For many individuals, a physical dependence on alcohol or drugs must be addressed before he/she can fully and safely can participate in substance abuse treatment.
Substance abuse treatment is intended to address the biological, psychological and social aspects of addiction. Individuals who are having issues with the use of drugs or alcohol have often developed a physical dependence on substances. This means that the body has adapted to the drug or alcohol and the individual requires more in order to achieve the same effect. This physical dependence must be addressed before the individual can benefit from any type of substance abuse treatment. Many people who have become physically dependent are no longer using substances to feel euphoric, but are rather using to feel “normal” and prevent the body from going through withdrawals. If the individual stops using drugs or alcohol suddenly, the body begins to go through the withdrawal process.
There are a number of drugs that can cause physical dependence. The following is a common list of substances that can cause physical dependence if used consistently over a period of time:
- Opioids (includes heroin, morphine, oxycodone, methadone, fentanyl)
- Benzodiazepines (e.g. Valium, Xanax)
The physical withdrawal symptoms from drugs and alcohol vary from substance to substance. While some individuals may experience mild discomfort, others may need medical monitoring to reduce the risk of serious complications such as seizures. Even individuals who are using substances that do not cause physical dependence can experience withdrawal symptoms. It is important to note that the withdrawal process from some substances can be dangerous. In particular, it is highly recommended to seek medical monitoring for the detoxification from alcohol and benzodiazepines. Withdrawal symptoms can include:
- Intense worry or anxiety
- Restlessness or insomnia
- Sweating or hot flashes
- Flu-like symptoms: body aches, headaches, weakness
- Muscle and bone pain
- Lack of appetite
- Nausea, vomiting or diarrhea
- Shaking or tremors
Detoxification is the process of allowing the body time to rid itself of the substance(s) on which it is dependent. This process can take anywhere from three to ten days, on average, and the length and severity depend on the type of substance and the length of time that the person has been using the substance. Many individuals who are physically dependent on substances continue using simply due to the fear of the withdrawal symptoms. Opiate users who are physically dependent, for example, often talk about a fear of being “dope sick.” Daily opiate use becomes not about getting high, but instead about preventing the flu-like symptoms that come with the withdrawal from opiates. Medical detoxification can be very useful in these circumstances. The medical staff monitors vitals and symptoms on a regular basis and provides medical treatment as appropriate to make the individual as comfortable as possible.
Pathways Florida has a 30-bed medically-supervised detoxification unit. Upon admission, each client is evaluated by a Registered Nurse. Testing is conducted to determine what substances are involved and a full medical history is gathered. Based on the results of the testing and the evaluation, a detoxification protocol is initiated. Each client is also oriented to the detox unit by an Admissions Counselor.
Detox clients meet regularly with the physician staff to address possible protocol adjustments and to determine when the client has safely completed the detoxification process. Once admitted onto the detox unit, clients are guided through the physical and emotional crisis of withdrawal. In addition to the challenges of physical detoxification, many individuals also struggle with the psychological aspects of no longer using substances. The education and support for ongoing recovery begin during the stay at detox in order to build a foundation for the ongoing care at the Pathways Florida residential program. There is an emphasis on good nutrition, linking to self-help support groups and planning for continuing care. During the average stay of three to ten days, clients participate in structured, daily activities including educational groups, 12 Step meetings and discharge planning.
Residential (28 Days)
When it comes to substance abuse treatment, there are two options available: outpatient or residential. Outpatient treatment (link to outpatient page) involves an individual living at home, or in the community, and attending substance abuse treatment sessions at a clinic. Residential treatment involves an individual residing at the location where substance abuse treatment is being provided. While some people are successful using outpatient treatment, many find that residential treatment provides a solid foundation for a long-term recovery journey.
There are a many pitfalls and obstacles with living in the same environment and attempting to get clean and sober. The temptation to revert back to the substance use can be overwhelming. Residential treatment offers a safe, supportive environment where individuals can learn new coping skills surrounded by like-minded people who are beginning the same journey. Completing a 28 day residential treatment program provides many benefits, including 4 weeks of not using substances and a chance to step away from the stressors of life to truly focus on getting better.
Pathways Florida is a 28 day residential substance abuse treatment program. The program has been successfully helping people on the journey of recovery for over 20 years. It is designed to help individuals who are using substances or alcohol establish a firm foundation in the recovery process. The treatment approach is based on the belief that addiction is a primary disease that impacts all areas of a person’s life. The counseling staff works with each client to assist him/her increase awareness of how addiction has affected major life areas such as legal, family, social, financial, and vocational/educational. Clients are routinely under close observation and are monitored on a regular basis during their stay.
The Pathways Florida clinical team utilizes a number of evidence-based practices (link to modalities page) in providing high-quality substance abuse treatment. Some of these services include Motivational Interviewing, Cognitive-Behavioral Therapy, and Moral Reconation Therapy. The staff focuses on treating the “whole person,” coupled with proven medical and mental health care practices.
Clients in the Pathways Florida program receive a minimum of 20 hours of high-quality individual and group counseling per week, as well as psycho-educational group services, recreational therapy, art therapy, and experiential exercises. Special education presentations supplement therapy sessions to create a unique and valuable program. The twelve-step programs are emphasized and treatment goals are client centered and individualized. Clients are screened for drug use on a regular basis. In addition to substance abuse treatment, each Pathways Florida client receives a psychiatric evaluation and weekly follow-ups if needed.
Each client in Pathways Florida is assigned to a Licensed Mental Health Counselor. This counselor will provide weekly individual counseling, family counseling as indicated, and treatment planning. Each client’s plan for treatment is individualized, however the following are some goals that Pathways Florida has for each client:
- Increase client knowledge about addiction as a disease
- Establish a firm foundation in recovery by increased participation in self-help groups
- Re-establish a healthy lifestyle
- Improve quality of life
- Increase functional status
- Improve support system for the client
- Improve family and other interpersonal relationships
- Increase participation in leisure activities
Individuals who have been using alcohol or drugs often have had very little in terms of daily structure. With that in mind, Pathways Florida is a highly structured program and adheres to a daily schedule. A typical day in the Pathways program begins with chores, morning meditation and breakfast. This is followed by a two-hour group led by one of the clinical staff members. Lunch is followed by another two-hour counselor-led group session. Late afternoon is a time for homework, quiet reflection or recreational activities. After a daily wrap-up discussion and dinner, clients participate in a 12 Step meeting session.
The 28 day program follows a basic four week curriculum that focuses on a different addiction-related topic each week. Educational groups are offered each week that provide a wealth of information. Group topics include an introduction to the disease of addiction, the various stages of recovery, relapse prevention planning, and family roles/dynamics. The four weekly topics are: addiction, recovery, relapse and family.
Residential Extended Care
The longer an individual with a drug or alcohol problem remains engaged in substance abuse treatment, the better chance of success. Many people have completed an outpatient or residential program only to relapse and fall back into old patterns afterwards. According to the National Institute on Drug Abuse, research has shown unequivocally that good outcomes are contingent on adequate lengths of treatment. Research also shows that total participation (including residential and outpatient) in treatment for less than 90 days is of limited or no effectiveness, and treatments lasting significantly longer often are indicated.
Many individuals who are admitted into Pathways Florida have a need for intensive residential treatment that lasts longer than 28 days. This need may arise for various reasons. A longer stay may be necessary due to the individual’s history, due to court involvement, or due to family desire. Many clients have been using drugs or alcohol for a very long time. This creates patterns and daily habits that can be very difficult to break. When someone has been using for an extended period of time, 28 days of residential treatment often is not enough to help break those learned patterns of behaviors. A longer stay in intensive residential treatment provides an opportunity for expanded exploration of these behavior patterns and more time for clients to practice using newly found skills.
We have many clients in treatment who are involved with the legal system. Sometimes treatment has been mandated as a part of a sentencing by a judge. Based on the nature of the charges, the Court may require intensive residential treatment for longer than 28 days in order to satisfy legal requirements.
Pathways Florida Extended Care Program frequently works with the Court to satisfy legal requirements and to provide treatment in lieu of incarceration. Sometimes an attorney will recommended treatment prior to the outcome of a legal situation and the length of treatment can significantly impact the Court’s decisions.
Families are impacted greatly by an addict or alcoholic’s behaviors. While 28 days may feel like enough time in treatment to the addict or alcohol himself, families often feel more comfortable with longer lengths of stay. This provides a greater foundation for the client’s recovery and provides some reassurance to the family. The Pathways Florida Extended Care Program was developed to meet these needs.
After the completion of the core 28 day curriculum, Extended Care clients receive intensive treatment based on his or her particular needs. The Pathways Florida Extended Care Program has groups that focus on co-occurring issues for individuals who have mental health issues along with substance abuse. The program also has a track that focuses on criminal thinking (link to modalities page) for individuals with a history of legal involvement.
In addition to the groups that address specific needs such as mental health or legal involvement, the Extended Care Program also includes additional addiction education classes, individual counseling, family counseling, trauma counseling, and a focus on involvement in the 12 Step programs or support groups. The primary counselor works with the client and the client’s support group to develop a plan for the Extended Care treatment that is individualized to the client’s specific needs.
Transitional Housing (Level IV)
It is not uncommon for individuals entering substance abuse treatment to have a need for some type of supportive housing after completion of the program. This need can arise for several reasons. Many individuals have lost housing due to substance abuse and are homeless. Sometimes the environment that an individual was living in prior to entering treatment was not supportive of recovery. Others can simply benefit from being in an environment with other recovering people and that provides continued recovery support. The purpose of a halfway house to help addicts in recovery learn the necessary skills to re-integrate into society. A halfway house provides safe housing with other individuals in recovery. Services provided can include urinalysis testing, 12 Step meetings, meals and counseling.
Historically, halfway houses and other types of transitional housing for substance abuse have not been regulated. This has unfortunately led to a number of disreputable places. Many halfway house programs have taken advantage of the lack of oversight and do not provide an environment that is supportive of recovery. The Florida Department of Children and Families has begun the process of providing certification to recovery residences, but the progress is slow and not all halfway houses are willing to participate in the application process. Since Pathways Florida is licensed by the Florida Department of Children and Families, client and families can be assured that the Transitional Housing Program is reputable.
The Pathways Florida Transitional Housing Program offers a number of services to assist people in recovery re-integrate back into society and learn to manage daily responsibilities. The Transitional Housing clients work off-campus during the day. The Pathways Florida staff stays in close contact with the employers to make sure that the clients are performing their work duties appropriately. Once the clients return to the program for the evening, they attend 12 Step Meetings and have group therapy sessions to specifically address their needs. In addition, weekly individual counseling is provided along with family counseling when necessary. Random urinalysis testing is used to ensure that clients remain clean and sober.
Individuals with drug or alcohol difficulties who remain engaged in both substance abuse treatment and support groups for a longer period of time have higher success rates. Many people have completed an outpatient or residential program only to relapse and fall back into old patterns afterwards. According to the National Institute on Drug Abuse, research has shown unequivocally that good outcomes are contingent on adequate lengths of treatment. Research also shows that total participation (including residential and outpatient) in treatment for less than 90 days is of limited or no effectiveness, and treatments lasting significantly longer often are indicated.
It is important that individuals have access to various levels of substance abuse treatment so that they can engage in and remain in treatment that meets their needs. As recovering addicts and alcoholics began to put the pieces of their lives back together, their needs and schedules change. Pathways Florida offers a wide range of substance abuse treatment services. Each client’s treatment recommendations are individualized and based on clinical assessment information. Some of the services offered include:
- Triage assessment
- 28 days residential program
- Extended residential programs
- Aftercare and Alumni Association involvement
- Partial Hospitalization Program
- Intensive Outpatient Program
- Outpatient Programs
- Outpatient Aftercare Programs
Partial Hospitalization Programs
Partial Hospitalization Treatment Programs, or PHPs, are beneficial for individuals that have completed their inpatient or residential treatment for substance abuse disorder and can benefit from a step down support system. The typical PHP program offers services six hours a day, five days a week. The majority of commercial health insurance plans cover PHP treatment.
It is the goal of Pathways Florida to provide a continuum of services so that clients have an established support that travels with him/her on the recovery journey. The Partial Hospitalization Program (PHP) is just one of these many services. Typically, the Partial Hospitalization Program is recommended for individuals who have successfully completed the intensive residential component of the program (28 days or extended care) and find that they continue to need additional support and structure. The PHP program includes additional addiction education and focuses on teaching and practicing coping skills. PHP clients receive weekly individual counseling and family counseling as needed. Psychiatric services are available if clinically indicated. Pathways Florida also offers PHP with room and board for individuals who do not yet have a safe living environment in the community.
Intensive Outpatient Programs
Intensive Outpatient Programs (IOPs) are beneficial for clients that have successfully completed an inpatient program or a Partial Hospitalization Program. They are also helpful for clients who are relapsing while in a traditional outpatient program. IOP offers a structured environment with a focus on gaining the necessary tools to remain clean and sober. Typical IOP programs meet three hours a day, three days a week and typically last for ten to twelve weeks. One major benefit of IOP programs is that they allow for individuals to continue with daily activities, such as employment, while receiving necessary substance abuse treatment. The majority of commercial health insurance plans will cover IOP treatment. Pathways Florida’s IOP program includes additional addiction education and focuses on addressing triggers and life stressors that clients experience on a daily basis. Many everyday events (family issues, legal issues, employment, etc.) can be overwhelming and individuals in recovery run the risk of relapse without having the proper skills to process them. IOP clients receive weekly individual counseling and family counseling as needed. Psychiatric services are available if clinically indicated. Pathways Florida also offers IOP with room and board for individuals who do not yet have a safe living environment in the community.
Commercial health insurance companies sometimes have strict guidelines about what types of treatment they will cover and what lengths of stay they will cover. Pathways Florida has multiple treatment programs available and the ability to be flexible with lengths of stay. This ensures that Pathways Florida have the best opportunity to receive the substance abuse treatment that he/she needs.
Alumni Association and Aftercare
An essential part of any substance abuse treatment is the follow-up plan that is created for when that treatment is completed. Pathways Florida offers several options to assist with ongoing recovery efforts. Both of these options are available at no additional cost to all Pathways Florida clients.
Pathways Florida offers a weekly Aftercare Group to all Pathways Florida clients. This group is led by a licensed counselor and is comprised of all Pathways Florida Alumni. There is no cost for this group and Alumni may attend this group as often and for as long as they wish. Issues addressed in this group are based on the needs of the attending Alumni. The Aftercare Group is regularly attended by Alumni who have been clean and sober after graduating from Pathways Florida more than 15 years ago. In addition to providing a weekly group counseling option, this group also provides recovery support and connections with others in recovery.
The Pathways Florida Alumni Association was created several years ago with the goal of providing additional recovery support and a supportive way to become involved in social activities. The Alumni Association is involved in a number of activities, including a softball team, community service projects, and regular social outings such as bowling or attending local sporting events. This group provides clients a way to become involved with social activities with other individuals in recovery.
Medication Assisted Treatment
Medication Assisted Treatment (MAT) uses a combination of prescribed medications, such as buprenorphine (SUBUTEX), buprenorphine and naloxone (SUBOXONE) or naltrexone (VIVITROL) and comprehensive treatment services. These drugs can counter the effects of opioids on the brain or relieve withdrawal symptoms and cravings, helping the client avoid relapse.
Naltrexone is an antagonist medication that prevents other opioids from binding to and activating opioid receptors. It is used to treat overdose and addiction. An injectable, long-acting form of naltrexone (Vivitrol®) can be a useful treatment choice for patients struggling with opiate dependence as well as alcohol dependence. This medication is non-narcotic and is administered once monthly by a health care provider.
Buprenorphine is a partial opioid agonist – it binds to the opioid receptor but only partially activates it – that can be prescribed by certified physicians in an office setting. Like methadone, it can reduce cravings and is well tolerated by patients.
Buprenorphine and naloxone (SUBOXONE) is a once daily sublingual film used for the treatment of opiate dependence. Buprenorphine is an opioid medication, sometimes called a narcotic. Naloxone blocks the effects of opioid medication, including pain relief or feelings of well-being that can lead to opioid abuse.
Some clients, especially those who have had prior failed treatment attempts, may benefit from MAT. Each Pathways Florida client is assessed by a medical professional at the beginning of treatment and MAT options are discussed, if appropriate. Many of our clients find that by utilizing MAT, cravings are reduced and they are better able to focus on the counseling and education services provided in the program.