What is rehabilitation, and how is it different from AA?

Rehabilitation is a therapeutic intervention that attempts to provide the patient with the tools that he or she requires in order to maintain sobriety after returning to the community. Rehabilitation programs offer several levels of intensity of care as the patient placement protocols suggest. Rehabilitation generally offers very structured programs that include individual and group therapy as well as educational programming and occupational/vocational support. Additionally, either a psychiatrist or an internist who specializes in addiction medicine is available for consultation. These programs range in the degree of intensity from as little as 9 hours per week as defined by an intensive outpatient treatment program (IOP) to inpatient 24 hours a day 7 days a week for up to several months. AA is relatively unstructured, does not follow a specific didactic program, and relies completely on the fellowship of its members to provide the support necessary to maintain abstinence. Most addiction medicine specialists feel that AA alone is generally inadequate but is a critical adjunct to a well-structured rehabilitation program. AA is also required for follow-up after completing a rehabilitation program. These two treatment modalities are seen as complementary and not mutually exclusive. Rehabilitation is more comprehensive and follows a medical model. This has meant, at least in the past, that the concept of addiction as a disease was held to more strongly by rehabilitation programs and the use of medication more readily administered and accepted as an adjunct to care for the alcoholic. Only recently has AA become more accepting of that model, although members remain generally divided on which medications they are willing to consider as reasonable. Some AA members continue to condemn the use of various medications for either a psychiatric condition or their alcoholism.

What are the different kinds of outpatient and inpatient rehabilitations?

IOPs and partial hospital programs (PHPs) generally differ in the amount of time that a person spends in them during the day. Insurance companies define those differences and thus determine whether they are willing to pay for one or the other. An IOP provides 3 hours of treatment daily for up to 9 total hours weekly (Monday, Wednesday, and Friday). A PHP offers a 4- hour program daily for a total of 20 hours weekly (Monday through Friday). PHPs are generally used as a stepdown from an inpatient psychiatric stay, and then the amount of time the individual spends in the program rapidly decreases over the following weeks (such as decreasing by a day each week over 4 weeks). Most programs do not offer ambulatory or outpatient detoxification but require detoxification to occur before the individual is accepted into the program. Generally IOPs and PHPs require patients to attend daily AA meetings in addition to the treatment that they offer.

Partial hospital program (PHP) a program usually run by inpatient personnel as part of the discharge plan for their inpatients.

Most insurance plans will pay for inpatient programs based on the patient placement protocol, which usually requires a patient to have failed an outpatient program first. Such inpatient programs range in the length of stay from 2 weeks to several months. Insurance benefits usually also determine this. Most private insurance companies will pay for up to 2 weeks of inpatient rehabilitation annually. Inpatient rehabilitation is less restrictive than an inpatient psychiatric facility, and for that reason, it should really be regarded as a residential program rather than an inpatient program. First, rehabilitation programs are entirely voluntary. Many patients hospitalized psychiatrically with drug or alcohol problems are hospitalized involuntarily because a physician has considered them to be at high risk for harming themselves or others as a result of a mental illness and not merely because of their drug or alcohol use. Second, rehabilitation programs generally do not provide daily physician contact as occurs in the acute psychiatric or medical setting; patients in rehabilitation programs are considered to be medically and psychiatrically stable. The only long-term (i.e., more than 1 month and up to 6 months) residential programs available to patients are those that accept either private pay, payment from state general assistance, or a combination of those two along with an opportunity to work for your keep. Finally even within inpatient rehabilitation programs, varying levels of support exist. Halfway houses are a less intense form of residential care and offer approximately 5 hours of professional services weekly. The expectation is that while the patient is in the halfway house, he or she will find work, attend AA meetings regularly, and attend the program. In contrast, sober houses offer no programs to their residents. Both halfway houses and sober houses require residents to support their stay financially through either working for the program or obtaining employment on the outside.

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