For Therapists: Does My Client Need Residential Treatment?

As a therapist, sometimes you have to make a tough call and recommend your clients for residential treatment for their addiction or substance abuse disorder. You may be hesitant to do so for a variety of reasons:

• Residential treatment involves a total disruption of life-as-usual
• You believe your client will resist the idea
• You may need to stage an intervention
• The cost may be prohibitive, even if you client is fully insured
• Finding the right program in the right location may be difficult

There’s another big reason you may not want to recommend a residential program: you suspect your client may need one, but you’re not entirely convinced you’re correct. If you specialize in treating addiction and substance abuse disorders, you typically know by the end of a session or two if your client is a good candidate for residential treatment. You’re trained to see the signs and symptoms right away, and your recommendation is based on both training and experience. If addiction isn’t your specialty, however, there are specific things to watch for if your client is suffering from a substance abuse disorder. The following list contains the primary indicators your client needs more than weekly therapy, support group meetings, or outpatient therapy:

1. Habitual Relapse: If you’ve worked with your client through several failed attempts at sobriety, then you may need to consider the residential option.
2. Failed Attempts at Outpatient Programs: If you client has been unsuccessful in Outpatient, Intensive Outpatient, or short-duration Inpatient or Partial Hospitalization programs, you may need to consider the residential option.
3. Lack of Support: Your client may live or work in an environment that’s not conducive to sobriety, or they may have tapped out their available support systems. Often families and peers do everything they can to help a loved one trying to get and stay clean and sober, but their support is finite – and they’re also not trained professionals. If your client’s family has reached the end of both their energy and abilities, then you may need to consider the residential option.
4. Dual Diagnosis: If you’re treating your client for a mood disorder or other emotional/psychiatric issue and you discover they’re been covering up a substance abuse problem, then a period of detox followed by residential treatment will help both of you get to the root of their behavioral disturbances. Sometimes it’s impossible – even for a trained and experienced therapist – to understand what’s really going on with a client, emotionally and psychologically speaking, when their symptoms overlap with those associated with substance abuse disorders.
5. Safety: If your client’s behavior is rapidly escalating in a way that creates a safety risk for them or their immediate family, then a residential program may be necessary – sooner rather than later.

Finding the Right Program

In the 42^nd edition of their “Treatment Improvement Protocol Series” published in 2005, The Substance Abuse and Mental Health Services Administration (SAMHSA) established the following nine criteria for evaluating the quality of residential substance abuse treatment programs:

1. Screening and Assessment: Any potential program must have adequate pre-intake screening and assessment programs in place.
2. Mental/Physical Health Exams: All examinations must be performed by fully qualified physicians and/or psychiatrists
3. Onsite Prescribing Psychiatrist: Residential programs should have an on-site or on-call board-certified prescribing psychiatrist on staff in order to meet your client’s medication needs.
4. Medication and Monitoring: Residential programs should staff either licensed nurses or physicians with the training to monitor and adjust medications as needed.
5. Psychoeducational Classes: All residential programs should include solid addiction education and rehab prevention classes.
6. Onsite Double-Trouble Groups: Each potential program should include support groups for individuals with dual diagnosis/co-occurring disorders.
7. Offsite Support Groups: Residential programs should have direct connections to peer support groups such as A.A., N.A., SMART Recovery, or others.
8. Family Education: A residential program should have formal systems in place which include your client’s family in the recovery process.
9. Discharge planning: Quality residential programs create exit strategies – or re-entry plans – for all clients. These plans should include follow-up medical and psychiatric visits, support group resources, and emergency steps to take in case of relapse.

After Rehab: How You Can Help

The work of easing your client through the step-down process from residential treatment back to day-to-day life starts before they enter the program. The first step for you, as their therapist, is to find out which individual, within the administrative hierarchy of the treatment center, should be your primary contact. Reach out to them by phone or email and have a frank and honest conversation about your client’s history and immediate needs. Make yourself available as a resource while your client is in treatment and stay abreast of which treatment modalities are working and which aren’t. This knowledge will be crucial for your client’s continued sobriety upon discharge. If possible, collaborate with the treatment center staff to design a realistic and sustainable post-residential sobriety plan. Be ready to support your client when they begin the step-down process. There will be challenges, of course, but if your client feels supported by everyone involved, their chances of avoiding relapse increase dramatically. The most successful recovery is one in which everyone involved – client, families, and therapists – have all the information they need to make good decisions before, during, and after residential treatment. Call us at 800-701-6997 to learn how we can help your client.