Choosing Drug and Alcohol Treatment Centers: Types of Rehabilitation Facilities and How They Differ

Too often families and the addicts and alcoholics themselves are so desperate for help that they check into any available facility without understanding the differences in philosophy and approach. For some, the lack of investigation costs them the ability to relate well to staff and fellow patients, two very important factors in early recovery.

Methods and Modalities

Alcohol and drug addiction treatment has evolved over time to become more professional and policy-driven–but is this always a good thing? Remember that dealing with alcoholics and addicts–people who generally hate being told what to do and are most likely to rebel against authority figures–requires more than compassion and a desire to help. It requires understanding.

Social Model

Social Model recovery homes are based on 12-step philosophy. They are peer-oriented, which means help comes from one alcoholic/addict talking to another, reliance on a higher power of the individual’s understanding (not a specific religion), and personal willingness to face issues and participate.

Staff are known as advocates. They guide, facilitate, and maintain a supportive home-like environment. Residents are responsible for their own recovery. Advocates show by example how a program of recovery works in day-to-day life, because they are in recovery themselves. The successes of other alcoholic/addicts offer hope, and exposure to suffering newcomers and the loss of peers due to relapse demonstrate the seriousness of the disease.

Social model recovery homes offer educational and practical services, including orientation, group discussions, and recovery planning. The program of recovery is available in 12-step meetings held on-site. Faith and self-control are emphasized and the advocate-client relationship evolves. Recovering persons served are known as residents and peers, who support each other. Residents are responsible for their own behavior, and families are encouraged to participate.

Social model treatment may be less expensive, however as a general rule they do not accept insurance reimbursement. Only life-saving prescription medications are allowed. Referral to sober living facilities and continuing participation in 12-step fellowship and alumni associations, provide aftercare.

Social model facilities may be certified and regulated by the county and state in which they operate and may receive funds to assist people who cannot afford to pay. Most are run by non-profit organizations.

Clinical Model

Medical and mental health professionals staff clinical model facilities, they are known as counselors and therapists. The recovering persons served are known as patients. Staff assumes authority for patient care in a formal environment. Directive services include diagnosis, treatment planning, individual and group therapy. The emphasis of treatment is on etiology and insight; the therapist-patient relationship does not evolve. Staff accepts disruptive behavior and the role of the patients as ill. The family is ignored. Insurance reimbursement is sought, and prescription medications are frequently allowed.

Hybrid Models

Because of county and state regulations, most social model facilities have incorporated the certification of staff members. Many have also bowed to pressure to allow prescription medications for those clients that have underlying mental illnesses in addition to substance abuse problems. Treatment plans complement recovery planning, and optional visits to a professional therapist may be incorporated into treatment.

Because of better outcomes demonstrated by social model treatment, clinical model facilities increasingly are adopting and adapting some attributes of social model recovery. Participation of family and attendance at 12-step meetings may be encouraged.

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