RehabPath

The Ultimate Guide to Choosing Treatment

Intro

Trying to find substance abuse and mental health treatment that meets your needs can be overwhelming. Why? Well, one main reason is we often don’t know where to even begin and we have misconceptions about “rehab” and recovery. When someone breaks a bone, most of us lay people have common knowledge about treatment protocol: See a doctor, get an X-ray, get a cast or sling to hold things in place to allow healing, go to follow-up appointments, and so on.

But what about when you find out a loved one has been injecting heroin? Or when you see signs in your child for something amiss—are those mood swings “normal” or does their depression and anxiety need clinical attention? Is your teenager’s drug and alcohol use experimental and they’ll grow out of it or should you not wait to find out?

Then, when you do decide to seek out treatment, you’ll find a world of options, approaches, and therapies. How do you know which one is right for you or the person you care about? Combine it with the fact that not all treatment centers are good. How can you tell which one offers quality care from the ones who are in it just for the money? You’ll also run into logistical hurdles, such as insurance, payment, and leave from work, and social hurdles like stigma.

You get the picture—it’s absolutely overwhelming and finding hope along the way to long-term recovery can seem near impossible.

It should not have to be this way! So, we created this guide because we want to support you in getting help—in a genuine, no-strings-attached way.

Getting Started: Navigating Pre-Treatment

We identified 7 steps for navigating getting into treatment. We’ll take a closer look at each one.

  1. Recognize the need for help.
  2. Get an assessment/evaluation (by a licensed professional).
  3. Consider the recommended treatment options.
  4. Find a treatment provider.
  5. Call the treatment provider (and ideally, schedule a tour).
  6. Set a start date.
  7. Go!

The Short Version

Since we just mentioned how overwhelming finding treatment can be, here’s the most concise version of the above 7 steps. If you’d like to dig deeper, you can keep scrolling or jump to certain sections using the Table of Contents.

1. Recognize the need for help.
If you’re reading this, you or your loved one needs help. (Why? We often wait too long when it comes to mental health concerns to finally do some research about it.)

2. Get an assessment/evaluation.
Mental health and substance use assessments are best done in person with a clinician. Ask your primary care physician about psychiatrists they’d recommend or if they know of experienced licensed professional counselors in the area. You may be able to find a local treatment provider who offers stand alone assessments without having to commit to a program.

It’s important to get a clinical assessment before you decide which treatment program is best for you. Let an experienced clinician help you know which treatment option is best for your needs and ask them questions about any concerns you may have.  

3. Consider recommended options.
At the end of the assessment, the clinician will recommend treatment options based on the severity of your condition (e.g. an inpatient or outpatient program). They may also recommend treatment providers (if not, ask them for provider recommendations).

Great, now you’re much more equipped to find a treatment provider!

4. Find a treatment provider.
Take a look at the recommended providers’ websites. You can search the internet for other providers too. The SAMHSA treatment provider directory is a great resource for finding treatment providers in the US.

Here are just a few things to pay attention to:

  • Do they have Joint Commission or CARF accreditation?
  • Do they have a team webpage showing licensed clinicians?
  • Do they have pictures of their space? Does it look comfortable, safe, and clean?

5. Call (and ideally, schedule a tour)
Give the treatment provider a call. Ask them to describe what a day (or week) in their treatment program looks like. See if they accept your insurance and discuss the costs. If possible, schedule a tour and see the center in person beforehand.

6. Set a start date
Once you have decided on which provider to partner with for your care, set a start date. This is easy—Start as soon as possible.

If you’re participating in a residential program, look on the provider’s website or ask for a packing list so you know what things to pack (or not to pack).

7. Go!
Yes, you’re here! Now you just need to stay and get the most out of your treatment program.

1. Recognize the Need for Help

Chances are that if you’re reading this guide you’ve already done this step. Lovely, that was easy! A few important notes before we move on though:

Be sure to be honest with yourself. Don’t choose recovery just because your __ (mom, dad, husband, wife, partner, brother, sister, daughter, son) ____ wants you to. Obviously, having loved ones in your corner is a good thing! But if you’re not in the ring, treatment may not be as effective.

*Loved ones, this does not necessarily mean treatment will not work if your loved one does not want it. Some recovery stories start with family basically forcing their loved one into treatment, like in the video below (caution: the video shows substance use):

We often convince ourselves that we do not need treatment for drug and alcohol abuse, addiction, and mental health disorders. A variety of reasons sway us against treatment:

  • Denial
  • Stigma associated with mental health and its treatment
  • Fear of the unknown
  • Difficulty of getting into treatment
  • Change is extremely hard

Denial

Denial is a very powerful part of mental health issues, especially drug and alcohol addiction. This is worthy of its own article. Read more about denial (specific to alcohol use) here.

Intervention

This is another topic worthy of many articles, but we’ll try to describe it briefly. Intervention is basically when you recognize your loved one needs help, but they do not (or at least, are not coming forth to admit it), and you encourage, or in some cases force, them to get help. “Intervention” is often used to describe a professional intervention by an interventionist.

Ways to Intervene

Informal, small personal question. Yes, intervention can be as simple as asking your loved one if they would like to get help. They often know they need it, but are too afraid to stop or ask or take the first steps toward getting it. Be opportunistic when you ask; that is, don’t ask when they’re high or drunk. You could lead with stating a behavior you have observed or your concern for their health. Tone and coming from a place of love, support, and willingness to help (not judgment, anger, or shaming) is very important.

Example 1

“May I ask you a personal question? … Would you like to get treatment (for the way you __drink, take pills_)?”

Example 2

“I love you and I’m concerned that drinking is having negative effects on your life. I’ve noticed that when you drink, you drink a lot and miss work the next morning. Would you like to get help?”

If they say no or blow up at you, avoid being defensive in return. A simple “Okay.” will do. Walk away if you have to, and start considering a bigger intervention.

Formal, 2+ person intervention. A variety of intervention styles exist with different levels of effectiveness. Confrontational, ARISE, systemic family, Johnson, and love-first models to name a few. Do-it-yourself intervention literature is available too, if you are hoping to save money by not hiring a professional.

This video is a family who set a few ultimatums to encourage their family member to get treatment:

However, hiring a professional interventionist is generally going to have higher chances of convincing your loved one to go to treatment. Most interventionists are in recovery themselves, which helps them understand your loved one (they’ve been in those shoes before), they have a lot of experience compared to you doing it on your own, and they are a third-party who may see and help with issues you might not have noticed since you’re deeply involved in the situation.

Questionnaires

Be Cautious About the Results

A quick word on questionnaires and quizzes that gauge if someone has a drinking, depression, etc. problem. They can be a helpful tool, but keep in mind its accuracy varies per person and per the organization behind the quiz (that is, the validity in the way they’ve designed it).

Another thing to be cautious about is these quizzes and questionnaires can be a form of denial or procrastination. In other words, don’t wait for a questionnaire result to tell you that you’ve reached the threshold for needing treatment. If you know that something is not right, or that alcohol and drug use is having a negative impact on your life, then stick with your gut. You do not have to be a full-blown addict or have deep depression to seek out treatment. The earlier you receive treatment for mental health conditions, the higher the likelihood for your long-term recovery. On the flip side, if the questionnaire result says you likely have a problem, then you likely have a problem and probably don’t need to fill out 5 more quizzes to confirm it.

“You do not have to be a full-blown addict or have deep depression to seek out treatment.”

2. Get an Assessment (Evaluation)

Just like you would go to the doctor to assess a broken bone or a suspicious lump, you should go to a mental health professional to assess behavioral patterns that are interfering with your life.

What Is an Assessment?

A clinical assessment, or often called evaluation, takes an hour or so where the clinician gets to know you, your story, and ask questions about your medical history, substance use, and mental health. Based on the assessment, the clinician will then go over recommended treatment options with you. With their recommendations and your own personal preferences, then you are able to decide which treatment option is right for you and what type of center to start searching for.

How Much Does an Assessment Cost?

Insurance may cover the assessment or you may have to pay for it out-of-pocket. Typically, an assessment costs $100–500. If you have an flexible spending account (FSA) or health savings account (HSA), you may be able to pay for it that way. Double check to be sure it’s an eligible expense.

Where Do I Get an Assessment?

A mental health professional should conduct your assessment in person. To find one, start by asking your primary care physician about psychiatrists they’d recommend or if they know of experienced licensed professional counselors in the area. You may be able to find a local treatment provider who offers stand alone assessments—conducted by one of their licensed professional counselors—without having to commit to a program.

Why Is an Assessment Important?

An assessment helps you and treatment professionals know where you’re at and offers insight for  possible care plans that fit your situation.

Currently, it is more common for people to make treatment decisions themselves, either after researching endlessly, going with what insurance coverage dictates, or what an admissions coordinator helps them decide. We believe people should find treatment that’s right for them, but also believe appropriate experts should be involved to help support and guide you toward treatment options that best fit your needs and preferences.

Treatment providers often perform a full clinical assessment as the first step in your treatment, after you’ve already committed to a program at their facility. However, if you’ve flown across the country to attend a residential program and the assessment reveals you are not a fit for their services, then you will likely get referred out to a different center. To mitigate this, admissions teams will do their best to make sure you’re a fit before you travel and come, and often providers will conduct an over-the-phone pre-assessment.

3. Consider the Recommended Treatment Options

Now you should have some treatment options recommended by a professional based on your assessment. Let’s take a look at the main ones.

Detox

Detox is where your body is getting rid of toxins (i.e. drugs and/or alcohol). Medically-supervised detox provides safety and comfort as you go through withdrawal.

Inpatient

Inpatient, commonly called residential—and what most mean by “rehab”—provides 24/7 support in a residential setting. Programs commonly last 30, 60, or 90 days.

Day

Day treatment, or PHP, offers full-time treatment, similar to inpatient, yet the living arrangement is separate, either at home or in a sober living environment.

Outpatient

Outpatient treatment varies in intensity, from group therapy once a week to group therapy, individual counseling, and educational lectures multiple times a week.

MAT

Medication-assisted treatment refers to using medications in combination with counseling or therapy to help people recover from addiction.

Counseling

Counseling includes meeting with a primary therapist (or counselor), individually, as a couple, or even as a family.

Sober Living

Sober living environments provide a safe, drug-free space to live.

Support Groups

Support groups (e.g. AA) generally are free and flexible in attendance.

Detox

Detoxification, or detox, is the period of time where an individual is withdrawing from drugs and alcohol. A doctor will prescribe medications, usually on a titration (gradually less and less), to help keep symptoms as comfortable and safe as possible.

Inpatient, also called Residential

Inpatient “hospitalization”, or residential treatment, is what many know as and call “rehab”. An individual resides and receives treatment at the provider’s facilities. Some providers have all the buildings on a single “campus”, while others may have houses nearby and provide transportation to the clinical portion of treatment during the week. Therapies and approaches vary per center.

Day Treatment, also called PHP

Day treatment, or sometimes called PHP (which stands for partial hospitalization program), is just that, treatment during the day full-time, but living is separate. Sometimes living could be in an individual’s own house, a sober living house, or a “structured” living environment (often owned by the same provider).

Intensive Outpatient (IOP)

Intensive outpatient treatment, or IOP for short, can be thought of as part-time treatment. Some IOP programs run cohorts, that is, an individual will be with the same group of people throughout the program. Other IOP programs will have the opposite, sometimes called rolling enrollment, where people can jump into the program at any point.

Outpatient (OP)

Although outpatient treatment is a general term that can mean varying levels of care in which you’re not living on premises, it’s also used to describe the lightest level of outpatient care. Other names for this level are “continuing care” or “aftercare”—both can be confusing since that sometimes describes any care after initial treatment.

Sober Living

Sober living is just like it sounds, a drug and alcohol free place where an individual can live. It goes by other names (some have nuanced differences):

  • Sober living environment (SLE)
  • Sober living home / house (SLH)
  • Structured living
  • Transitional living
  • Halfway house

Support Groups

The most common support, or self-help, groups are 12-Step meetings, so AA, NA, Al-Anon, etc.. There are other alternatives too: SMART Recovery, Women for Sobriety, Celebrate Recovery, and LifeRing.

4. Find a Treatment Provider

This step is very important. You’ll likely be able to receive some center recommendations from the assessment. Get ready to put on a detective hat and do some research though.

First and foremost, you’ll want to make sure the treatment providers you’re choosing from have the following characteristics:

  • Reputable
  • Trustworthy
  • Accredited and/or Trustworthy Affiliations
  • Quality
  • Licensed professionals

Then, you can weigh differences in approach, amenities, location and cost.

Must-Have Characteristics

Reputable

Does the treatment center have a good reputation? What do others think of it? How can you find that out? Here are some strategies: read reviews and ask others.

Read online reviews.
The big three sources for reviews currently are Google, Facebook and Yelp. At the same time, take the reviews for what they’re worth. That is, take extra time discerning really bad and really good reviews:

  • Some providers encourage their employees, family members, and friends to leave reviews. These reviews may still follow the guidelines of the review platform, but obviously, the raving review is biased. A quick comparison of the team page and names attached to reviews may uncover employee reviews. It actually adds more credibility if the reviewer discloses they’re an employee in the review.
  • Sometimes ex-employees will rant about the provider when there were legitimate reasons for the provider firing them—also biased.
  • Providers could be delivering the best treatment in the world and still have an upset customer who leaves a scathing review. If there are multiple bad reviews of similar issues though, then there is most likely truth to the issues they raise.
Ask around.
You might be wondering who to ask.
  • Often primary care physicians do not know of many centers, but asking your doctor is a good place to start.
  • Ask your primary therapist (if you’re seeing one).
  • This may seem odd, but if you’re on the phone with a treatment center who appears to be trustworthy, ask them if they’ve heard of the other provider you’re curious about and what they think of them. Naturally, they will be biased toward their own services, but their answer will likely have some truth to it.
  • Attend an open AA meeting and in side, individual conversations, ask the person if they’ve ever heard of the particular treatment provider(s). (AA doesn’t allow “endorsements”, thus the emphasis on side, personal conversations.)

Trustworthy

Trustworthiness is very similar to good reputation, yet slightly different. Is the center reliable, honest, and ethical? Here are some characteristics to consider: length of operation, accreditation, and affiliations.

Length of operation
This may not always indicate trustworthiness, but generally speaking, if a provider has been around for a long time, they likely provide good services. Sometimes newer providers offer great services too, so do not necessarily avoid a provider simply because they are newer, but do look for accreditations and affiliations (or that they’re working towards getting them) to make sure they’re legitimate.

Accreditation
Accrediting bodies have set standards of excellence for operation, quality, and safety. They certify a provider when they have met requirements and help keep providers accountable to them. Unfortunately, a few providers may be accredited and not following the standards, so accreditation is not an absolute stamp of approval. However, it is certainly a good sign to see accreditation compared to providers who are not accredited.

If accredited, most providers will have an accreditation “badge” on their website. (Yes, some could dishonestly put the badge on their website, but you can double check the accreditation organization’s website to be sure the provider is indeed accredited.)

Here are the two main accrediting bodies for behavioral healthcare in the United States:

joint commission seal

Joint Commission

(formerly known as JCAHO (“jay-co”))

You can check for Joint Commission accredited providers here: https://www.qualitycheck.org/

carf seal

CARF

(Commission on Accreditation of Rehabilitation Facilities)

Check for CARF accredited providers here: https://www.carf.org/providerSearch.aspx

Trustworthy affiliations
Many providers will also have badges or logos of other organizations to show affiliations. Certain affiliations are more credible than others. Some providers will have state-related ones or ones related to addiction professionals.

Instead of listing them all, we want to point out 3 important affiliations (in the United States). Just like accreditations, affiliations are not necessarily an automatic stamp of approval, but they certainly help in the trust category.

NAATP logo, hexagon of triangles, purple, orange and gray, National Association of Addiction Treatment Providers

NAATP

(National Association of Addiction Treatment Providers)
NAATP (“N-double-A-T-P”) members must meet a set of standards. If interested, you can read the Code of Ethics their members must agree to.

Search the NAATP provider directory here: https://www.naatp.org/resources/addiction-industry-directory

Trusted Provider Network

(TPN)

This network is geared for treatment professionals when they need to refer a client to another provider. Although it’s professional-targeted, it adds trust for clients too. TPN members must meet a code of clinical services, ethics, and professional standards.

Search for TPN providers: https://trustedprovidernetwork.com/provider-search

LegitScript badge example, blue circle with green bar containing site url and white box with date "LegitScript.com Monitored"

LegitScript

If any badge is a stamp of approval right now, it’s this one. Google partnered with LegitScript to better control which treatment providers are allowed to advertise (safe and legal ones!). Facebook relies on this for treatment provider ads too. If a provider is not LegitScript certified, they may still be a safe and legal. LegitScript certification started slowly rolling out in July 2018, and it’s not cheap.

LegitScript does not list a directory, but you can check a provider’s website to see if they are LegitScript certified here: https://www.legitscript.com/websites

Quality

If a treatment provider is accredited and/or has credible affiliations (see the Trustworthy section), then it most likely offers quality care since it is a key component for receiving the accreditation or certification in the first place.

What does quality care look like?
Quality care, of course, is always up for improvement, yet most can agree on certain standards of quality. After all, behavioral healthcare has come a long ways from methods of the past (such as lobotomies, confinement (although some countries still approach treatment this way), straightjackets and the like).

Here are some standards of quality:

Evidence-Based Practices

(EBP)

Evidence-based practices sounds complicated, but its meaning is literal. Practices are based on evidence. The evidence comes from best available evidence (from academic research), as well as the clinician’s own expertise, and with regard to patient values and preferences.If you do decide to research this deeper, keep in mind that academic research uses the word “intervention” to generally describe a therapy or treatment. University of Washington Alcohol and Drug Abuse Institute put together an EBP database that anyone can access here.

Licensed and Skilled Professionals

This should be a given, but licensed and skilled mental health professionals should be providing treatment services. (Of course, people need to start a career somewhere, so some clinicians may have less experience than others or may be working toward a specific certification, but they should only make up part of the clinical team.)

Integrated Care

 

Integrated care most often refers to general (physical) healthcare and behavioral (mental) healthcare working together.

The World Health Organization (WHO) put together a QualityRights Tool Kit which has guidelines for quality services. Some of these guidelines we may take for granted, but they are worth noting since they have been neglected before:

  • Services respect human rights (e.g. dignity, privacy, liberty).
  • Services provide an adequate standard of living. (For example, the building is in good condition. Sleeping conditions are comfortable and have sufficient privacy., etc.)

What to look for on website, brochures, etc.
Many providers will include phrases like “evidence-based” and a “multidisciplinary team” on their materials. Many will claim to treat “dual diagnosis” or “co-occurring disorders” as well. These are all good, but it’s challenging to tell if the descriptions are true.

Current industry “buzzwords”:

  • Evidence-based
  • Multidisciplinary
  • Holistic
  • Individualized
  • Personalized
  • Dual diagnosis
  • Co-occurring disorders
  • Trauma, trauma-informed care

So rather than just look for the keywords many treatment providers are using, also take a look at the following:

  • Sample schedule: A sample schedule (by day or week) helps you visualize what the program may be like and how “holistic” or “individualized” it actually is. For example, you may see that a residential program who boasts individualized care only provides 1 individual counseling session per week.
  • Photos of the space: Often stock photos make up the photos on websites and brochures because they’re the easiest to get. However, you want to see photos, or video, of the real space, both inside and outside. Do the spaces look comfortable and clean? Some treatment providers will simply take photos of the rooms empty. It’s nice to see people interacting with the spaces, but due to privacy these photos are harder to come by. Some ask patients to sign a release form to publish photos of them. Other treatment providers may stage a photo session with “models” and their own therapists.
  • Staff bios: If a program claims to be holistic, are some of the clinicians trained in alternative therapies? If a provider claims a multidisciplinary team, does the clinical team have varying disciplines? More importantly, do they work together? To tell if the staff actually collaborate to provide a multidisciplinary approach, you may have to ask the admissions person when you call (“Can you tell me more about what multidisciplinary looks like? Does the entire clinical team meet and discuss client cases?).
  • Treatment approach and therapies: Reading through the approach and therapies will also help you see if a program has evidence-based (e.g. cognitive behavioral therapy (CBT)) and/or holistic therapies (e.g. yoga, acupuncture).

Differences to Consider

Treatment Approach

A variety of treatment approaches exist. Many centers will combine multiple approaches and some will adjust the approach and therapies to meet your needs. Look for or ask about a provider’s treatment philosophy to see if it resonates with your preferences and values. Here are the most common treatment approaches:

  • 12-Step or a modified 12-Step
  • Non 12-Step
  • Holistic (alternative)
  • Evidence-based
  • Systemic
  • Faith-based (or spiritual)
  • Therapeutic community

Family Involvement

Many addiction professionals agree that substance use disorders affect the entire family, so most providers will offer a form of therapy for the family. Each provider varies. Some have a family day every week that includes time for the family to meet with the loved one’s therapist and families to meet together (sometimes called multifamily group). Others may have a family week with various therapy sessions.

Location

Perhaps the biggest question for location is does one partner with a local provider for treatment or go to a “destination” treatment center. Each has its advantages and disadvantages.

Distance
  • Some find the total break from environment beneficial to their recovery.
  • Going out of state, or even out of the country, likely adds privacy and confidentiality.
Local
  • The closer location makes it easier for family to be involved.
  • The transition into a recovery community after completing a program will be smoother.

Amenities

Accommodations, activities, and food certainly impact a treatment experience (for better or for worse). Naturally, some conditions must be met (like cleanliness and catering to dietary needs), but for the most part, amenities are “nice-to-have” not must-have.

It’s challenging to make a decision without being swayed by a provider’s amenities because they are so visual. You see a beautiful location, delicious food, a glistening pool, fun activities, and so on. The treatment itself is much harder to capture visually. Be sure to read and ask about the treatment though. Once you know a provider has a quality treatment program, then let amenities factor into your decision.

To some degree, a treatment environment should be comfortable and conducive to recovery. Consider how much your comfort level will be impacted by accommodations. If you are not comfortable, then it may dampen your treatment. (Note: the first few weeks of treatment, you may be miserable regardless of accommodations and amenities.)

A few “gray” areas:
A treatment provider who has a really good program, but looks like an awful place to stay—Ask yourself a few questions:

  • Why does it look like an awful place to stay?
  • Did they simply take bad pictures and it may look better in person?
  • Is there something I care about too much that is not a big deal compared to the treatment I’d receive?
  • Is there another treatment provider who has a good program and looks like a better place to stay?

A treatment provider who has amazing amenities, but a semi-quality treatment program—Ask yourself a few questions:

  • Is there something I care about too much that is not a big deal compared to the treatment I’d receive?
  • Are the amenities worth possibly needing more treatment in the future?
  • Is there another treatment provider who has a better quality program and still looks like a comfortable place to stay?

Cost

Cost, particularly insurance coverage, is an important deciding factor for many people. See if the provider accepts your insurance and what the out-of-pocket costs would be.

Many providers offer payment plans and some offer “hardship” scholarships.

5. Call the Treatment Provider (& Schedule a Tour)

Call the Treatment Provider

This step can happen simultaneously with the previous step of finding a treatment center. Calling a treatment center is the fastest way to find out more information that perhaps is not listed on their website. Although the call will be based on one interaction with one employee, that interaction can go a long way for informing your gut if you’d like services from that treatment provider.

Rather not talk on the phone? Some centers have live chat on their website or online forms that you can use to ask questions or even request that they call you. Some are also responsive over Facebook Messenger. (Eventually, you will have to talk on the phone.)

Schedule a Tour

The surest way to figure out if a treatment provider is right for you is to visit the center. Understandably, this may not work if you live very far away. However, if you’re able, definitely schedule a tour, go and see the place in person and meet some of the staff and clinical team before you agree to admit.

6. Set a Start Date

Start as soon as possible.

The thought of taking 4 weeks or more off often holds people back from treatment they need. Definitely ask the treatment professional at the end of your assessment how soon they recommend you starting treatment. At the same time, do not underestimate the urgency to get into treatment.

If you are struggling with severe substance use and/or mental health conditions, start as soon as possible—your life is at risk. If you are struggling moderately, it’s still an urgent matter. Each time you abuse substances, you continue to damage your health, jeopardize your job and possibly legal record, and harm your relationships.

7. Go!

Now, it’s just a matter of logistics for getting to the center. If it’s a residential program, look on the website for a packing list (or ask them for one). Some providers list “What to Bring” and “What NOT to Bring” on their website, while some may email expectations, rules, and so on.

Once there, stay and get the most out of your treatment program.

After the first week or so in treatment, you might be tempted to leave. One exercise you can do is write yourself a letter before going (or on the first day of treatment) about why you’re there and what your goals are for after treatment. Maybe take a selfie too. Read that letter and look at the photo; they may help support you to stay.

Note: We are not affiliated with any of the parties referenced. Duffy’s Napa Valley Rehab does advertise on one of our sites, but we included the video solely due to its quality content.

Most Helpful