Residential Treatment

Substance-related residential treatment is characterized by service facilities that offer supervised, structured care 24 hours per day, 7 days per week to individuals seeking assistance with overcoming addiction. These facilities exist within a continuum of care, and it is assumed that individuals with severe addictions will [Page 787]benefit from a stable and controlled environment that removes the client from maladaptive lifestyles. Residential facilities are usually operated by either nonprofit organizations or private for-profit organizations, and payment for services can be made by clients as self-payers or from publicly funded sources (e.g., Medicaid). Individuals may enter residential treatment by self-referral or by referral from another party, such as an employer, physician, or social service agency.

Although there are several similarities across various programs, there are also many differences. For example, many residential programs are similar in that they are abstinence-based and require detoxification from alcohol and other drugs prior to admission. On the other hand, some programs support the harm reduction model and allow clients to attend treatment while engaged in a medically supervised methadone maintenance program. Furthermore, some residential programs operate an ongoing intake process, and others are closed programs where groups of clients start and complete the program together. The number of participants in a residential treatment facility depends on the bed capacity and staffing of the facility, and programs can range from 10 to 30 clients or more. The length of stay can also vary across facilities, with many programs lasting 4 weeks in duration and other programs lasting up to a year or longer. In the event that a client lapses during his or her treatment, some facilities will automatically discharge the client from the program, and others may attempt to work with the client to reassess his or her treatment plan and to retain the individual in residential treatment if appropriate (e.g., if the safety of the community is not severely compromised).

Many residential programs employ a multidisci-plinary staff that may include physicians, psychiatrists, psychologists, nurses, addiction counselors, family counselors, clergy, and other support staff in varying degrees. In most cases, some form of counseling (e.g., individual, group, family) is the predominant professional activity in treatment, and this service can be provided by professional counselors or by informal counselors (who may be in recovery from addiction themselves). In addition, many residential facilities require clients to participate in general activities, such as household chores (e.g., cleaning, meal preparation) and recreation, and these activities are intended to contribute to the development of a sense of community, cooperation, and support.

Throughout the entire process of residential treatment, there are a number of therapeutic modalities that can be employed. One fundamental distinction is whether or not a program utilizes the Twelve-Step philosophy (e.g., Alcoholics Anonymous, Narcotics Anonymous) as a framework to guide its activities. Another distinction could be the level of intensity that a residential program may provide, with some programs engaging in methods such as confrontation and experiential techniques (e.g., role play and self-disclosure), which may lead to strong emotional expressions or catharsis. Most programs incorporate didactic lectures to educate clients on addiction-related issues, such as the effects of alcohol and other drugs on the body, HIV/AIDS, nutrition, and exercise. Finally, many programs utilize cognitive and behavioral methods, such as desensitization, operant conditioning, assertiveness training, stress management training (e.g., progressive relaxation), and social skills training (e.g., drink or drug refusal skills).

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