Types of Treatment

Medical Detox

If needed, medical detox can be the first step in recovery.

It It helps you safely withdraw from drugs or alcohol, usually under the care of a physician. It treats the immediate symptoms of withdrawal and safely manages you through the withdrawal process.

Detox can be done as an outpatient at mental health centers and addiction clinics or as an inpatient at a hospital or residential treatment center. With inpatient detox your are monitored closely and the detox process is quicker. Outpatient detox fits into your life more easily and costs less. The choice depends on which substance you are using, how long and severe your use has been, your age, and any other health conditions you may have.

While treatment centers often have their own detox facilities, others make arrangements for patients to use detox programs at nearby sites, including hospitals and clinics.

There are licensed detoxification facilities in most areas of the United States.

To Find Detoxification Programs

Alcohol Detoxification

Many patients have only mild to moderate symptoms during withdrawal and do not need medications during detox. For those with less severe alcohol use disorder, outpatient detox with daily check-ins works as well as inpatient detox and costs less. Anti-anxiety medication is used every 6 hours for the first 24 hours and decreased as symptoms lessen.

Inpatient detox is best for people at risk of serious complications from withdrawal or those who have other medical conditions. Medications are used to help reduce symptoms such as tremor, mild depression, high blood pressure, anxiety and tension, and to prevent seizures or delirium.

Cocaine Detoxification

Withdrawal from chronic cocaine use can cause anxiety, depression and intense cravings for the drug. Different types of medications handle these issues in different ways.

• Antidepressant and anti-anxiety medications treat the changes in mood that can be brought on by cocaine withdrawal.

• Amantadine, a drug used to treat Parkinson's Disease, may also work for severe cocaine withdrawal symptoms and cravings.

• Bromocriptine, a drug that works on the brain's chemical system, reduces cocaine cravings during detox and helps even out the emotional ups and downs.

• Propanolol, a drug used to treat high blood pressure, calms the body's response to stress, including rapid heartbeat and sweating, and reduces cocaine craving. But its use for cocaine detox has risks and can lead to heart rhythm problems and a severe rise in blood pressure. Because of this, its use for detox requires careful medical monitoring and caution.

Opioid Detoxification

There are several ways to detox from opioids. To be safe, itmay be best and sometimes necessary to have medically supervised detox in a hospital or a residential treatment center that has a detox unit. This is especially important if you have been using opioids heavily for a long period of time or have major health problems. Medical detox allows you to be closely monitored during the process and given medication to prevent severe withdrawal symptoms.

Rapid Detox: Rapid detox eases the symptoms of opioid withdrawal if you are dependent on opioids such as heroin or prescription opiate painkillers. It shortens the detox period and may help you complete detox even if you weren’t successful in the past because of severe withdrawal symptoms.

In rapid detox you are asleep under general anesthesia in a hospital intensive care unit. Injections of medications called opioid blockers are given as well as muscle relaxants and anti-nausea medications. Withdrawal happens over 4 to 8 hours with discharge in 48 hours.

But there are high costs and risks with the use of general anesthesia. Rapid detox must be done by well trained medical professionals in a medical setting that is fully equipped to deal with any medical problems that may arise.

Stepped Rapid Detox: This is done in a medical clinic or hospital with specialized doctors and nurses. Very small doses of Narcan (Naloxone) are injected under the skin and naltrexone is given by mouth every hour. This removes the opioid from the body more slowly than intravenous Rapid Detoxification. The pacing can be controlled and any withdrawal symptoms can be quickly reduced by giving Buprenorphine tablets under the tongue. You are awake during the process and can then be stabilized on naltrexone which blocks all the opioid receptors.

Ultra Rapid Detox: In this form of detox you receive the drug naltrexone while under general anesthesia. This speeds up the withdrawal process, pushing patients into 100% detoxification within 5 to 30 minutes. Although this is an extremely painful process it is tolerable under anesthesia. As with rapid detox, it is very costly and has significant medical risks.

Outpatient Detox: This is usually safe and works well if you have mild to moderate withdrawal symptoms. It can be done with a variety of medications such as buprenorphine-naloxone (BUP/NX) or clonidine alone or combined with naltrexone. Detox usually occurs between 7-14 days.

Methadone: The most common method of opioid detox is to use Methadone in an approved clinic. It is slowly tapered down from the usual dose to zero over a period of 21 days. There is still has an uncomfortable withdrawal period and people often use drugs during this time.

Inpatient treatment is intensive 24/7 care delivered in a hospital setting or a non-hospital setting (called residential treatment).

Residential centers offer live-in care in a group setting that ranges from short-term (3-6 weeks) to long term (6-12 months). They have a structured treatment program designed to address each person’s specific needs. It can begin with the detox process and end with aftercare planning to support early recovery and prevent relapse.

Programs often include individual and group counseling, 12-step programs, nutritional counseling, stress reduction, holistic approaches such as yoga and acupuncture, physical exercise, work training, relapse prevention support, and educational services.

Some residential centers can be costly, while others are affordably priced. Centers in the mid to high range may become affordable if you have medical insurance. Your insurance company will let you know your covered benefits. In-network benefits can be as high as 80%-100%, while out of network benefits are often 50%.

Low cost treatment can be found through the SAMHSA Substance Abuse Treatment Facility Locator. You can select Medicaid, Sliding fee scale, Free or no-cost care, or private insurance from the left menu bar when doing a search.

It is important that treatment centers are licensed by the state they are in and accredited by a health care accrediting body such as The Joint Commission or CARF (Commission on Accreditation of Rehabilitation Facilities).

You can also go to our RECOVERY RESOURCES BY STATE section for treatment information in your area.

In an outpatient recovery program, you live at home and go to a local center for treatment, such as a mental health clinic, counselor’s office or outpatient hospital setting. Treatment is usually 10 to 12 hours a week.

Sessions focus on drug use education, individual and group counseling, and learning how to cope without using drugs or alcohol. It may also include relapse prevention training, family counseling and 12-step group support.

Intensive outpatient treatment (IOP) may work better for those with more severe addictions who would benefit from longer, more frequent and more in depth treatment sessions per week.

You can use the Findtreatment.gov Facility Locator to find outpatient treatment centers in the US. Just type in your zip code or city. Then in the left menu bar select Outpatient and a list of centers will come up. If you click on more info next to the center’s name you will find a full description of their services.

You can also go to our RECOVERY RESOURCES BY STATE section for treatment information in your area.

Some medications are used to ease uncomfortable parts of the treatment process, such as withdrawal symptoms during detox. Others have proven useful for specific types of substance disorders, including alcohol, cocaine, heroin and opioids, methamphetamine and nicotine. These can help people reduce cravings and stay alcohol or drug free.

Visit our Medications to Treat Addiction section to learn about what they do, how they work, side effects, and what the research shows.

Medication-assisted treatment (MAT) combines medications, counseling, and behavioral therapies to treat substance use disorders. These therapies help you change old patterns of thinking and learn new ways to manage cravings and stress.

MAT may increase your chance of success because it works on important aspects of recovery – the physical changes, mental stress and emotional process of change.

Along with MAT, it is very important to have social support (group work, a 12-step program or other peer recovery group) and to nourish your spirit in whatever ways are meaningful to you (walks in nature, meditation, religious studies, music, poetry and so much more).

Learn more about MAT here.
Find certified practitioners and opioid treatment programs by state for Medication Assisted Treatment.

Working with a Drug and Alcohol Counselor, a certified Recovery Coach or a pastoral counselor can help you change old patterns that affect your recovery. If you have had longstanding depression, anxiety or past traumas such as physical or sexual abuse the best recovery approach includes treatment with a psychologist or psychiatrist.

Addiction Counselors

Addiction counselors provide support and treatment for those with substance use issues. They will help you plan your treatment and set goals, lead group or individual therapy sessions, help you develop skills to maintain your recovery, and connect you with other recovery resources.

Addiction counselors can work with people in a hospital, outpatient or residential treatment centers, private practice or social service agencies.

BEHAVIORAL THERAPIES

These short-term therapies are often used in addiction recovery programs. They help you see the harmful and negative patterns of thinking that shape how you feel and act. When you understand this connection you can begin to change the choices you make in life.

Cognitive Behavioral Therapy (CBT) is a form of short-term talk therapy that teaches you practical skills to stay substance-free long term. These include recognizing and avoiding triggers, changing false beliefs, and practicing more helpful ways of seeing yourself and the world.

Behavioral therapies have had success in treating substance use disorders in residential and outpatient settings. Healthcare providers may recommend cognitive and behavioral therapies alone or in combination with medications.

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Pastoral Counseling

You can also get help from your pastor, rabbi, priest, imam or other spiritual leader. Pastoral counselors work within traditional faith communities using counseling, prayer and spirituality to help in the recovery process.

The Association for Clinical Pastoral Education accredits Pastoral Counseling Centers throughout the U.S. Visit Accredited CPE Centers to find pastoral centers in your state.

For more information on Faith-Based recovery programs see our Programs and Support section.

Psychiatrists

Many psychiatrists are certified in addiction psychiatry. These physicians specialize in treating patients with substance use disorder and a psychiatric disorder, such as depression, anxiety or bipolar disorder. After a consultation with a psychiatrist a diagnosis and treatment recommendations are made. Treatment often involves medication and behavioral therapy techniques.

Psychiatrists also play a major role during detoxification. Because addiction can affect the brain’s chemistry, their medical expertise can be important during this process.

Addiction psychiatrists treat people at a hospital, in private practice, or as part of a treatment team. Addiction treatment centers typically have psychiatrists as part of their team.

The American Board of Psychiatry and Neurology certifies the subspecialty of addiction psychiatry.

Psychologists

Psychologists can help with many aspects of addiction – including anxiety or depression that can be a part of substance use.

Psychotherapy (talk therapy), couples/family therapy, or group therapy help you understand yourself and your relationships in a deeper way – and keep you connected to your recovery.

RECOVERY COACHING

Part of staying sober depends on learning healthier ways to handle problems and seeing your life in a new way.

Working with a certified Recovery Coach can support and guide you in this process. These specialists are trained in substance use disorder treatment and recovery.

Peer specialists often have personal experience with substance use disorders. They help people create their own recovery plans based on their goals, strengths and needs – and are very valuable in supporting long-term recovery. There are now peer recovery training and certification programs.

Online treatment is a private and convenient way to get alcohol and drug use treatment over the Internet.

Like in-person treatment it includes group sessions led by addiction counselors, family therapy, individual therapy, peer support and tools for recovery. Schedules are flexible, many offer 24/7 support, and you can often take refresher courses going forward.

Studies show that online treatment is effective in reducing alcohol and drug use.

Telehealth allows healthcare professionals to evaluate, diagnose, and treat patients at a distance using the Internet. This approach has become an increasingly important part of the American healthcare system. Insurance now covers telehealth treatment. More and more clinics are offering this treatment, especially in rural communities.