A Guide to the Different Pathways of Addiction Recovery

When an individual is struggling with a substance use addiction it is extremely challenging for the entire family.  There is often guilt, shame, sadness, anger, anxiety, among a host of other negative emotions.  When the addicted individual is ready and willing to receive help it can be confusing and overwhelming.  There are various forms of addiction treatment available that have varying philosophies and approaches, as well as different levels of care with varying levels of quality of care.  We take you through the various pathways to addiction recovery, providing strategies and tips along the way.


Medical Detoxification


Medical detoxification, also often referred to as medical detox, alcohol and drug detox, or just detox, is often the first step of the recovery process.  It is needed for individuals who have a physical dependency to their addictive substance.  In other words, if they stop using their substance of choice, they will experience withdrawal symptoms.  Withdrawal symptoms vary depending on the substance used, the individual, and various other factors.  It is always suggested that an addicted individual seek out a medical professional to determine if they require a detox.  Under professional medical care from doctors and nurses, detox is the process by which an individual can safely rid their body of their addictive substance.  Substances such as benzodiazepines (ex: Xanax, Klonopin, Ativan) and alcohol can be extremely dangerous to stop cold turkey, can cause seizures and even be fatal.  Other substances such as opioids [opiates] (ex: heroin, oxycontin, oxycodone, fentanyl) can also be very dangerous to quit without being supervised by a medical professional.  Withdrawals from such substances without medical support frequently leads to relapse.  During the detox process, medical professionals can provide medications that make the detox process not only safe, but also east discomfort from unpleasant and painful withdrawal symptoms.  Depending on the substance that the individual is addicted to, as well as the length of use, frequency of use, and quantity of use, medical detox usually lasts anywhere from 1 to 7 days.  While there are medical professionals who provide at-home detox, the majority of detox is done at facilities that specialize in substance abuse detox, at rehabilitation centers that have a detox unit, or at hospitals.  A proper detox will cleanse your body and prepare you for the beginning of your recovery journey.  Detox is usually covered by health insurance and depending on the detox prices can range up to over $5,000.00 USD per day.


Inpatient Rehabilitation Centers


Often referred to as inpatient alcohol or drug treatment or alcohol or drug rehab, an inpatient rehabilitation center is what most people think of when they think of an individual going away to a rehab to get sober.  A rehab is a facility where you go to stay, typically for 28 days (or 1 month) up to 90 days (3 months).  Rehab facilities are often staffed with medical doctors, nurses, psychiatrists, and therapists who work with you on behavioral issues, emotional issues, mental health issues, and substance abuse issues in order to prepare you for a life free of drugs and alcohol.  Days are mostly spent in group therapy and in individual therapy, as well as other forms of therapy and extracurricular activities.  Many rehabs also have amenities such as gyms, pools, and meditation centers and often have physical trainers, spiritual mentors, nutritionists, and chefs on staff.  Many high-quality rehabs are more like resorts and are much different from what is often perceived.  Being in a nice environment can have a big impact on your mood and subsequent recovery.  The size of rehabs often varies with respect to the number of residents as well as the patient to staff ratio.  Some rehabs may have as few as 8 residents at a time, while others can have up to 100.  Rooms are generally either 1 to 2 residents per room.  Many rehabs also cater to executives and other career individuals who need to work remotely, while others do not allow for communication with the outside world unless there is an emergency.  Some rehabs specialize in certain areas such as trauma or grief, while others may specialize in working with a certain population such as young adults or executives.  Many rehabs also have a family program which encourages family members to be involved in the treatment, whether that be by the family coming in for family therapy sessions, educating them about addiction and recovery, or some other means of family involvement.  Many individuals who are unaware of the nature of addiction are under the impression that an individual will be cured once they successfully complete inpatient rehab, but this is far from the case.  Unfortunately, studies reflect that up to 40-60% of individuals relapse within the first 30 days of leaving treatment, and up to 85% relapse within the first year.  As such, aftercare (treatment after rehab) is extremely important for the subsequent 90, 180, and 365 days.  The longer one is able to sustain their sobriety within their first year, the better chance they have at maintaining it in the long-term.  Rehabs are often covered by health insurance and depending on the rehab prices can range up to over $70,000.00 USD per month.  Additionally, there are also long-term residential treatment programs that are typically a 12-month stay, but these are generally alternative to incarceration programs and offer low quality of care.  However, they often offer career counseling, education counseling, and other types of case management that can help individuals re-enter society in a meaningful way.


Outpatient Rehabilitation Centers


Often referred to as outpatient, an outpatient rehabilitation center is where people often go either after coming out of an inpatient rehabilitation center, or in lieu of an inpatient rehabilitation center.  Outpatient is where an individual goes for addiction treatment during the day or evenings while living at home (or while living in a sober home).  Outpatient generally consists of group therapy and individual therapy, and also a psychiatrist if needed.  Depending on the severity of the individual’s addiction, their current life circumstance, and the level of support needed, individuals may attend treatment anywhere from once per week up to five or six times per week.  Group therapy is often 60-90 minutes per day, and individual therapy is often approximately 45 minutes once per week.  If needed, an individual may attend Intensive Outpatient Treatment which is often 3 to 5 hours of treatment per day.  During this time an individual may also be seeing a psychiatrist for medically assisted treatment or to address any mental health concerns.  Outpatient rehab also often provides urine drug screens, mouth swabs, breathalyzer, or other methods of accountability to ensure their patient’s sobriety.  Outpatient rehabs are often covered by health insurance, and depending on the rehab prices can range up to $500.00 USD per day.


Therapist, Addiction Specialist, or Psychiatrist


Oftentimes individuals do not know the difference between various mental health professionals such as a therapist, licensed clinical social worker, licensed mental health counselor, addiction specialist, psychologist, or psychiatrist.  For all intensive purposes all are able to assess, diagnose and treat addiction.  That being said, it is always best to see a professional who specializes in addiction rather than a general practitioner.  Furthermore, of all the aforementioned professionals, psychiatrists are the only ones who are medical doctors who are able to prescribe medication.  Psychiatrists are often seen solely for medication management (if medication is needed), and often do less therapeutic work (i.e. talk therapy).  As such, individuals may see a therapist in addition to a psychiatrist.  For example, an individual may go to therapy once or twice per week while seeing their psychiatrist once per month for medication management.  Some therapists also offer group therapy, but more often than not the therapy will be one-on-one.  Therapy and psychiatry is often covered by health insurance, and prices can range from $50.00 per session to over $600.00 per session.


Recovery Coach, Sober Coach, Recovery Companion or Sober Companion


All of the aforementioned types of professionals are seen on an outpatient basis.  Recovery Coaches or Sober Coaches are trained professionals who can coach you to stay sober, and oftentimes are an individual in recovery themselves.  Think of a life coach, but for sobriety.  They are more interactive than a therapist because they are able to spend their time with you outside of the office being more “hands on” such as by taking you to a recovery meeting, going to the gym, or other such recovery related activities.  Recovery Coaching and Sober Coaching is not therapy and should not be confused as such.  Most recovery coaches and sober coaches do not hold recognized credentials in the field of addiction treatment, but rather hold certifications that allow them to be a type of recovery support.  Similarly, Recovery Companions and Sober Companions are individuals who can stay with you for extended periods of time to help ensure your safety and sobriety.  For example, they may be hired as a sober transport to take you to and from two locations, travel with you on business or pleasure, or attend events with you.  Recovery Coaches, Sober Coaches, Recovery Companions and Sober Companions are usually not covered by insurance, and prices can range greatly from $50.00 per hour to over $1,000.00 per hour.


Sober Home


A sober home, sometimes called a sober house or recovery home, is a home where individuals live in early recovery with other individuals who are sober.  Sober homes generally do not offer any type of therapy but offer support through mutual comradery or accountability through alcohol and drug screen monitoring.  Depending on the rules of the sober home, individuals are often required to either be working during the day, in school, looking for work, or otherwise attending an outpatient treatment center.  Sober homes often expose individuals to the recovery community by having them attend mutual help groups such as Alcoholics Anonymous, Narcotics Anonymous, Smart Recovery, Refuge Recovery, or other such support meetings.  Sober homes vary in size, often housing anywhere from 5 to 10 residents at a time.  Rooms are often 1 or 2 individuals per room, sometimes up to 4 people per room.  Sober homes are generally on a month-to-month basis, with individuals frequently staying for 6 to 12 months.  Sober homes serve as a good transition from inpatient rehab back into their home environment, or for individuals who may feel too triggered to be at home or have some type of home conflict such as marital discord or family discord.  Some sober homes offer amenities such as gyms, pools, and gourmet chefs.  Sober homes are often not covered by insurance, and prices can vary substantially depending on the home from $1,000.00 per month up to over $20,000.00 per month.


Mutual Help Meetings


Also referred to as self-help groups, recovery meetings, or by the name of the actual recovery group, are free donation-based support groups that can be found throughout various communities.  Meetings are often held in Churches or other houses of worship, community centers, drug and alcohol rehabs, or other such spaces.  Some of the most popular mutual help groups include Twelve-Step meetings such as Alcoholics Anonymous or AA and Narcotics Anonymous or NA, as well as other recovery meetings such as Refuge Recovery, Smart Recovery, or Recovery Dharma.  Mutual help groups can be a great source of ongoing support for an individual in addiction recovery, and allow them to meet peers in recovery.  It is important to note that mutual help meetings do not have licensed mental health professionals or addiction professionals in the meetings to offer clinical support and guidance.  Rather, meetings are simply one addicted individual in recovery helping another addicted individual in recovery.  At anonymous meetings such as AA or NA individuals are encouraged to find a sponsor which is an individual who is stable in their recovery, often with over a year of sobriety, who can serve as a support system and guide you through the twelve-steps that the program is based on.  As such, mutual help meetings are often encouraged to be attended as an ongoing method of support for an individual in recovery rather than for an individual who is continuing to struggle with active addiction or alcoholism as their sole means of treatment.


While most rehabilitation programs are abstinence based, meaning the goal is to abstain from all drugs and alcohol, there are programs that offer a moderation management or harm reduction approach.  Different methods of treatment work for different people, and finding the right method of treatment often involves being honest with yourself.  Cognitive Behavioral Therapy and Motivational Interviewing are widely accepted as “evidence based treatment,” meaning there are studies that show them to be effective.  That being said, there are various methods of treatment and every individual is unique.  Some other common methods of therapy include Dialectical Behavioral Therapy, Person Centered Therapy or Client Centered Therapy, Gestalt Therapy, Existential Therapy, Positive Psychology, and Psychoanalytic or Psychodynamic Therapy. Medication Assisted Treatment is also widely recognized to be an effective method of helping an individual establish long-term sobriety.  Medication Assisted Treatment or MAT simply means the individual is given medication in sobriety to help them reduce cravings and/or stop the effects of substance use.  For example, Vivitrol (naltrexone) and Suboxone (buprenorphine and naloxone) is commonly used to help individuals with an opioid dependence.  Vivitrol is also occasionally used for individuals with an alcohol dependence, as is Antabuse (disulfiram).  Counseling and behavioral therapy should always coincide with medication assisted treatment.


We always encourage individuals to think through their options, do their research, and not be impulsive.  Call providers and ask them questions such as, “What type of treatment do you provide?,” “What services will I get?,” “What level of privacy will I have?,” “What experience do you have treating someone with these issues?,” “What is your success rate?,” “How long will treatment be?,” and other such important questions.  Understandably the window from when an individual is ready to receive help to the point of getting them into treatment is often a small one.  You do not want to wait too long because the addicted individual may change their mind about getting help.  However, finding the right treatment option for a loved one is an incredibly important step that can change the rest of their life.  Sometimes individuals find it helpful to first think through if you want to use your health insurance or if you are willing to pay out of pocket.  If you must use your health insurance, it may be worthwhile calling your provider and asking them for suggestions that are within your insurance plan.  Some also find it useful to call a resource such as the Substance Abuse and Mental Health Service Administration who can help direct you (1-800-662-4357).


For more information on NYC addiction treatment and to find the best addiction counselor, or for general therapy and mental health, or to inquire about Family Addiction Specialist’s private concierge sober coach Manhattan, recovery coach Manhattan, sober companion Manhattan, Manhattan addiction therapy services and/or our Manhattan teletherapy services (online therapy/virtual therapy), as well as our Manhattan hypnosis services in New York City please contact our undisclosed therapy office location in the Upper East Side of NYC today at (929) 220-2912.

Lin Sternlicht & Aaron Sternlicht

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