Treatment Services on the Continuum of Care
The continuum of care covers a range of services that address different stages of a person’s pathway to recovery.
Acute Treatment Services (ATS or Detox)
Length of treatment: generally 3–5 days
Detoxification is the medical supervision of withdrawal from alcohol or opiates. Medical management is sometimes necessary because the symptoms of withdrawal from certain drugs can be dangerous and even life threatening. For example, withdrawal from alcohol can cause seizures and convulsions which can be fatal.
Detoxification takes place in an inpatient or overnight program that provides around the clock evaluation and management of withdrawal symptoms. Counselors work with clients to develop a treatment plan and find services to guide them through the next phase of treatment and recovery.
Clinical Stabilization Services (CSS)
Length of treatment: usually around 14 days but can be longer
Clinical Stabilization Services (CSS) provide short-term inpatient treatment, stabilization, and referral services for clients who don’t qualify for medically monitored detoxification or who have already completed a detoxification program. Stabilization programs include a comprehensive assessment, individual and group counseling, health education, some medical support, and planning for longer-term support services.
Transitional Support Services (TSS or Holding Programs)
Length of treatment: often between 2 and 4 weeks but varies depending on personal need and bed availability at the next level of care.
Transitional Support Service (TSS) programs, also known as “holding”, are short-term residential programs that accept clients from detoxification, clinical stabilization services (CSS) programs, or from homeless shelters if the individual is not at risk for medical withdrawal complications. In order to enter a TSS program, the person seeking services must plan on moving on to a Residential Treatment Program, also known as a halfway house.
Residential Treatment / Halfway House (HWH)
Length of treatment: Approximately 4 to 6 months, but can be longer based on need and the type of program.
Residential treatment programs or “halfway houses” are licensed and overseen by the Massachusetts Department of Public Health, Bureau of Substance Abuse Services. The goal of treatment is to help the person gain a deeper understanding of addiction, recovery, and the practical skills needed to live alcohol and drug free with a better quality of life. Examples of residential treatment include recovery homes, social model programs, and therapeutic communities (TC).
Residential treatment programs provide:
- an alcohol and drug free living environment with meals
- case management services
- recovery support meetings in the house and in the community where members can find mutual or “peer” support as they focus on recovery
Residential programs serve different populations. Some admit men or women only, adults only, families, and others are for youth under 18. In Massachusetts, some women’s halfway houses allow children to live with their mothers, and a small number are geared for women who are dealing with domestic violence or sexual abuse. At many programs, the staff supports clients’ efforts to find and keep a job, to enroll in programs with services to aid in their recovery, and help them create an aftercare and post-treatment plan.
Alcohol and Drug Free (ADF) Housing or Sober Homes
Length of treatment: varies
Alcohol and Drug Free (ADF) Housing, also known as “Sober Homes”, are an option after completing a halfway house. Sober homes are not regulated or licensed by the Commonwealth, therefore their quality varies. When considering a sober home, it is critical to visit the site and interview other clients to determine if the culture is supportive to someone in recovery. Sober homes should offer an alcohol and drug-free living environment that is less structured than a halfway house. Most sober homes require that residents be employed, pay rent, remain in recovery and undergo regular drug screenings. They do not offer treatment services.
Length of treatment: varies but often 1 year or longer
When a patient has completed a course of treatment in one or more residential programs, ongoing support through outpatient services will help them stay sober as they return to a healthier pattern of life. Outpatient treatment programs often include case management, individual and group counseling, support groups, and psychiatric services. Intensive Outpatient Programs or IOP’s offer group support sessions that meet several times a week, providing structure, discipline and motivation to maintain progress. Some outpatient programs are designed for adolescents; others provide child care. Many providers offer morning and evening hours so that clients can keep jobs, look for work, and honor family commitments. Medications such as Methadone, Suboxone, Vivitrol, and Naltrexone may be offered for individuals recovering from opiate addiction.
Medication-Assisted Treatment and Recovery
Medication-Assisted treatment for addiction includes the use of medication often coupled with counseling and other supports. Treatment that includes medication is often the best choice for opiate addiction. Medication gives a person who is addicted to opiates an opportunity to regain a normal state of mind without experiencing the drug-induced highs and lows. Medication also can reduce cravings and withdrawal symptoms. Medication-Assisted treatment can give the person a chance to focus on the lifestyle changes that lead back to healthy living.
Taking medication for opiate addiction is like taking medication to control heart disease or diabetes. Some people may need it for a short period of time, and some may need it for longer periods of time, or even for the rest of their lives. It is not the same as substituting one addictive drug for another. Used properly, the medication does not create a new addiction. It helps people manage their addiction so that the benefits of recovery can be maintained. Medication-Assisted treatment allows many to successfully work, maintain healthy relationships, and participate in their families and communities. The three most common medications used in the treatment of opiate addiction are methadone, buprenorphine and naltrexone. Cost varies for the different medications. As with all medications, discussing the pros and cons of different treatment options with trained professionals is the best way to determine which course of treatment might be best for a loved one.
Methadone and buprenorphine trick the brain into thinking it is still getting the drugs the person was using (heroin, OxyContin, etc.). When properly dosed, the person feels normal and does not experience intense cravings. If someone does experience intense cravings, nodding, or appears high while using these medications, they may not be properly medicated. Their medical provider may need to adjust the dose or determine if there are interactions with other medications they may be taking.
Naltrexone blocks the effect of opiate drugs and takes away the feeling of getting high if the problem drug is used again.