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Patient and Family Resources for Substance Abuse

1: About substance use disorders.

2: What is alcohol and drug treatment?

3: What Treatments are Available at McLean Hospital?

4: How Effective Is Treatment? What is the Prognosis?

5: As a Family Member or Friend of an Addict, What Can I Do to Help?

6: What Supports Are Available for Family Members and Friends of People with Substance Use Problems?

7: How will family members be involved in treatment at McLean and aftercare planning?

8: Will patients receive treatment for co-occurring psychiatric issues while in McLean Hospital’s Alcohol and Drug Abuse Treatment Programs (ADATP)?

9: What do I need to know about insurance and addiction treatment?

10: Who do I call to get admitted to a McLean Alcohol and Drug Abuse Program?

11: What are some other resources and websites where I can get information about addiction and addiction recovery?

12: What do I do if my family member or friend is not willing to go to treatment for their substance abuse problems?

1: About substance use disorders.

DSM V definition:
A substance use disorder is defined by the Diagnostic Statistical Manual of Mental Disorders (DSM V) as a pattern of substance use in which an individual continues to use despite problems that result.  Substance use disorders are caused by a combination of biological, genetic, and environmental factors, and are very common.  Problems that arise from substance use are defined by these 11 criteria:

  1. Taking the substance in larger amounts or for longer periods than you meant
  2. Wanting to cut down or stop using the substance but not managing to do so
  3. Spending a lot of time getting, using, or recovering from use of the substance
  4. Cravings and urges to use the substance
  5. Not managing to do what you should at work, home or school, because of substance use
  6. Continuing to use, even when it causes problems in relationships
  7. Giving up important social, occupational or recreational activities because of substance use
  8. Using substances again and again, even when it puts you in danger
  9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance
  10. Needing more of the substance to get the effect you want (tolerance)
  11. Development of withdrawal symptoms when you stop using the substance, which can be relieved by taking more of the substance

The DSM V also classifies substance use disorders in terms of severity, from mild to severe.  An individual who meets 2-3 of the criteria above would have a mild substance use disorder, one who meets 4-5 would have a moderate disorder, and one who meets 6 or more would have a severe substance use disorder or addiction problem. 

How do I know if I have or someone I know has addiction?:
Careful screening and assessment or evaluation by a trained professional is the first step towards determining if an individual has a substance use problem. With substance use disorders, as with most physical and mental health problems, early detection and treatment is best.  Almost always, people feel nervous or defensive about their substance use, which is one reason people may not seek help or share the extent of the problems they are having.  It is important that you or your family member report accurately what you are using, how often, the impact it is having on your life, and other pertinent information professionals will ask during an assessment.  This information will help determine which treatment(s) are most appropriate for you moving forward. 

To schedule an evaluation at McLean Hospital’s outpatient clinic, please call the outpatient clinic number at 617-855-2368.¬† If you know you need inpatient detoxification, call the hospital’s main number at 800-333-0338 to inquire about admission.¬† ¬†If you are seeking residential or partial hospital, or are uncertain about what treatment makes sense at this time, please call 617-855-3505.


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2: What is alcohol and drug treatment?

Overview:
Many people are successful with stopping substance use on their own, or with the aid of self-help groups such as Alcoholics Anonymous or SMART Recovery .  However, for some, through no fault of their own, professional treatment consisting of some combination of  assessment, counseling, medication, skills-building, and supports is necessary.  Treatment for substance use disorders occurs in a variety of settings, depending on the severity of use and the treatments that are required to assist an individual with stopping safely.  There is no one way to recover from a substance use disorder.  Individuals with moderate to severe substance use disorders may require multiple treatments over time to attain and sustain extended abstinence from substances.  The treatments outlined below are listed in order of intensity, from most to least intensive.

Inpatient Detoxification
For some people who have been using heavily or for a sustained period, treatment may need to begin in an inpatient detoxification, where there is 24-hour medical monitoring and stabilization with medications.¬† ¬†This is often the case for those who are stopping alcohol, opiates (heroin, OxyContin, Vicodin), and benzodiazepines (Xanax, Valium, Klonopin).¬† Detoxification medications and/ or tapering assist people with becoming substance-free by reducing withdrawal symptoms and making people feel more comfortable during the process.¬† These can include Librium or Ativan for alcohol and buprenorphine for opiate detoxification.¬†¬† Detoxification is a first step in the process of recovery, and is usually a short treatment of about 3-5 days.¬† Following this initial step, learning about substance use disorders and developing relapse prevention skills is crucial to sustained recovery.¬† ¬†If you would like to learn more about McLean Hospital’s detoxification program, please see: Alcohol and Drug Abuse Treatment Program: Need to Know (PDF).

Residential Treatment
Residential treatment is sometimes referred to as ‘rehab’ and is for people who have just stopped using substances, perhaps with the aid of medical detoxification. ¬†It consists of assessment and evaluation, extensive group treatment (5-6 groups per day), overnight accommodations, monitoring and accountability through breathalyzer and urine toxicology, case management and referral, and individual and family therapy support.¬† It also includes assessment and treatment for co-occurring psychiatric disorders.¬† Medications may be recommended either for the substance use disorder itself or for co-occurring psychiatric disorders, if they are present. The treatment is focused on helping individuals with severe substance use disorders learn new coping skills and learn to live with life’s stresses without using addictive substances.¬† It also helps people to manage cravings to return to substance use, educates and connects participants to community support networks, and helps people with maintaining motivation for recovery.¬† Residential treatment can be particularly helpful for individuals who have tried other outpatient treatments and have not been able to sustain sobriety, or for those who are transitioning to half-way houses or other sober settings.¬† On average, individuals receive treatment in residential settings for 10-12 days (if insurance funded) or 30-90 days (if privately funded) and step-down to less intensive levels of care to continue in their recovery.¬† If you are interested in learning about McLean Hospital’s residential treatment programs for substance use disorders, go to mclean.harvard.edu/patient/adult/nauk.php.¬†

Partial Hospital
Partial hospital is similar to residential treatment however, individuals receiving partial hospital treatment commute from home on weekdays and manage their time on nights and weekends practicing the skills learned in treatment during the day and obtaining support as needed from their own communities.¬† Participants usually receive treatment for 8-10 days and transition to lesser levels of care.¬† ¬†If you are interested in learning more about McLean Hospital’s partial hospital program for substance use disorders, go to mclean.harvard.edu/patient/adult/adatc.php.

Intensive Outpatient Treatment (IOP)
Intensive Outpatient Treatment (IOP) is primarily a group program consisting of 2-3 groups per day, 3-5 times per week.  Some intensive outpatient programs offer evening hours which make it a great option for people who work and are not able to take the time off to participate in other daytime programs.  Intensive outpatient programs also offer case management and psychiatric treatment on a limited basis if needed.  People who attend IOPs can usually attend over a period of 2-4 weeks. 

Outpatient Treatment
Outpatient treatment can be a range of treatment options, occurring as needed.¬† It may consist of weekly individual or group therapies, substance abuse counseling, and/ or psychiatric evaluation and medication management.¬†¬† These treatments may be focused on identifying high risk situations for relapse, triggers, reducing cravings, treatment of co-occurring disorders, and learning new coping skills.¬† If you are interested in learning more about McLean Hospital’s Substance Abuse outpatient clinic, go to mclean.harvard.edu/patient/adult/adatp.php.

Other Supports for People with Substance Use Problems:

Halfway House
For some people, short-term treatment programs may not be enough to help achieve sustained abstinence.  Halfway houses can be helpful in providing longer-term rehabilitation in the community for those who cannot afford private pay residential treatments.  A halfway house has an active treatment program throughout the day, where the residents receive intensive individual and group counseling for their substance abuse while they establish a sober support network, secure new employment, and find new housing. Residents stay for a week to six months, depending on the program and the individual's situation. 

Sober Homes
Sober homes are group sober environments where people live together substance-free, pay a weekly rental fee, and create their own day structure.  There is some monitoring and supervision, usually consisting of at least once weekly urine toxicology screens and an on-site house manager available at times during the week.  Residents often attend self-help meetings together and have one community meeting per week. 

Self-Help Groups
Self-help groups such as Alcoholics Anonymous, Narcotics Anonymous, and SMART Recovery (Smart Management and Recovery Training) can be very helpful for people in recovery from alcohol or drugs.  In fact, many people recover from substance use problems without professional treatment, using just self-help. These groups hold meetings worldwide, and are easily accessible in most communities.  Self-help groups are also free and anonymous. People attend self-help groups to meet and get support from others who are in recovery.  Addiction professionals encourage the use of self-help, as research shows that people who actively participate in these groups do better with their recovery.  Below are some links to self-help webpages where meeting lists are provided.

The Evidence Base- Outcomes Research/Treatment Outcomes Research
There is an extensive evidence base in the treatment of substance use disorders.  To highlight some particularly important points in the research:


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3: What Treatments are Available at McLean Hospital?
Please click here for program descriptions.

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4: How Effective Is Treatment? What is the Prognosis?

The prognosis for recovery from substance use disorders is varied, depending on the substance used, duration of use, the presence or absence of co-occurring psychiatric disorder(s), level of motivation, and many other biological and socio-cultural factors.  Some people will recover completely, others experience periods where they remain sober, but then relapse, and others have a hard time sustaining any sobriety.

The good news is that many people do achieve long-term sobriety, and learn to live with their substance use disorders and manage them.¬† Like other chronic medical and psychiatric illnesses, the key is staying engaged in treatment, following treatment recommendations, and getting help quickly when things are not going well.¬† A sobering fact ‚Äď remaining sober can increase life expectancy by 15 or more years 1.

1Harvard Medical School, “Alcohol Dependence (Alcoholism),” Community Connect to Research http://www.connecttoresearch.org/publications/69. Last reviewed July 8, 2010.¬† Accessed January 30, 2014.


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5: As a Family Member or Friend of an Addict, What Can I Do to Help?

Family and friends play a huge part in the recovery process for people with addiction problems.  One of the most important steps you can take is to educate yourself about addiction.  Listed below are websites where you will find more information about substance use disorders, treatments, and resources for your reference.  Another important role for family and friends is providing encouragement and support for any progress made towards getting help.  This can include things like offering to attend self-help meetings together and providing sober social opportunities and a substance-free living environment (if you are living with the individual).  Another way to encourage progress towards recovery is to verbally acknowledge positive changes, and avoid accusations or rehashing the past.  This can be difficult sometimes, so attending self-help and other support groups for family and friends is also important.


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6: What Supports Are Available for Family Members and Friends of People with Substance Use Problems?

Having a family member or friend who is struggling with substance use problems can be very distressing and sometimes devastating.¬† Constant worry, broken trust, financial struggles, poor self-care, difficulty concentrating, and depression are just some of the common problems with which family members and friends struggle.¬† It’s important that family members and friends get help, whether through an individual counselor, self-help or therapy group.¬† Listed below are free and anonymous support groups for family and friends of people with addiction problems.


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7: How will family members be involved in treatment at McLean and aftercare planning?

Patients who are 18 years old or older are legal adults with legal privacy rights. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) prohibits clinical staff from sharing treatment information without a patient’s written consent.¬† All health providers must comply with these federal regulations, which mean that they must obtain formal permission to share information (including diagnosis, treatment and prognosis) with you, or anyone else, even if you are a spouse, a parent or a guardian of a patient.¬† A patient provides permission by signing a release of information form.¬† Release of information forms are normally signed during the admission process, but may also be completed on the unit. If the patient has not signed a release for the clinical staff to give you information, they cannot share this information. Please note, however, that you may share with clinicians any information that you think is important for the patient’s treatment and recovery.

In the McLean Hospital Alcohol and Drug Abuse Treatment programs, case managers provide phone contact and offer family meeting opportunities while patients are in treatment.  Family contact is crucial to treatment for the patient, as family members can offer helpful insights about the history of the substance use problem and potential resources for aftercare.  And for family members, family meetings can provide education about addiction or co-occurring disorders, identify appropriate aftercare plans, and point families in the direction of essential supports and resources.

Family meetings usually last one hour.¬† To prepare for a family meeting, it is helpful to think ahead if there are questions you’d like answered and make a list of your concerns (see possible meeting topics below).¬† If the family has financial resources, begin a discussion ahead of the family meeting of whether or not it makes sense to tap into these resources for treatment at this juncture in your family member’s recovery. ¬†Think about how members of the family are coping with the patient’s addiction and if supports are needed. ¬†¬†Begin these discussions with the case manager by phone and set an agenda for the meeting.¬†

Possible family meeting topics include:

McLean Hospital’s Alcohol and Drug Abuse Treatment Family Support Program
For family members of patients who are currently participating or have previously participated in any of McLean Hospital’s Alcohol and Drug Abuse treatment programs, there are two family support and education groups available.¬†

Monday Family Support and Education Group:  The Monday evening support group runs from 5:30-7:30 p.m. and is led by an expert in treating addicted patients and their families.  The first portion of the group, from 5:30-6:30 p.m., is an education group for family members who are new and may need help understanding substance use disorders, their treatment, and how best to help an addicted family member.  The education group is made up of a four topic series that run on an ongoing basis, and include the following topics:

From 6:30-7:30 p.m., there is an ongoing support group where family members receive support and guidance from their peers with a clinician present to help facilitate as needed.  Family members can participate in both the education and support groups as long as they feel it is beneficial. 

Saturday Family Support and Education Group: The Saturday program is offered once per month, on the 2nd Saturday of the month from 1:00-5:00 p.m.  The program is led by an expert in treating addicted patients and their families, and offers an intensive education curriculum on the following topics, followed by an ongoing support group:

If you are interested in attending one or both of these groups, please contact Joe Scholl, LICSW at 617-855-2787 or Judy Faberman at 617-855-2119.


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8: Will patients receive treatment for co-occurring psychiatric issues while in McLean Hospital’s Alcohol and Drug Abuse Treatment Programs (ADATP)?

Yes.  For all of the ADATP programs, a comprehensive evaluation occurs at admission.  This includes assessment of co-occurring psychiatric disorders.  Treatment of psychiatric disorders is integrated into addiction treatment through psychopharmacological treatment and monitoring, education and skills building related to psychiatric illness management in both individual and group therapies, and aftercare planning and referrals.


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9: What do I need to know about insurance and addiction treatment?

Insurance companies can vary widely on the coverage they provide for addictions treatment.  Contact your insurance company to get specific information about your benefits.  For a first treatment, insurance companies will typically cover the least intensive treatment likely to be effective.  With substance use problems that have not responded to first treatments, more intensive programs are more likely to be authorized.  If you are a patient or family member at McLean Hospital, your treatment team will work with you and the insurance company to obtain coverage for the recommended treatment. 


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10: Who do I call to get admitted to a McLean Alcohol and Drug Abuse Program?

For inpatient detoxification, call McLean admissions at 800-333-0338.
For residential treatment:
Naukeag Residence, call 800-230-8764.
McLean Center at Fernside, call 978-464-2141.   
McLean Residence at the Brook, call 781-647-0155.                         
For partial hospital or Proctor House residence, call 617-855-3505.
For evaluation, psychopharmacology, therapy and/or group therapy on an outpatient basis, call 617-855-2368.


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11: What are some other resources and websites where I can get information about addiction and addiction recovery?

For information on the drugs of abuse, visit www.drugabuse.gov/drugs-abuse and www.drugfree.org/drug-guide

For facts about alcohol use, visit http://www.niaaa.nih.gov/publications/brochures-and-fact-sheets and www.connecttoresearch.org/publications/69

To find substance abuse and mental health treatment nationwide, visit http://www.samhsa.gov/treatment/index.aspx  and for Massachusetts, visit db.state.ma.us/dph/bsas/search.asp

For information about addiction, visit www.hbo.com/addiction/understanding_addiction and    www.helpguide.org/topics/addiction.htm   

For a guide to helping your child with substance use problems, visit timetogethelp.drugfree.org/sites/default/files/treatment_guide.pdf

For information on smoking cessation, visit makesmokinghistory.org

For information on how people become addicted to drugs, go to www.drugabuse.gov/publications/drugfacts/understanding-drug-abuse-addiction

For facts about protracted withdrawal, go to 162.99.3.213/products/manuals/advisory/pdfs/SATA_Protracted_Withdrawal.pdf

For information on how to prevent and avoid opioid overdose, go to www.mass.gov/eohhs/docs/dph/substance-abuse/naloxone-info.pdf

For information on how to file a Section 35 (involuntary hospitalization), go to www.mass.gov/eohhs/gov/departments/dph/programs/substance-abuse/addictions/drugs-and-alcohol/section-35-faq.html


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12: What do I do if my family member or friend is not willing to go to treatment for their substance abuse problems?

In many instances, family and friends are concerned about a person’s substance use problem before the person is.¬† Seeking assistance from self-help groups such as Alanon and SMART Recovery Family program is important.¬† These groups provide peer support and guidance, both crucial to sustaining you if you’re struggling to cope with the situation.¬†¬† Self-care is particularly important for you and can be difficult when confronted with a loved one who is not accepting help.¬† It can be helpful to speak to a knowledgeable professional about the situation, and get advice on the best way to approach it.¬†¬†


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03.2014