This is another frequently-asked question:

“Why do I need to go to drug rehab?”

Answering this question requires a deeper understanding of the disease of addiction.

Virtually every person who has ever checked into a rehab program has tried to quit before. They make such statements as:

• “I can quit anytime I want.”
• “All I have to do is make up my mind.”
• “It just takes willpower.”
• “I’m NEVER going to use drugs again.”

Some people will even try to manage their drug use by making deals with themselves:

• “I'll only use on the weekends.”
• “I’m still going to smoke pot, but I’m not going to do meth anymore.”
• “I won’t use when the kids are here.”
• “I’ll just do a little bit to relax.”

MAYBE this kind of bargaining works in the beginning, when substance use is still a personal choice. But when the disorder has progressed to dependency and addiction, choice is no longer a factor. Drug use becomes an irresistible compulsion.

The idea that a person can easily and successfully quit drugs on their own relies on the misconception that true addiction is nothing more than a bad habit that someone can overcome with enough willpower. It ignores the decades of scientific research that has concluded that addiction is a medically-diagnosable chronic disease of the brain.

Also, safety is a factor. Certain substances affect the brain so profoundly that when they are discontinued, withdrawal symptoms can be so severe as to be potentially dangerous or even fatal. For that reason, close medical supervision and monitoring is an absolute necessity. Where appropriate, medical staff can administer FDA-approved medications to alleviate cravings and reduce symptoms of withdrawal.

Finally, addiction is typically associated with other problems – emotional, relationship, health, legal – that must be addressed if recovery is to be successful.

Evidence-based therapy utilizes those treatment approaches and strategies that are supported by actual evidence, rather than by personal beliefs or bias – generally-accepted science, statistics, clinical reviews, and measurable success.

Evidence-based therapy addresses the disease of addiction on several multiple fronts. Each specific strategy/approach is employed to address two things:

• The specific manifestation of the SUD in the individual, and
• The consequences that have arisen because of problematic substance use, affecting not only the individual, but also their family, their friends, and the rest of society.

Generally, evidence-based addiction recovery involves several different behavioral therapies, which can be further supported by pharmacological options – medications to help with cravings, anxiety, and depression.

Behavioral therapy gives struggling substance abusers an opportunity to change their dysfunctional behaviors. The overall goal is to replace any bad/negative habits with good/positive ones. There are several objectives:

• Engage the addict and empower them to actively participate in their own recovery
• Provide positive reinforcement, motivation, and incentives for ongoing abstinence
• Modify addictive behaviors
• Teach the person healthier new life skills
• Help the person develop new stress-reduction techniques
• Assist the person in acquiring better coping mechanisms
• Come up with specific strategies to avoid triggers that might lead to resumed drug use
• Methods to overcome drug cravings
• How to prevent/react to relapse

During behavioral therapy, service providers don’t just talk in generalities about addiction – they focus on getting the substance abuser to examine the specific ways that problematic drug use has affected them personally. In this way, the person practices using responses and strategies that they can then apply to their own life.

Whenever a struggling drug abuser acquires a positive new recovery technique, they actually gain a new tool that they can use whenever cravings, stress, or temptations arise in their life.

Behavioral therapy modifies the addict’s thoughts, so that they can change their behaviors.

• Cognitive-Behavioral Therapy – CBT develops new coping mechanisms, focusing on anticipating and avoiding potential problems. CBT improves self-control when problems do arise. It is particularly effective for marijuana, methamphetamine, or cocaine abuse.
• The Matrix Model – This therapy focuses on fostering an encouraging, positive patient/therapist relationship. The Matrix Model is most successful when treating cocaine, ADHD medication, or methamphetamine abuse.
• Contingency Management – Patients receive tangible rewards to reinforce positive behaviors such as prolonged abstinence, successful trigger avoidance, etc. It is most helpful with marijuana, opioid, or stimulant abuse.
• Motivational Enhancement – Increases the motivation of patients ambivalent about staying drug-free. By spurring the person to make rapid changes, the hope is that they will be able to quickly realize sobriety’s benefits and give greater effort. This is best for people with minor-to-moderate SUDs.
• Family Behavior Therapy – FBT addresses (1) addiction as a disease, and (2) the effects on loved ones. Family members learn about their roles – enabling, codependency, and excessive care-taking. Emphasis is placed upon improving communication, setting boundaries, and resolving conflict.
• Family Education Group – The recovering drug addict and a family member attend weekly group sessions, learning new skills and strategies that can improve the home environment. Both parties actively work on their own separate-yet-similar treatment goals.
• Community Reinforcement – CE emphasizes living a drug-free lifestyle after completing rehab. By focusing on positives – family, friends, work, and substance-free recreation – the idea that drugs are unnecessary for a happy life is reinforced. This approach is best for cocaine or opioid abuse.
• 12-Step Meetings – Regular 12-Step meeting attendance gives the recovering addict an opportunity to:
• Gain judgment-free acceptance not found elsewhere.
• Find strength and inspiration from peers with similar experiences.
• Learn the recovery value of service to others.

The 12 Steps are applicable to any form of recovery.

Residential treatment, also referred to as inpatient rehab, is when the person physically checks into a facility to receive around-the-clock care and monitoring, 24/7. Because it is in an immersive therapeutic environment that is safe and secure from the stresses and temptations of everyday life, patients can turn their full attention to recovery and healing.

In fact, to completely remove themselves from temptation and stress, many patients choose to travel out of their local area – or even out-of-state – to go to residential drug rehab. Being away from home makes it harder to just drop out of treatment on a whim.

For most substance abusers, inpatient drug treatment is the preferred choice that gives them their best chance to successfully recover from their addiction and regain not just their sobriety, but also their emotional balance, serenity, and hope for the future.

The standard residential rehab program runs for 30 days, but it can be adjusted on an individual basis for those people suffering from severe addiction or who need more time to respond to treatment.

Some of the services offered at inpatient facilities include:

• Secure, private facility
• 24/7 monitoring
• Medical supervision, to include round-the-clock nursing care
• Clean, comfortable accommodations
• Licensed clinical staff – mental health professionals and addiction specialists
• Healthy meal options, including nutritional guidance
• Educational classes about the disease of addiction
• Regular therapy sessions, both individual and group
• Medication assistance
• Concurrent treatment for any comorbid issues – PTSD, anxiety, depression, etc.
• Drug screening
• Exercise programs
• Yoga and meditation
• 12-Step fellowship meetings
• Planned recreational opportunities

Inpatient programs give newly-sober addicts the kind of structure and support not possible during a chaotic addiction-driven lifestyle.

For those people with mild-to-moderate addictive issues, or who are unable to attend residential treatment, another option is an Intensive Outpatient Program (IOP). While participating in an IOP, clients can continue to live at home, work, go to school, and remain with their families.

IOP and other outpatient offerings are of particular benefit to those people who need drug treatment but who can’t get away for some reason, such as:

• Single parents with dependent children
• Workers who are unable to take time off for a month or more
• Full-time students
• Caregivers for elderly or disabled family members

IOPs offer most of the same clinical services – counseling, education, drug screening – as inpatient rehab, over a longer period of time. Typically, IOP attendance is 3 to 5 sessions per week, 3 hours per session. Most programs are 12 weeks in length, again adjustable on a case-by-case basis.

For flexibility, most IOPS offer participants a choice of morning or evening sessions.

Most people who have recently “graduated” from an inpatient facility prefer to receive aftercare from an IOP in their area. This helps them by providing continued structure and accountability while they transition from the temptation-free residential program back to the real world.

People with mild addictive disorders may choose to participate in a regular outpatient rehab program. Again, although the therapy and counseling offerings are largely the same, the differences are mainly in time and intensity.

A regular outpatient drug program might only meet 1 or 2 times per week, typically in a group setting. Most programs also require 12-Step meeting attendance. Obviously, this infrequency does place some limits on how in-depth the treatment received really is.

Many people use a regular outpatient program as continuing aftercare following residential rehab and/or an IOP.

In between the highly-structured 30-day at an inpatient drug facility and the flexibility of an outpatient program is the partial hospitalization program, or PHP.

This is a good option for those people who cannot attend residential rehab, or who have graduated from such a facility but still feel that they need a great deal of help to remain sober. For example, a PHP might be the right fit for someone who still needs regular access to medical personnel, who but doesn’t require 24/7 monitoring.

A typical PHP might meet 6-8 hours per day, five days a week. At the end of the day, patients can return home, full of newly-acquired recovery information and skills.

Ultimately, the choice between an inpatient or outpatient program depends on the individual – their recovery needs, commitments, family situation, and budget.

Inpatient Treatment – Pros

• Private
• Secure
• Monitored
• Medically-supervised
• Opportunity to focus completely on recovery
• Immersion in a drug-free lifestyle
• Removal from daily stress, temptations, and triggers

Inpatient Treatment – Cons

• Requires a time commitment of at least 30 days
• Separation from family and friends
• Patient must take time off from work or school
• Expense – residential rehab is the most expensive kind of addiction treatment

Outpatient Treatment – Pros

• Flexibility that allows work or school
• Ability to go home at night to family and children
• Chance to practice recovery lessons in real life
• Better yet, a chance to receive feedback and make adjustments
• Expense – outpatient drug treatment is much less expensive than residential rehab

Outpatient Treatment – Cons

• Less structure – this is the biggest problem for people with moderate-to-severe addictions
• Exposure to stress and temptations
• Less variety in treatment options
• Length of time – Outpatient rehab is at least three times longer than inpatient.

There is room for discussion on two of those “cons”.

FIRST, current laws require insurance providers to cover drug rehab services. This could mean that the difference between the out-of-pocket expenses for inpatient versus outpatient treatment is essentially negligible.

SECOND, the ability to take off from work is a non-issue. Because addiction is a medically-recognized disorder, your employers are required by law to give you time off to seek treatment for a medically-diagnosed addiction. They are even legally-bound to protect your position, pay rate, and privacy.

One of the biggest challenges to receiving effective care for an SUD is the common co-occurrence of addiction with other mental illnesses. Without the right kind of treatment, recovery from both can be complicated.

The Journal of the American Medical Association reports:

• Approximately half of individuals with a mental disorder also meet the criteria for an SUD diagnosis
• Correspondingly, 53 % of drug addicts also struggle with mental illness.

Some of the mental disorders link with substance abuse include:

• Anxiety – Roughly one-third of anxiety suffers also abuse substances, and vice versa.
  • When marijuana addiction and anxiety co-occur, the anxiety precedes the substance abuse 80% of the time.
  • 75% of methamphetamine abusers will exhibit symptoms of anxiety.
• Depression – Up to 64% of substance abusers suffer from depression.
  • Long-term opioid use has been linked to an increased likelihood of new-onset depression.
• Attention Deficit Disorder – Over 50% of people with untreated ADHD will abuse substances. Among ADHD patients, the SUD rate is two-and-a-half times that of people without ADHD.
  • 50% of ADHD patients who self-medicate with marijuana daily will progress to Cannabis Use Disorder.
• Bipolar Disorder – 60% of patients with BPD will at some point abuse substances. Of special relevance:
  • Marijuana use can trigger episodes of mania.
  • Stimulants such as methamphetamine or cocaine can induce “highs” and “lows” that closely resemble BPD.
  • Opioids can worsen depressive episodes.
• Posttraumatic Stress Disorder (PTSD) – Up to 70% of people in treatment for an SUD also have PTSD. In two-thirds of those cases, the substance abuse preceded the trauma.
  • People with SUDS are six times more likely to attempt suicide.
• Schizophrenia – 1 in 7 schizophrenics have an SUD.
  • Heavy marijuana usage at age 15 or younger increases the risk of schizophrenia by 700%. The risk rises to 1000% if the person has a family history of schizophrenia.
  • Methamphetamine addicts have a tripled risk of schizophrenia.

The best way to treat dual diagnoses is to create an integrative treatment plan that addresses both disorders simultaneously. Different service providers should work in cooperation using a shared strategy.

The best drug rehabs will have clinical teams that include both addiction specialists and mental health professionals working in tandem to create an individualized service plan.

The most important thing to do after completing a stay in a residential drug treatment program is to avoid becoming complacent in your recovery. Addiction has been referred to as a "cunning and baffling disease" that can strike again at any time.

Top drug treatment programs provide you with a solid foundation on which to build. Additionally, it gives you the tools you need to craft your own continued successful recovery.

No, rehab does not “cure” the disease of addiction. Precisely because there is no cure, you must continue to do those things that support your ongoing physical and emotional sobriety. This will take a lifetime of work.

• Continue with aftercare, preferably a professional local outpatient program or IOP
• Attend 12-Step meetings, as many as you can.
• Make the necessary lifestyle changes – avoid the people, places, things, thoughts, and emotions that can trigger a relapse. If you have to, make new friends or even find a new place to live.
• Keep working on your Relapse Prevention/Response Plan
• Use your resources – recovery sponsor, sober family and friends, mental health professionals
• Take your anti-craving medications as directed – even if you feel “fine”
• Practice stress-reduction techniques
• Read recovery literature
• Volunteer to help others – science has shown that being of service to others helps keep you sober.
• Look for clean and sober ways to entertain yourself – museums, movies, coffee with friends, taking a class, etc.

If it sounds like staying sober is a lot of work, that’s because IT IS. But the arithmetic of recovery is wonderful, because you get back so much more than you ever put in – you get your life back.

One of the most powerful recovery savings is – “It works if you work it”.

Affordability is the biggest perceived barrier that keeps people from getting the addiction treatment they need. Struggling addicts and their families put off getting help because they think that quality drug treatment is far too expensive to even consider.

Make no mistake – rehab for drug addiction is not cheap.

Because the disease of addiction varies considerably from person to person – the substance abused, the length and severity of the addiction, etc. – it is difficult to give a truly accurate price without knowing specifics.

However, it is possible to give some “ballpark” estimates for the costs of professional drug addiction treatment, based on national averages. Keep in mind that every drug detoxification facility and addiction recovery program uses its own treatment approach and offers its own set of services.

These estimates should only be used as a starting point from which additional research should be conducted.

The consensus among addiction specialists is that 90 days of some combination of inpatient and outpatient services is the shortest length of treatment acceptable for it to be effective.

In some cases, it can be considerably longer.

For instance, the minimum recommended length for a methadone maintenance program is 12 months. Without the addition of specialized behavioral counseling, methadone maintenance can go on for years.

Per the National Institute on Drug Abuse, the typical costs are:

• Detox – $500 per day, lasting 3 to 14 days.
• Outpatient drug rehab –$10,000
• Residential/inpatient drug rehab – $8000 to $32,000 per month
• Methadone Maintenance –$5000 per year
• Vivitrol injections –$1600 per monthly injection
• Luxury Drug Rehab Resorts, up to $80,000 per month

For most people, those costs are prohibitive. But here’s the good news – thanks to federal law, drug treatment may be far more affordable than you think.

Most people don’t realize is that their private insurance plan is REQUIRED BY FEDERAL LAW to cover substance abuse treatment.  Right now, the Affordable Care Act requires insurance carriers to pay for qualified outpatient and inpatient addiction treatment services.

• This coverage extends to both policyholders and their dependents.
• Drug rehab and mental health coverage applies even if they are pre-existing conditions.
• There is no waiting period – rehab coverage begins immediately upon activation of the policy.
• Because drug treatment is considered an “essential health benefit”, providers are prohibited placing a limit on the dollar amount of coverage – either annually or lifetime.

The best news?

Depending on the details of your individual plan, it may be possible to go to drug rehab with little-to-no out-of-pocket expense.

There is one important consideration when choosing a rehab facility, however—although every insurance carrier is required to cover substance abuse treatment, individual facilities are NOT REQUIRED to accept every insurance plan.