Levels of Treatment and 12 Step Self-Help Recovery Programs

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1 Read the following information. When you come to the questions (which are in italics), enter your answers to them in the space provided. Often a family crisis, such as the intervention of child welfare due to a child safety or risk issue, is the catalyst that promotes a chemical-abusing parent to seek treatment. Appropriate substance abuse treatment may be difficult both to find and to complete successfully; however, the right substance abuse treatment has been shown to be effective for families who have co-occurring child welfare issues. Example: A U. S. Department of Health and Human Services study of grantees of the Substance Abuse and Mental Health Services Administration (SAMHSA) who were operating substance abuse treatment programs targeting women and children reported that 75% of parents who successfully completed treatment remained drug free; 46% obtained employment following treatment; and 65% of parents children in foster care were reunited with their families. (1995) Generally, referrals for treatment result from an evaluation done by an addictions counselor or other staff person at a treatment facility. The appropriate level of care/treatment is determined by an evaluation performed by an addictions counselor. The evaluation will include consideration of the parent s: overall health and medical needs withdrawal symptoms and withdrawal history history of use (i.e., duration, specific drugs used, method of ingestion, progression) level of denial knowledge of addiction concurrent problems such as psychiatric/emotional issues history of alcohol/drug treatment family/social/employment supports motivation for treatment Following the evaluation, a level of treatment is recommended CDHS/Research Foundation of SUNY/BSC Module 1 Resource Guide (05/14/08) A52

2 There are approximately twelve levels of treatment and intervention. After each description of a level of treatment or an intervention, enter the specific name of the resource in your area. 1. How are referrals for substance abuse evaluations handled in your district/agency? Acute Care Hospital Detox: Short term, 3 to 10 days, monitoring of withdrawal symptoms. The length of stay is determined by the drug or drugs used and the medical withdrawal history of the parent. Acute care detox is not necessary for marijuana or cocaine use. 2. Acute Care Hospital Detox for parents I work with is available at: Specialty Hospitals: Some facilities are licensed, such as specialty hospitals for MICA (Mentally Impaired Chemical Abuse) patients. They may provide only alcohol and drug treatment or combine chemical and mental health treatment. Many specialty hospitals will include a detox unit that is licensed to medically treat withdrawal, which can be complicated. This type of medical detox unit should not be confused with a primary care unit in an inpatient setting. Primary care units monitor withdrawal where there is little likelihood of seizures, convulsions, DT s, or other medical or psychiatric complications. After the detox phase, specialty hospitals provide care similar to that provided by short-term inpatient alcohol and drug facilities. 3. Specialty hospitals that are available to parents I work with are: Long-Term Drug Treatment or Therapeutic Community: Length of stay varies from 3 months to 18 months. Parents need to have been medically detoxed or drug-free for 5 days prior to admission. Parents live in the facility and participate in the treatment program. 4. Long-term drug treatment resources or therapeutic communities that parents that I work with have access to are: 2008 CDHS/Research Foundation of SUNY/BSC Module 1 Resource Guide (05/14/08) A53

3 Short-Term Inpatient Alcohol and Drug Facilities: These were historically known as 28 day programs. Length of stay now varies from 7 to 28 days, averaging around 17 days. Managed care companies require compelling medical necessity for inpatient care reimbursement or failure at intensive outpatient treatment. While involved in inpatient treatment, the parent is housed in the facility and participates in the treatment program. 5. Short-term inpatient alcohol and drug facilities available to parents in my area are: Crisis Units: Historically termed sobering-up stations, they usually accept parents who are at a certain level of inebriation for the purpose of housing and monitoring as the person withdraws. They are generally not medical facilities. They do assess parents and attempt to motivate them for treatment. Referrals for follow-up treatment are generally made. 6. Crisis units available to parents I work with include: Halfway House: For people who primarily abuse alcohol, a halfway house may be appropriate. These facilities house parents and provide treatment at an outpatient clinic. Parents are usually not allowed to be employed. They are engaged in treatment, self-help, and vocational or educational programs. The length of stay varies with each facility and individual needs. 7. Halfway houses available to parents I work with are: Transitional, Supportive Living, or Sober Houses: There are a variety of housing opportunities that are tied to recovery from substance abuse. They vary in criteria for entry and retention, as well as in restrictions and supports. 8. Transitional, supportive living, or Sober Houses available in my area include: Outpatient Drug Clinics: Some are medically supervised while others are not. Length and types of treatment provided vary greatly. Some facilities offer only individual treatment while others incorporate group process and family treatment CDHS/Research Foundation of SUNY/BSC Module 1 Resource Guide (05/14/08) A54

4 Outpatient Alcohol Clinics: These clinics provide various levels of treatment, which include services for parents with alcohol abuse histories or parents who use a combination of alcohol and other drugs. Family members of substance abusers may also receive treatment. Day rehabilitation programs are usually the most intensive outpatient treatment. They can vary in amount of days, number of hours per day, and length of stay. They need to provide a minimum of five hours per day, five days per week. Intensive treatment day or evening may also be available and again vary in services. They range upward from a minimum of nine hours of treatment per week. Group therapy is usually involved in all levels of treatment at an alcohol clinic. Parents not involved in or needing intensive treatment can be helped through various group therapies varying in focus, intensity, and length of treatment. Individual treatment is normally used to monitor an individual s progress and to supplement group therapy. Individual sessions are also used to deal with sensitive or specific issues not appropriate for a group setting. Couple or family treatment may be available. This, too, can vary greatly from clinic to clinic. Some facilities have family education programs, family intensive treatment, codependency groups, and/or individual sessions. 9. Outpatient alcohol clinics available to parents I work with include: 12 Step Self-Help Programs: These consist of regularly held meetings at various locations throughout the community. They are based on the concept of Alcoholics Anonymous. AA remains the largest and most used self-help program. Other groups include: NA, Cocaine Anonymous, Rational Recovery; for families, AlAnon, NarAnon, AlAteen, and AlAtot. It is important for the child welfare worker to remember that these are self-help groups and not treatment. They are a significant help to recovering people and should be used. However, self-help participation can not be easily monitored by the worker CDHS/Research Foundation of SUNY/BSC Module 1 Resource Guide (05/14/08) A55

5 A listing of self-help numbers is available in telephone directories. Addiction treatment providers can also supply information on self-help groups in your community. 10. The locally available 12 Step Self-Help Programs can be reached by calling: Supportive Services: Since chemical dependency affects all aspects of a person s life and the functioning of the family, many services in addition to alcohol and drug treatment may be needed. It is incumbent on the child welfare worker to provide necessary services as identified in a family service plan. The help of the worker in facilitating access to adjunct services can smooth the way for persons engaged in treatment and recovery. 11. The following supportive services are accessible to parents on my caseload: Prevention Programs: Schools, community agencies, substance and alcohol clinics, alcohol councils, churches, and other community groups provide a variety of prevention services particularly aimed at youth. These can vary greatly in services provided. 12. The following prevention programs are offered in my area: 2008 CDHS/Research Foundation of SUNY/BSC Module 1 Resource Guide (05/14/08) A56