By definition, residential treatment means you are there 24 hours a day. There are two general types of residential treatment: long-term and short-term.
Long-term residential treatment usually lasts between 6 and 12 months, and often is called a therapeutic community (TC). Rehabilitation involves helping clients take responsibility for their life and learn how to contribute productively to society within the context of a community of counselors, others residents, administrative staff, and use of self-help groups like Alcoholics Anonymous. Treatment is structured, and often includes skills training specific to employment, parenting, and relationships. Research has shown that TCs can be adapted to special populations including adolescents, women, homeless people, and those with severe mental illness.
Short-term residential treatment usually lasts 3 to 6 weeks, but it some cases may last 2-3 months. There are a wide range of settings and programs, some based in hospitals, others operated out of resort-like compounds. Many treat clients utilizing a modified 12-step approach, while others advertise a more holistic experience complete with horseback riding, massage, yoga, and five-star meals. And as you might imagine, there is a wide range in cost as well. Some are free due to costs being covered by the government, while others can run you up to $2000/day.
Both short and long-term residential care is based on the idea that once you complete treatment, you remain engaged in treatment on an outpatient basis and utilize self-help groups for additional support.
Benefits of Residential Treatment
- Life-saving. If you are assessed for residential treatment based on criteria outlined in the levels of care, then the most significant benefit of residential treatment is that it hopefully will save your life. Every day more than 100 people die from addiction, most from overdoses on pain medication or heroin. It will save your life because you are there 24 hours a day, which means that there is no access to your addiction. The idea of residential treatment being “life-saving” is why many enter such programs, and parents push their addicted children into them. And the truth is that for some people, residential treatment leads to an important turning point in life that truly is “life-saving.”
- Brain healing. Addictive behavior over time alters the brain physically, hijacking it in ways that makes stopping addiction feel like you have to hold your breath for ten minutes. This is why the National Institute on Drug Abuse champions the idea that addiction is a brain disease. But the good news is that while addiction can eventually hijack the brain, control can be taken back when addictive behavior ceases. Abstinence – even for a number of weeks – can significantly contribute to healing the brain! So residential treatment can play a critical role in positive outcomes by simply keeping someone away from their addiction long enough for the brain to recover some control.
- Time-out. Life can be overwhelming and there are times when those who struggle with addiction can benefit from fully disconnecting from the chaos of everyday life. Residential treatment offers a safe environment for the head, heart and soul to rest, heal, and prepare for reengaging in life without addiction. Much of this work happens due to the benefits of structure, significant doses of social support, and a continued focus on recovery.
- Ah-hah moments. We know from research and outcomes associated with focusing, that change occurs when we awaken to new truths and insights about ourselves. The most powerful occur when we have “ah-hah” moments where something clicks inside us and we understand something like never before. While it’s not necessary to be in residential treatment to experience such moments, due to the high intensity of treatment when engaging 24/7, the opportunities for “ah-hah” breakthroughs are enhanced.
- Team approach. Unlike outpatient where you might see a counselor for therapy, a nurse practitioner for medications, a nutritionist for diet, and a primary care physician for pain management, in a residential setting you often have access to all these folks who are working together on your behalf. While the team does not follow you once you are discharged, there is a tremendous benefit in putting all the pieces of care together in one place and, then having a team of experts help you plan how to continue the care once you are discharged.
Downsides of Residential Treatment
- No better outcomes than outpatient, but much more expensive. You would think that you pay for what you get, but in the world of treatment, this is simply not true. My friend Dr. Dennis McCarty and his colleagues published a review comparing residential to intensive outpatient, and concluded that in most cases, residential care produced no better outcomes than intensive outpatient. This is a very significant finding because the cost differential between intensive outpatient and residential can be significant.
- Acute care for a chronic problem. At a conference not long ago, I spoke with a marketing representative from a highly acclaimed residential program that said they had reduced their 28-day program into a 14-day stay, while still maintaining positive treatment outcomes. I asked how this was possible given that addiction is a chronic condition with underlying adverse childhood traumas and developmental deficits and constrictions that require years – not months – to treat and overcome. As you might imagine, our conversation became uncomfortable when I continued to press for specifics and the marketeer was unable to backup claims of positive treatment outcomes.
- Death. In 2012 a report from the California Senate Rules Committee titled Rogue Rehabs: State failed to police drug and alcohol homes, with deadly results provided evidence that a number of residential facilities were in grave violation of standards of care leading to multiple deaths of patients while in treatment. While almost hard to believe, the report found that programs that were supposed to be life-saving, in some cases: (1) never did any formal evaluation after a patient died in treatment, (2) stayed open for business despite serious state violations that should have resulted in their closure, (3) failed to realize clients had died while doing breathing checks, and (4) provided medical care when not licensed to do so. One case highlighted in the report, the death of Brandon Jacques, was covered in detail by Senior Editor at VICE Wilbert Cooper in the story: A 20-year-old went to rehab and came home in a body bag. Want another example? Read about 28-year-old Ryan Rogers who entered residential treatment for an alcohol use disorder and was dead 17 days later.
- Profit motive. If you call an 800 number advertised on one of the programs that rank high on search results for addiction treatment, you will likely be asked a series of questions to verify whether you have insurance or money to pay for treatment. If you do, then a sales pitch often begins as to why the program you called is right for you (no matter the addiction in most cases). But if you are not a prospect for filling a bed, see how quickly they get you off the phone. Let’s be clear, treatment is a 30-billion-a-year industry, with venture capital firms calculating rates of return on patients struggling to save their lives. Don’t believe me? Bloomberg Business ran the story Addiction treatment goes public: American Addiction Center’s Recovery-Center Empire documenting how CEO Michael Cartwright took his eight facilities public, raising 75 million in an IPO. Now valued at over a half-billion dollars, Michael flies between programs in his private jet.
In summary, there are some very significant pros and cons to residential treatment. In most cases, I believe outpatient services can be utilized at a fraction of the cost and produce equal, if not better, outcomes. And the research bears this out as well. But there are times when residential treatment is the right thing to do.
If you are unsure whether residential treatment is right for you, I urge you to read the links on this page, study the material on this website, and get an independent evaluation by a professional clinician in private practice who can help you weigh the pros and cons of residential care versus intensive outpatient. And if you are still unsure, feel free to contact me.