Residential Alcohol Drug Rehab: Medical or non-medical setting?

To best address this question, two variables are considered: typical treatment progression, and the psychiatric profile of the individual client

First variable: Although arguments are fierce on the details, there are different, sequentially occurring phases in addiction recovery. In order: detoxification (withdrawal management), residential (inpatient), therapeutic community (half-way house), relapse prevention, after care (outpatient, regular support meetings), and self-care. Some programs would disagree on the necessity of some of these phases; other programs group certain phases together.

Is a medical setting required for any part of treatment? Only in the case of detoxification, if…
1. There is any possibility that the withdrawal symptoms are life-threatening.
2. Withdrawal is too uncomfortable to accomplish without medical supervision. This is difficult to determine, because it is dependent on the individual’s tolerance for physical, mental, and emotional discomfort.

For those that need medical detox: once you have safely detoxed, you can then choose any residential program for the duration of your rehab. If there is a fear that you can’t go from a detox facility to a non-medical residential facility without going back to drinking or drugging, then you might want to consider only those programs that do both detox and residential rehab. Medical detoxification is an additional and substantial expense.

After a person’s withdrawal symptoms have stabilized, a medical setting is not required for any other part of the treatment thereafter, unless the second variable (read below) is an issue.

Second variable: There are no two people with addiction problems that are exactly alike. However, simplifying for the sake of this discussion, there are two populations. One group that will need medical level (psychiatric) diagnosis and pharmacological support; and the other group that does not. The boundary between the two groups is fuzzy. Should one error towards one side or another? That depends on your perspective: should you give someone who may show some symptoms of depression, anxiety, or bipolar a diagnosis along with a prescription; or, would doing so diminish a person’s feeling of control over their addiction issue? Would medication enhance or interfere with treatment outcome?

A medical setting may be required if known or emerging (rarely, addictions may mask disorders beyond the awareness of the addict and others) psychiatric problems necessitate medical intervention and pharmacological support. This medical setting may be useful throughout all phases of treatment or just until the psychiatric issue is managed through medicine and patient compliance.

Dual diagnosis (or co-morbid) conditions are sometimes diagnosed more than necessary. A person that has lived a life of addiction is likely to have many problems with relationships, employment, finances, legal, health, self-esteem, etc. that may cause a great deal of stress, anxiety, grief, shame, and depression. These are normal human responses to the consequences of addiction. Unless these responses are so strong as to make life unmanageable, the simplest solution is to effectively communicate/educate the person on how they can best address these issues in the healthiest way possible.

Residential programs in medical settings cost substantially more (all other things being equal, which they rarely are). Medical settings tend to have more of a clinical ‘feel’ and may not be as comfortable or ‘normal’ to an addict trying to get well. Disagreement exists as to whether this might impact outcome.


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My email: betteraddcare@yahoo.com

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