What Is Continuum of Care in Addiction Treatment?

Learn about the importance of connecting addiction assessment to detox to treatment. More on the continuum of care and best practices here.

minute read
By Cara McLeod, LPC

The Components of a Successful Recovery

When it comes to effectively treating drug and alcohol addiction, the treatment professionals where I work at Enterhealth agree that a successful recovery is most often the result of multiple components working together to treat not just the addiction, but also the:

  • underlying psychological issues
  • physical ailments
  • real-life stressors

Each of these may have shaped the addiction in the first place.

Addiction treatment involves people from all walks of life and all stages of addiction. It’s not strange to see adults with powerful corporate jobs who have been maintaining habits for decades working on their recovery alongside high school and college-aged kids whose addictions rapidly spiraled out of control within a few months or years.
For these reasons and more, we believe that the best approach to addiction treatment is a holistic one which pairs each individual patient with the best components of treatment to suit their needs. This means that addiction treatment should not be the same for everyone and that all patients will have a customized plan.

Continuum of Care: Elements of Multidimensional Treatment

If you’ve done any research on addiction treatment or been in the addiction treatment field, you’ve probably heard the term “continuum of care.” This term refers to the various components of the addiction treatment process. In fact, the continuum of care concept promotes an integrated system of care that guides and tracks patients over time through a comprehensive variety of health services spanning all levels of intensity of care.

For those who aren’t familiar with the concept applied to addiction treatment, it generally goes like this:

  1. Patients are usually admitted and interviewed at an inpatient treatment facility, where they begin to detox (also known as medically assisted withdrawal stabilization).
  2. Following detox, they can begin inpatient treatment.
  3. After their stay at inpatient, they transition either back to their home or to a sober-living house, where they continue with their treatment through an outpatient facility.

That’s a broad overview, and there are always exceptions, so let’s go a little more in-depth.

Care Begins with Assessment

Whether a patient needs to start at the inpatient level or outpatient level, the first step is getting to know the patient. This allows psychologists and physicians to obtain the information they need to create a roadmap for the treatment regimen.
Not everyone is going to need to go through every level in the continuum of care. Some may only need to detox and then move to outpatient; some may only need outpatient therapy. Obviously, this is decided on a case-by-case basis and depends upon the severity of the addiction and the physical and mental health of the patient. Another reason why assessment is so important.

Detox Protocols are Critical

Next, most patients need to detox to remove all of the unwanted substances from their systems. This is where medication-assisted treatment (MAT) comes into play. Utilizing the latest FDA-approved anti-addiction medications allows patients to detox with fewer of the uncomfortable side effects, cravings and other issues which come along with drug or alcohol withdrawal. If not done correctly, detox can be detrimental to the patient’s health and ability to continue with the program.

The detoxification process is an important step for obvious reasons, but for not-so-obvious reasons as well. Patients frequently enter treatment with psychological and physical issues. Common psychological issues include:

  • Depression
  • Post-traumatic stress disorder
  • Bipolar disorder

…and various psychoses, and typical physical issues range from cognition challenges to reduced organ function, injuries and more. These issues may be the cause of a patient’s addiction, such as a person using drugs or alcohol to numb pain from an old injury or calm their mind when feeling stressed. These issues can also be a result of the addiction itself, such as psychosis, cognition problems due to brain shrinking/damage and a host of other injuries. Sometimes the addiction simply exacerbates a pre-existing condition, as is commonly the case with people who are bipolar or depressed and have a problem with substance abuse.

This is why detox is such an important step: Once the patient’s system is clean, clinicians get their first glimpse of the actual person rather than the disease of addiction.

Inpatient Education and Therapy are Key

The next point in the continuum of care is inpatient treatment, where much of the education and therapy comes into play; where families are highly encouraged to participate and where many of the discoveries are made about and (hopefully) by the patient. Many patients who finish detoxing and begin therapy can finally view their lives and their addiction from a broader perspective – a much easier thing to do when your brain is no longer clouded by drugs or alcohol.

Each person comes into treatment with a host of issues unique to him or her, and the remedies need to reflect this. Some patients will have their family get heavily involved, others may not have family and may need to establish safe support systems to help them after their stay. Different patients may also require different modalities of treatment.

For example, a person who uses drugs or alcohol because they suffered a traumatic event would be an ideal candidate for Eye Movement Desensitization and Reprocessing (EMDR), which is used to lessen the negative impact of traumatic memories and work to associate them with empowering thoughts. Others may find more benefit from elements of traditional Chinese medicine or acupuncture.

No matter what the unique issues of patients, the goal is to provide a safe, comfortable and drug-free environment where patients can come to terms with why they use alcohol or drugs and learn what they can do to prevent it from happening again. Whether their addiction was the result of trauma, depression, loss, shame or a litany of other issues, the patient needs to recognize the cause or causes and really want to change before he or she can reestablish a positive sense of self and purpose, both of which foster sustainability in recovery.

This is the crux of treatment for most people: Through education and therapy during treatment, the hope is that patients will come to terms with the underlying issues which led them down the road to addiction and move from being motivated by external consequences such as threats or ultimatums from family members, legal issues, loss of a job or school expulsion to being internally motivated to take responsibility for their recovery.

Outpatient Care Completes the Cycle

The final point on the continuum of care we will discuss is outpatient treatment. This is another crucial part of the continuum, as it helps to further instill the lessons patients may have learned at inpatient, and it also helps them to readjust to life outside of treatment while still having the support network of professional caregivers to turn to if they get overwhelmed.

It’s important to keep in mind that just as addiction is a progressive brain disease, recovery is a progressive remedy. This means that the best elements of treatment and the kinds of things patients need to work on will change over time.

Addiction Treatment with Enterhealth

Enterhealth offers premier drug and alcohol addiction treatment across the continuum of care at our multiple locations. Enterhealth Ranch, our inpatient treatment facility just north of DFW, employs a variety of methods and behavioral therapies, along with acupuncture, Eye Movement Desensitization and Reprocessing (EMDR), traditional Chinese medicine, neurofeedback therapy and more.

Our Enterhealth Outpatient Center of Excellence in the Park Cities area of North Dallas offers a broad range of therapeutic services for ongoing addiction management, including our Intensive Outpatient Program (IOP) and Supportive Outpatient Program (SOP). Additionally, Enterhealth now offers outpatient care via our HIPPAA-compliant telehealth/telemedicine portal. This allows patients access to private and group therapy sessions over a secure connection anywhere they can use their laptop, smartphone or other mobile device.

About the Author: Cara McLeod, Enterhealth therapist, is a Licensed Professional Counselor specializing in the treatment of addiction and trauma.  She has more than 15 years of experience in the fields of mental health and addiction. Prior to joining Enterhealth, Cara was licensed in Colorado and worked with adolescents struggling with substance abuse issues. She is a certified Multisystemic Therapy (MST) clinician and participated in a research project which utilized this therapy approach at the University of Colorado. Previous to this, Cara was licensed in New Hampshire and worked in community mental health where she completed extensive training utilizing both DBT and CBT therapy modalities.
Cara earned her undergraduate degree at Baylor University and Master of Arts in Counseling at Colorado Christian University. Cara completed her EMDR basic training in 2015. Since that time, she has acquired EMDR DeTUR Protocol certification as well as additional training and supervision for EMDR certification.
About the author
Headquartered in Dallas, Texas, Enterhealth offers a science-based alcohol and drug addiction treatment program created by a dedicated team of addiction experts determined to dramatically improve treatment outcomes. Based on the latest National Institutes of Health research identifying addiction as a chronic brain disease, this program is implemented by a full-time staff of addiction-trained physicians, psychiatrists, nurses and therapists, beginning with a thorough medical and psychological assessment designed to create a personalized treatment plan for each patient. Enterhealth Ranch is nestled on 43 scenic acres just 30 minutes north of Dallas/Fort Worth and features 40 beds, private rooms and bathrooms, chef-prepared meals, housekeeping service, a luxurious pool, a gym and more. Enterhealth Outpatient Center of Excellence, an outpatient treatment facility, is located in the Park Cities, just north of downtown Dallas, and provides ongoing addiction management care and support. For more information, visit http://www.enterhealth.com/.
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