CHAPTER 30
Treatment Settings
LEARNING OBJECTIVES
After studying this chapter, students should be able to:
• 30.1: Define and identify various types of outpatient rehabilitation programs
• 30.2: Understand the advantages and disadvantages of outpatient rehabilitation
programs
• 30.3: Define and identify various types of inpatient rehabilitation programs
• 30.4: Understand the advantages and disadvantages of inpatient rehabilitation
programs
• 30.5: Define and identify various types of aftercare programs
CHAPTER OUTLINE
An Introduction to Outpatient Treatment
Outpatient Treatment: A Working Definition
Components of Outpatient Treatment
Varieties of Outpatient Rehabilitation Programs
Advantages of Outpatient Rehabilitation
Disadvantages of Outpatient Treatment Programs
Introduction to Residential Treatment Programs
Definition of Inpatient Treatment
Hospital-Based Residential Treatment
Therapeutic Communities
Is There a Legitimate Need for Inpatient Treatment?
The Advantages of Inpatient Treatment
Disadvantages of Residential Treatment
Aftercare Programs
Partial Hospitalization Options
Aftercare Programs
Halfway Houses
Sober Houses
CHAPTER OVERVIEW
For many students, when you mention the phrase “substance rehabilitation” they think of the
portrayals of this process either seen in the movies or on television. In reality “treatment” or
“rehabilitation” can begin (or take place) in a variety of settings. Imagine two men on a golf
course: one of them turns to the other and says, “Did you see how I managed to ‘slice’ that ball?
Sometimes the addictions are like that—we mean to use them for one purpose, only to have the
outcome be far different!” This could be said to be a form of “treatment,” if only by drawing an
analogy between the poor golf shot and how the addictions entrap the individual. In this chapter
we will look at some of the more common treatment settings.
DISCUSSION QUESTIONS
Break-Out Discussion #1:
What constitutes “treatment?” It often surprises students and the general public that, unlike in
the world of medicine, there is no standard definition of treatment. While various schools of
thought might advocate different treatment methodologies to treat the same condition in
medicine, they all have the same goal: control or elimination of the disease state.
1
Differences in
treatment philosophies are not uncommon in the world of medicine. However, they are seen at
their most extreme in the world of substance rehabilitation. Would providing three meals a day,
medical supervision, and quiet time in which to contemplate one’s problems or walk through
the woods qualify as “treatment?” What if the client were required to attend one 12-step group
meeting a week and one educational lecture a week?
Questions
1. What constitutes treatment? Can both of the above suggestions be considered treatment?
Why or why not?
2. Imagine, if you would, an ultra-elite “rehabilitation” program that provided yachts for its
“guests” to use during the afternoons, massage therapists, tennis courts, and gourmet meals,
with the occasional optional lecture or individual counseling session. Could this be considered a
“rehabilitation” center?
3. Should a wealthy celebrity be required to attend a community support group in which other
members could violate the confidentiality of the treatment center and reveal the celebrity’s
secrets? How do you balance the needs of a true rehabilitation program, if such could be
defined, against the client’s status? Can you think of a scenario in which you would feel justified
in making an exception to the norms of treatment because of who the client was? What factors
would affect your decision?
Break-Out Discussion #2:
Treatment planning in special cases: Imagine a situation in which the conclusions of the assessor
called for a person to be admitted to an inpatient rehabilitation program. However, the
individual is unable to accept this recommendation because he or she is the primary care
provider for children or a disabled spouse, is the primary source of income for the family and
does not have health insurance benefits that will pay for residential treatment, and so on. Now
you are faced with a dilemma very similar to that of the physician who has a patient who
responds to the recommendation for surgery by saying, “I can’t afford to take time off from
work to recover! I have to find a job! Can’t you do something less drastic?”
Questions
1. What do you do if the patient’s position in life will not allow him or her to participate in the
recommended form of treatment?
2. Should you allow the client or patient (depending on who is working with the individual at the
moment) to refuse the recommended treatment, would you be acting in the individual’s best
interests? How do you balance the patient’s needs against the patient’s desires? This is an
3. To complicate matters, substance rehabilitation professionals know that some clients will ask
for the less intrusive outpatient treatment modality because it has been possible for them to
continue misusing alcohol or illicit drugs when in an outpatient rehabilitation program in the
past. For example, a client might drink alcohol in the morning, safe in the knowledge that the
alcohol will be biotransformed and that he or she will test “negative” for alcohol by the time of
an evening therapy group. How do you identify which cases should be referred to a lower level
of care, and those that you must insist enter the recommended treatment program? Can you
defend your answer?
KEY CONCEPTS AND TERMS
Outpatient substance rehabilitation program: A formal treatment program, involving one or
Inpatient substance rehabilitation treatment: A treatment setting that provides a 24-hour
treatment milieu, with staff members on duty 24 hours a day
LO/STANDARDS CORRELATION CHART
A-head
LO
Standard—CACREP
An Introduction to
Outpatient Treatment
30.1: Define and
identify various types
of outpatient
rehabilitation
programs
3d: theories and etiology of addictions and
addictive behaviors
6f: types of groups and other
considerations that affect conducting
groups in varied settings
An Introduction to
Outpatient Treatment
30.2: Understand the
advantages and
disadvantages of
outpatient
rehabilitation
programs
3d: theories and etiology of addictions and
addictive behaviors
6f: types of groups and other
considerations that affect conducting
groups in varied settings
Introduction to Residential
Treatment Programs
30.3: Define and
identify various types
of inpatient
rehabilitation
programs
3d: theories and etiology of addictions and
addictive behaviors
6f: types of groups and other
considerations that affect conducting
groups in varied settings
Is There a Legitimate Need
for Inpatient Treatment?
30.4: Understand the
advantages and
3d: theories and etiology of addictions and
disadvantages of
inpatient rehabilitation
programs
addictive behaviors
6f: types of groups and other
considerations that affect conducting
groups in varied settings
Aftercare Programs
30.5: Define and
identify various types
of aftercare programs
3d: theories and etiology of addictions and
addictive behaviors
6f: types of groups and other
considerations that affect conducting
groups in varied settings