The 9 Phase Continuum of Care
When I was in treatment I heard a lot about the continuum of care but no one ever outlined for me exactly what it was or what it would look like for addiction treatment. In this post I outline what the normal continuum of care looks like for someone who is trying to recover from addiction. I will also say from my own experience that I needed the whole care program that I followed in order to stay sober. Before I turned myself over to trusted professionals I tried a number of things on my own. I tried harm-reduction models, only going to recovery meetings, and going to only outpatient, all to no avail. It was not until I actually went to treatment and followed the care plan that mental health professional laid out for me that I was able to really commit to my recovery. I have now been sober for over five years and have been working in treatment for the past three.
Generally the first step when someone wants to stop using drugs or alcohol is to go to a detox. Some inpatient treatment facilities have their own detox while some will have you go somewhere else until you are ready to go to residential treatment. For many people a medically assisted detox is necessary because it can be dangerous to stop taking drugs or alcohol without professional help. When people are addicted to substances they go through physical symptoms of withdrawal. These symptoms might include shaking, fever, vomiting, and more. A detox facility helps treat these symptoms and make sure that people are safe. This means that they will usually not take someone off of the substance they are addicted to all at once but might wean them off slowly. Detox can last anywhere from a few days to a couple of weeks depending on what drug the person is addicted to. When the person is no longer physically dependent on the drug they are ready to go to residential treatment.
After detox it is recommended that people go to a residential treatment facility. Inpatient treatment is a great way to get someone out of the environment in which they were using. It is often recommended that someone go to treatment in a different city or different state than they used to live in. By doing this the person can commit to the program they are in without the temptation of knowing that all of their old friends and bars are waiting for them just down the road. Residential treatment is also a great way to focus on only recovery for a period of time. Usually, while in treatment the person doesn’t work or go to school. Instead, they commit to taking a break from these activities in order to just focus on recovery. Treatment centers will usually drive residents everywhere they need to go and provide food so that there is even less to worry about. While in treatment the person usually starts receiving one-on-one therapy, group therapy, and other holistic treatments. Treatment centers will also sometimes bring residents to recovery meetings or meditation meetings. This phase of treatment can last anywhere from 30-90 days. It is important to note that longer stays are associated with better recovery rates.
3. Intensive Outpatient and Sober Living
After some time in residential treatment, centers will often recommend intensive outpatient (IOP) and sober living. IOP entails going for the whole day to groups and therapy sessions. After a while this is stepped down to only half-days. Many inpatient treatment centers have their own IOP so people are able to continue working with the same professionals and be with the same group of people they were in treatment with. Sober living is a structured living environment where everyone is sober and there are professionals there all day and night. Sober living is like a bridge between inpatient treatment and living on your own. There are rules and curfews to follow but there is more independence than residential treatment. Often after some time residents are allowed to have their own car and go places freely. IOP can last anywhere from a month to three months and sober living can be anywhere from a couple of months to a year.
4. Therapy, Sober Coaching, and Meetings
After a few months of IOP it is likely that the treatment team will recommend someone stays in sober living but stops going to IOP. Rather than stopping all contact with professionals, it is suggested that someone continue with a therapist and or sober coach once a week. Additionally, it is always a good idea to continue going to whatever recovery meetings they have been going to. Often they are able to see a sober coach or therapist that they have already been working with. Sometimes the facility might offer a referral to a professional in its network of trusted people.
5. Getting a Job and/or Starting School
While still in sober living the treatment professionals someone is working with will usually offer help finding a job or starting school. This is where a sober coach is especially useful. They might do things like help fill out applications or help pick classes. It is great to do this in the safety of sober living and to have people who can offer support during this time of transition. It is good to add things back in slowly. This might mean only working part-time or going to school part-time at first. Professionals will also help someone decide when the time is right to start work or school. It is great to have other people around to make sure someone is on solid ground with their recovery before they start adding things back in.
6. Moving Out
Moving out of sober living is the next big step someone will take in their recovery. Sober coaching, therapists, sober living staff, and trusted friends can all be seen a source of support during this transition. It is great to stay in sober living until you have people recommending that you move out. One big mistake people make is to move out of sober living too soon. This is a big transition as it comes with more freedom and responsibility. Sober coaches might offer help finding apartments or filling out rental applications. Many people don’t move into their own place until they have about a year sober.
7. Building a Community
Once someone has moved in somewhere on their own or with other sober people, the focus becomes about building a sober community. Hopefully over the course of the first year sober this has already happened. At this time it might become more amplified by getting bigger commitments at recovery meetings or mentoring other people in recovery. Building a community is about finding supportive friends and mentors that will keep someone feeling held. Many people may begin dating other sober people and building new healthy relationships in their lives.
8. Check Ins
The next part of after care is about checking in and maintaining sobriety. This might mean going back to alumni recovery meetings at the treatment center someone went to. Alumni meetings can be a great way to show current residents that there is hope. It is also a nice time to check in with any staff that might have helped someone in their recovery. Checking in might also mean a monthly check in with a therapist. Additionally it can take the form of weekly meetings with a mentor in a recovery program. At this phase it is all about staying plugged in and connected with that community of sober people someone has built.
9. Being Involved
The final phase of the continuum of care is about being involved in recovery. Recovery does not have to be the focus of someone’s life but it is important to stay involved so that sobriety can be maintained. A great way to get involved is by speaking at recovery meetings or the treatment center someone went to. When someone speaks to people who are new about their own experience it can offer a sense of real hope. It might also help people to know what the recovery process looks like. Another great way to get involved is by offering to drive people to recovery meetings or mentoring people who are new to recovery. It is so helpful to be there for someone else as they are starting this process.
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