What Is a Residential Treatment Center?

THE RESIDENTIAL TREATMENT CENTER

Facts, Fiction, Questions and Answers

A residential treatment center, or RTC, sometimes called a rehab, is a live-in health care facility providing therapy for a combination of substance abuse, mental illness and/or other behavioral problems. Residential treatment should, in many cases, be considered the "last-ditch" approach to helping a child, friend or other loved one suffering from severe problems. RTC’s vary widely in price depending upon their location and the services offered. Monthly fees range from no-cost in some nonprofit facilities to as high as $100,000 per month for what is often referred to as “high-end treatment.” These are self-described “luxury” facilities specializing in clientele who are often celebrities, professional athletes, top corporate executives or members of extremely wealthy families who wish to keep a low profile. These facilities also offer lavish amenities in order to justify the expense. Generally, though, there are more than enough low to mid-priced RTC’s currently in operation offering the standard services necessary to give the client the best possible opportunity for recovery. There are many factors to consider when selecting an RTC and include:

1. Do they have detoxification facilities?
2. What is their program like?
3. Is it coed or gender-specific?
4. Do they just treat alcoholism and addiction or other medical and/or mental disorders as well?
5. Are they licensed and for what?
6. Are they accredited and what does that mean?
7. What is their location and how is that important?

 Finally,

8. What is their recovery philosophy?

Let’s begin with #1, detoxification. First, alcohol detoxification. This is a process by which a heavy drinker's system and body is brought back to normal after chronic and extended alcohol use and abuse. Prolonged alcohol addiction decreases the body’s production of GABA, a reuptake inhibitor, because alcohol acts to replace it. Rapid and/or medically unsupervised withdrawal from long-term alcohol addiction can cause severe health problems and can be fatal, primarily due to the danger of seizures. It’s important to state her that alcohol detox is not a treatment for alcoholism – merely the first step in a long treatment process.

Drug detoxification is a process by which withdrawal symptoms are reduced or relieved while helping the addicted individual adjust to living without drug use. Like alcohol detox, drug detoxification is not meant to treat addiction but is, rather, the precursor to long-term treatment. Detoxification may be achieved with or without the aid of other medications. In many cases, drug detoxification and treatment will occur in a community program stretching over a time period of several months and take place in a RTC as opposed to a hospital.

Drug detoxification varies depending on the location of treatment, but most detox centers provide various forms of treatment to stave off the symptoms of physical withdrawal to alcohol & other drugs. Counseling and therapy during detox to help with the consequences of withdrawal is usually provided, but be sure to ask the facility when investigating it. The detox phase of treatment typically runs 7-10 days, depending on the substance abused and client’s particular needs. For example, opiate detox generally runs 8-10 days, while someone with a long-term benzodiazepine (xanax, atavan, valium, etc.) habit may need 2-3 weeks or more. No matter what type detox, it should be administered by a physician, assisted and monitored by a licensed nursing staff. The doctor will support the patient by prescribing the most effective detox protocol for each individual client, while the experienced staff ensures the client’s safety by regularly taking vitals and watching carefully for any anomalies.

      There are several different types of drug detoxification, which include:

• Medical Detox is a process that provides gradual, decreased doses of a drug similar to the drug being abused.
• Rapid Detox involves the administration of opiate blockers such as Naloxone, Naltrexone or Methodone while the patient is under general anesthesia. This process usually takes 4 to 8 hours.
• Ultra Rapid Detox is an accelerated process conducted while the patient is under general anesthesia, combined with administration of Naltrexone. Detox can be achieved within 30 minutes, but can be a painful or risky procedure.
• Stepped Rapid Detox is a gradual process of administering oral doses of Naltrexone or subcutaneous administration of Narcan. This method offers a more controlled approach to detox because the patient is awake and communicative.
• Acute detox is generally provided within a hospital or medical unit where the staff is specially trained to recognize the signs, symptoms and behavior of withdrawal along with standard medication protocols for the treatment of alcohol, opiate and benzodiazepine withdrawal and their complications. Often, large doses of medication will be prescribed in order to maintain the patient’s vital signs and bodily functions within normal limits, followed by a gradual tapering (or titrating) of the dosage.

Sub-acute detox is a step down from acute detox and does not necessarily need to take place in a medical unit. It is normally utilized to complete a medication protocol begun in acute care and can take place in the first week or so of residential treatment in a special unit of the facility where there is a registered nurse, physician presence and supervision as well as patient observation every 20 minutes. 

            There are nearly as many different types of programs as there are facilities. The important thing to remember is that the patient’s time is productively and adequately utilized. Therefore, it is helpful to ask the facility for a copy of their weekly activities.

             Another factor to consider is the characteristics of the population of the RTC itself. This is a personal choice that only the patient and their family can make. Many facilities are coed and still others are gender-specific. Depending upon individual comfort level and the nature and factors contributing to the patient’s disorder, it may be preferable to choose one over the other.

            Many treatment centers claim to treat a variety of disorders beyond alcoholism and substance abuse. There are also facilities that concentrate on gambling, eating disorders and sexual addictions as well. Still others state they specialize in “co-occurring disorders” or “dual diagnosis.”  The vast majority of addicts also suffer from some other form of accompanying primary mental or emotional disorder such as depression, anxiety disorder, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa, etc. In addition, several personality disorders such as borderline personality disorder, paranoid personality disorder, antisocial personality disorder, narcissism, histrionic personality disorder, obsessive-compulsive personality disorder, and intellectual disabilities are often present. As a result, RTC’s that offer these services should provide psychotherapeutic services by licensed professionals such as therapists and psychiatrists. Other centers simply treat the substance abuse disorders and are generally staffed by addiction and peer counselors in a supportive environment. Depending upon the patient’s needs, this information is important to consider.

            Licensing and certification is required in most states for RTC’s. In California, for example, the department of Alcohol and Drug Programs (ADP) provides a rigorous licensing process and regulates all treatment centers and can be found at: http://www.adp.ca.gov/Licensing/index.shtml . For a complete explanation of all states’ requirements, a free review can be ordered from the federal agency known as the Substance Abuse and Mental Health Services Administration (SAMHSA) by contacting their website at:  http://store.samhsa.gov/product/BKD517. Be wary of other unlicensed and unregulated facilities such as group and sober living homes that purport to offer inpatient treatment as well.

            Some RTC’s are also accredited. This means they have chosen to go through a scrupulous course of requirements and inspections by an agency that specializes in hospitals and institutions. It also means they are generally on several insurance panels and PPO’s and are able to take and bill insurance directly. Many RTC’s say they will take insurance clients but often require full payment up front and merely provide the patient with a super bill to submit on their own. The two most common accreditation bodies are the Joint Commission Accrediting Hospital Organizations (JCAHO), found at: http://www.jointcommission.org/about_us/about_the_joint_commission_main.aspx  and the Commission on Accreditation of Rehabilitation Facilities (CARF), found at: http://www.carf.org/home/.   Both are legitimate and well-respected and their approval is not easily earned. Generally, but not always, a RTC that is in the business for the long haul will seek and obtain accreditation.

            Location can be very important as well. Besides the pros and cons of being near or far away from home, other factors to consider are whether it is in or near a large metro area or a rural setting. Both have their upsides and downsides. For example, a city offers easy access to hospitals, mental health professionals and a wide choice of activities. It can also mean easier access to illicit drugs and the company of those who provide them. A rural setting can be much quieter and peaceful, with fewer distractions, but a long distance from some vital resources. Once again, it is a matter of choice, but a thorough investigation is always advisable.

            Finally, what is the recovery philosophy of the RTC? For nearly all of human history, people have been finding ways to become intoxicated and for nearly that long they’ve been searching for ways to stop. There are innumerable protocols that have been developed for this purpose. Some are more well-known than others, such as Alcoholics Anonymous and its myriad of offshoot 12 Step Programs. Others involve various treatments that utilize processes such as cognitive behavioral therapy, harm reduction theory and the like. Still others offer “cures” involving various combinations of positive thinking, nutrition, designer drugs and the like while others are religiously-based.

The important thing to remember is it has generally been proven that there is no easy way to get clean and sober and recover from alcoholism and drug addiction. It is a long, arduous road that requires a tremendous amount of dedication and work from all concerned. So no matter what philosophy you feel comfortable with, if you and your loved one commit fully to it, the chances of success are greatly increased.