the first week (“loading dose"), and 2-3 times per week thereafter, the participant comes in to take her Antabuse usually with the following procedure. Outpatient staff will crush the Antabuse tablet into a powder than dissolve it in a cup of water, the participant drinks the solution in front of the staff member who then inspects the cup for any leftover tablet powder (if so, than more water is added to it, it is stirred or shaken, and given back to the participant to finish it). Once the dose is taken, the participant must stay in a monitored area for about 30 minutes to discourage anyone from inducing vomiting. After 30 minutes the participant is free to go and an appointment is set up for the next visit.
Group counseling at these 'outpatient' programs is usually in two hour increments of group therapy or education and costs about $25-$40. Most such counseling is geared toward state required DUI education and therapy classes, but many counseling centers also offer groups for relapse prevention, anger management, domestic violence, etc. If you are voluntarily admitting yourself to their program you are NOT obligated to attend any of these sessions (if they pressure you to do this, just find another facility). If you have the financial means you may want to try it out, but if money is an issue see the section below on “AA, NA, or any similar 12-step program."
Finally, an "intake" is usually required to participate in any aspect of their program (fill out paperwork, brief interview) which costs about $25-$50.
Bonus: Many short-term residential rehabs recommend continuing your care through a local 'outpatient' program. By experiencing this before attending a residential rehab, you will know exactly what to expect afterward. If you, or your family, feel that a continuity of care is beneficial to leading a successful relapse-free clean and sober life; you may want to consider this program whether your residential facility recommends it or not.
AA, NA, CA, or any similar 12-step program
A large majority of residential rehab programs teach AA (Alcoholics Anonymous), NA (Narcotics Anonymous), CA (Cocaine Anonymous) and the general 12-step philosophy as an integral part of their program. It then (not surprisingly) becomes the most important part (if not the only part) of their aftercare program. So, a recommendation here of trying out AA, NA, or CA has the added bonus of allowing the participant a real-life experience in the very care that the majority of residential rehabs offer. If the participant likes the experience, but feels the need for residential care, then the choice of facilities can be narrowed to those that practice the 12-step philosophy. Likewise, if the participant does not like the experience, then she should seriously consider only those residential rehabs that provide alternatives to 12-step.
The first step to start attending meetings in your area is to contact with your local AA chapter. They can provide you with a directory of days, times, types, and places of meetings. Even in small communities, you will likely be surprised at the number of meetings held nearby on a weekly, and many times, daily basis. If you attend a meeting and have a general dislike for it, then at least you know better what may or may not work for you. If you just don’t like some of the participants at the meeting, remember that different AA meetings have different ‘personalities’ so you may find a meeting more to your liking elsewhere, or on a different day and time.
You can attend AA, even for a lifetime, at very little expense. If you have the means, you should donate a dollar during ‘collection’ time at the meetings. If you do not have the means, the donation is optional and is not required for participation. The only other costs are for the books necessary (especially, “Alcoholics Anonymous – Big Book, 4th edition, available in paperback) for you to fully vest yourself into the program. You do not have to buy the books at the meeting site (and don’t ever let anyone pressure you to do so), rather you can go to most any online bookseller to buy them either new or used. The free option: most public libraries have multiple copies available for checkout. You are encouraged to read the literature to make sure that this is the program that you can believe in. Full participation is strongly encouraged in this program.
If you are uncomfortable with the AA, NA, CA, and 12-step programs, you are advised to think twice before admitting yourself to a residential program that teaches these very same philosophies. When you eventually decide to go to a residential program, look for one that advertises itself as non-AA, non-12-step, or ‘alternative to 12 step.’ If you do like the 12-step philosophy, but you do need a residential program, you have a large selection to choose from that do teach 12-step, then expect you to continue regular meetings (an important component of their aftercare) in your local community.
Important: I am recommending AA as an option only. There are many other ways for a person to get well, and I have always believed that one-size-does-NOT-fit-all. I understand that there are many who oppose the teachings of AA, and I encourage anyone to do their research before making any serious commitments to any such program.
Antabuse (Disulfiram) and Naltrexone
Antabuse (usually for those that abuse alcohol, but has recently been tried for cocaine users) provides extrinsic motivation to remain relapse-free. Even a small amount of alcohol (one beer, one shot) will induce severe physical reactions in the user that are very uncomfortable. Antabuse can only be prescribed by a physician, and liver function tests (a simple blood test) are usually required prior to prescription. To make sure that the participant is actually taking the required dose of this medication certain procedures are necessary (otherwise the user may hide the pill under the tongue of inside the cheek to later spit out, or may induce vomiting after swallowing) – see above under “Voluntary admission to a local ‘outpatient,’ community-based program”). You can follow this same procedure for at-home monitoring of a loved one by simply purchasing a pill crusher at your local drugstore or supermarket.
Naltrexone reduces alcohol craving by lowering or eliminating the ‘pleasurable’ effects of drinking alcohol. Although it is not as popular (and some would say not as effective at preventing relapse) as Antabuse, it may be an alternative for some. Monitored use is recommended (see above under “Voluntary admission to a local ‘outpatient,’ community-based program”).
Church-based programs
If you are a person of faith, talk to your pastor, priest, deacon, or someone in the pastoral center that can talk to you about alcohol and/or drug abuse. Resources that might be available can range from free individual or group counseling, and in some cases, church-sponsored sober living facilities.
Therapeutic Communities (clean and sober living environments)
For some people with a long history of drug or alcohol use, a long-term (90+ days, but typically a year or more) structured living environment with a strong community support system already in place is an effective option.
Other options including counseling, self-care, and bibliotherapy will be discussed in a future article.
Combination
The best course of action for any individual that does not have an immediate need for residential rehab care, and is strongly motivated to pursue a free and sober lifestyle, is to try a combination of the above approaches. An example would be someone who signs up at an outpatient program for random drug and alcohol testing, tries AA/NA/CA, and if applicable: talks to his pastor for the availability of church resources. Another example might be the ‘alcoholic’ who goes on monitored Antabuse long enough (9 to 12 months) to decide whether some form of counseling, outpatient, or residential program is necessary to achieve fulfillment in living a clean and sober lifestyle.
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Related: Residential alcohol treatment center, drug rehab, addiction rehabilitation, substance abuse, alcoholism, twelve step, alternative to 12 step, recovery program, prescription drugs, before rehab, best rehabs
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