For decades, treatment for drug and alcohol addiction meant “rehab,” the 28-day residential programs popularized on TV. But not everyone can, or should, uproot their lives for a month.
Today, folks with substance use disorder (SUD), whether addiction to opioids, meth, or alcohol, have a wide range of treatment options.
Many patients shift from one type of treatment to another as they move through the phases of recovery and gain stability, support, and confidence.
To help you feel more in control and make the best choice for your unique situation, we’ve summarized nine of the most common treatment programs here.
SPECIALIZED Medication-assisted treatment (mat)
What it is: MAT is the opposite of “cold turkey”: Just as nicotine gum helps smokers quit tobacco, medication helps SUD patients maintain sobriety by suppressing withdrawal symptoms and cravings. MAT is highly effective for patients with opioid use disorder (OUD) and is commonly provided in specialized outpatient clinics. Some OUD patients wean off the medication after a few years. Others remain on a low dose indefinitely, just as many patients with depression take antidepressants long-term. The two government-approved medications for opioid addiction are buprenorphine (Suboxone®) and methadone. Most outpatient clinics specialize in one or the other.
Office-based opioid treatment (OBOT)
What it is: An outpatient clinic that prescribes buprenorphine (such as Suboxone®). Over the past decade, OBOTs like Ideal Option have become more widespread as the popularity of Suboxone has increased. Suboxone combines two drugs: the dominant ingredient buprenorphine, which suppresses withdrawal and cravings, and naloxone, which stops patients from experiencing a “high” from the medication. Patients receive a prescription that must be filled at the pharmacy.
Pros: Frequency of visits is dependent on the phase of treatment and will lessen as the patient stabilizes. In addition, because Suboxone is prescribed, patients can take the medication in the comfort of their own home. Almost instantly, the buprenorphine stops the nausea, vomiting, and other symptoms that make opioid withdrawal unbearable. Patients often feel more comfortable in a specialized addiction medicine clinic compared to a primary care office.
Patients often say after their first dose of Suboxone: “Oh my god, I feel normal again.”
Cons: Not suitable for patients who need medically managed detox, intensive behavioral health counseling, and/or environmental control. Buprenorphine may not be suitable for heavy opioid users.
Opioid Treatment Program (OTP)
What it is: An outpatient clinic that dispenses methadone. For decades, methadone was the only medication approved for the treatment of opioid addiction. Taking methadone once a day keeps the brain’s opioid receptors satisfied while staving off the nausea, anxiety, and other withdrawal symptoms that drive users to seek more dangerous opioids. By law, methadone patients must come to the clinic daily and be observed taking the medication.
Pros: Methadone has served countless OUD patients well—far better than residential treatment programs that offer counseling but no medication. The tight supervision required by law is helpful for patients who lack family support and those who can’t get to both a clinic and a pharmacy.
Cons: The daily visits required by methadone clinics can be cumbersome for patients, especially those with jobs and/or children to care for. In addition, methadone, unlike buprenorphine, does have potential for abuse. Methadone doesn’t bind to opioid receptors as tightly as buprenorphine does, so patients who, for example, use heroin on top of methadone can get high. Taking too much methadone can also cause respiratory depression and heart problems. Buprenorphine does not carry those risks.
Inpatient Detoxification, a.k.a. “Detox”
What it is: Patients are admitted to a hospital or treatment center while the body clears addictive substances. Detoxing at home can be miserably uncomfortable, even life-threatening in some cases, so inpatient detox is an important first step for many struggling with moderate to severe addiction. Withdrawal symptoms can include insomnia, paranoia, extreme agitation, hallucinations, and seizures. These symptoms can be minimized with the medication and monitoring offered by detox facilities.
Patients typically stay 3 to 7 days and then begin a comprehensive treatment program on an inpatient or outpatient basis.
Pros: Withdrawal symptoms can change quickly and, for some patients, cause serious medical complications, in which case medical supervision is essential. Detoxing at home can be so excruciating that many patients give up and start using again, losing the motivation to give recovery another try.
Cons: For patients who care for children or other family members, leaving the house for 3 days may be logistically impossible. Also, detox beds are not always immediately available.
What it is: Commonly known as “rehab,” inpatient rehabilitation refers to treatment facilities where patients live for one to three months. During this time, patients receive mental health evaluations, group and individual therapy, and education about substance use disorders. Facilities also offer medical supervision and family visitation focused on repairing family relationships. Some rehab centers offer medication assisted treatment (MAT) whereas others offer only counseling.
Pros: For some patients, the inpatient setting—with its scheduled meals, meetings, and counseling sessions—offers much-needed structure, accountability, uninterrupted time, and distance from drug-using friends.
The treatment allows patients to stabilize, reflect, and gain important coping skills.
Inpatient rehabilitation works best when patients are self-motivated rather than pushed to enroll. For OUD patients, it’s critical to enroll in a rehab facility that offers MAT.
Cons: Inpatient treatment takes patients away from their family and job and may be unnecessary for those who have stable living and work situations. For OUD patients in particular, combining outpatient MAT treatment with counseling may work just as well or even better—without forcing patients to explain a month’s absence to co-workers and acquaintances. Some patients report that the structure of inpatient rehab shields them from life’s realities and responsibilities, so the transition back to the “real world” can be difficult. Rehab programs that do not offer MAT for opioid addiction can even be dangerous. Upon leaving rehab without medication, OUD patients often use opioids immediately, and, having lost tolerance, overdose at higher rates than those who did not attend rehab.
What it is: “Outpatient rehab” is a catchall term for programs that are not residential. Patients live at home while receiving treatment, often a combination of medication, individual counseling, and group meetings. Programs vary in terms of time commitment and structure, ranging from PHP (partial hospitalization) to IOP (intensive outpatient) to simply receiving medication from a clinic.
Pros: Outpatient treatment is ideal for patients who have stable housing and support from family or friends—for those who want, and can handle, the freedom to work, care for children, and deal with daily life.
It’s also a common next step for those who have completed an inpatient or detoxification program. Patients are held accountable without the substantial structure and demands of inpatient rehab.
Cons: For some patients—particularly those with long-term, severe addiction and/or accompanying mental illness—outpatient rehab may not offer enough structure and supervision.
Partial Hospitalization Program (PHP)
What it is: Partial hospitalization is similar to inpatient rehab, only patients don’t stay overnight. PHP is designed for patients who need more structure, counseling, and medical supervision than the typical outpatient program offers but want to live at home.
Patients spend 4 to 8 hours a day at the treatment center.
Pros: PHPs are a common step-down option for those who have completed inpatient rehab and are struggling with both addiction and mental illness, such as depression, anxiety, bipolar disorder, or PTSD. Patients can receive intensive treatment—group therapy, individual therapy, and family counseling—without spending weeks away from their families.
Cons: PHP is more time consuming and structured than most SUD patients need.
Intensive Outpatient Program (IOP)
What it is: For some patients, IOP is an alternative to inpatient rehab; for others, it’s the next step. Patients attend IOP 10 to 20 hours a week for several months while living at home or in sober housing. Treatment includes group therapy, education about the disease of addiction, and individual counseling. Often treatment centers have both daytime and evening options, accommodating patients with full-time jobs.
Pros: IOP often works well for motivated patients struggling with moderate to severe addiction. The format holds patients accountable, requiring random drug and alcohol testing and regular attendance. Programs typically offer weekly group meetings for family members as well.
IOP patients with opioid use disorder should simultaneously receive MAT.
Cons: IOP requires a substantial time commitment and is more than some patients need or can fit in.
What it is: Sober living homes are privately owned group homes where people recovering from drug or alcohol addiction live for 6 months to a year. These drug-free environments often serve as a bridge between inpatient rehab and a return to independent living. Residents come and go as they please but must abide by a curfew, hold a job or attend school, take random drug and alcohol tests, and help with house chores.
Pros: Sober housing is a great option for folks in recovery who aren’t ready to live on their own or who don’t have a strong support system.
Research shows communal living can help residents maintain their sobriety, develop their coping skills, and learn to trust themselves.
Cons: Some in recovery may find house rules too restrictive. For example, residents typically are not allowed to bring a pet and must sleep at the house most nights.
Primary Care Provider (PCP) Treatment
What it is: Technically classified as an “OBOT”, PCP treatment simply means receiving a prescription for buprenorphine (Suboxone) from your regular doctor rather than from an outpatient clinic specializing in medication assisted treatment (MAT).
Pros: Not everyone lives in close proximity to an outpatient MAT clinic, so an OUD patient seeking a buprenorphine prescription may find it more convenient to get the prescription from a primary care provider.
Cons: Most primary care physicians don’t have the waiver required by the government to prescribe buprenorphine, and most are not specialists in addiction medicine. Even PCPs who do have the credentials to prescribe buprenorphine typically have a small case load of MAT patients and therefore limited experience with ongoing addiction treatment. Furthermore, patients often report feeling judged by their PCPs. Patients who receive their buprenorphine prescriptions from a specialized outpatient clinic typically feel more supported.
Though addiction should be treated like any other medical condition, such as diabetes or depression, some physicians make moral judgments and don’t disguise their feelings, alienating rather than encouraging patients.