Why Residential Rehab Isn’t Right for Everyone and the Other Options You Have
by Michael Walsh
When you or a loved one is grappling with substance misuse it can be challenging to know where to go for help. [Updated March 2023]
There are so many different ways to address alcohol and drug issues today. But often, those suffering from substance use disorders, and their families, aren’t aware of exactly what their options even are, let alone which one is best for them.
In the past, options were relatively limited. For the most part, people either checked into residential rehab or were handed a brochure and told to start attending 12-step meetings. Today there are a variety of treatment options whether addiction counselling or psychotherapy, intensive out patient treatment (IOP), in-patient rehab whether primary mental health, addiction focused or both. As well, online resources available have made help more accessible and also offered more choices.
Knowing which option is right for you comes down to the severity of your substance use and the level of care that is appropriate to address your needs and also what your goals for change are.
For some people, engaging in some kind of formal treatment is the right choice. You can choose between inpatient rehab versus outpatient programs — IOP. But rehab isn’t necessarily right for everyone. It can be extremely expensive and isn’t always necessary — same with IOP.
Many people can get the help they need by accessing addiction counselling online which has become widely available. Others may opt for building a custom treatment plan that allows them to stay in their home environment by accessing medical, clinical, and allied professionals when appropriate.
It may also be that you simply need to build a strong support system that easily fits into your life. In that case recovery coaching and/or counselling and use of support groups are a great option.
If you’re someone with a low to moderate substance use disorder then in-patient rehab and IOP may be more than you need.
But how do you know if residential rehab is in fact necessary? Well, first things first. Is inpatient treatment accessible based on your geographic location, and do you have the budget for it? If you do then the next step is to you could get a professional opinion.
One way to decide if you, or someone you love, needs residential rehab is to undergo an assessment with a qualified professional.
The following options are ideal when accessible:
- Registered Psychologist in Canada
- Psychologist or Neuropsychologists in the U.S.
- Psychiatrist or Physician with an Addiction Medicine designation in either country
Undergoing a professional assessment that provides a diagnosis will help you decide whether inpatient rehab versus outpatient or customized hybrid programs are the right fit.
It’s very difficult to make an informed decision on appropriate course of treatment without an expert evaluation and/or diagnosis. And with an assessment will also come a “treatment plan” so the professional can offer guidance on what would be an appropriate level of care and support.
An assessment will diagnose the severity of substance misuse at hand. Mental health challenges (if any are present) also will be weighed into the decision along with the stability of the home environment.
It’s hard to tackle more acute alcohol or drug dependency in an environment that is unhealthy and chaotic.
It is important to note that some treatment centres would have a primary mental health focus; some a substance use and addiction focus; and several that could offer solutions for concurrent situations — it is always best to do the research to find the best solution for the situation.
Do you need to see a Psychologist to determine what kind of treatment one needs? No — absolutely not. As someone experienced in my field — I would never offer a diagnosis but when provided appropriate history of a client and current circumstances I could certainly be a connector to resources the client could then research and together come up with a treatment plan that makes sense.
Inpatient Rehab Versus Outpatient
There are circumstances where residential rehab is the appropriate course of action.
In cases where an individual is suffering from substance use disorder and co-occurring mental health conditions, an addiction treatment centre could be beneficial.
When medical detox is necessary to manage withdrawal symptoms, a facility with on-site detox management that leads directly into inpatient treatment is ideal.
In-house medical staff, psychiatric professionals, and medication management create a cohesive treatment plan for individuals with a dual diagnosis.
Within the contained, and highly structured environment that inpatient treatment centres offer, those who have challenges in their home can additionally benefit. With severe substance use disorders, being removed entirely from the triggers of day-to-day life can provide the space needed to focus on substance issues. Gaining traction in early recovery can be well served by eliminating excessive triggers.
However, this can be a double-edged sword. For some, leaving home for 30 days or more can greatly disrupt families and put extraordinary pressure on spouses that are left to manage alone. It also may not be feasible to step away from your career for an extended period.
This is when choosing between inpatient rehab versus outpatient services can be helpful.
Intensive outpatient programs offer many of the same benefits as inpatient treatment while not having to leave home for treatment.
If you’re suffering from more severe substance use disorders but don’t need medical detox or 24-hour care, intensive outpatient services (IOPs) are a good alternative. IOPs are also equipped to address mental health challenges in conjunction with substance use treatment. Research has shown that IOPs can be just as effective as residential rehab for most people.
Online Addiction Counselling
While inpatient and outpatient treatment services are a good option for some, they can be very expensive and inaccessible for individuals living in rural areas.
For those who don’t need the level of care those intensive models provide and wouldn’t be able to afford the expense, online addiction counselling is a good option to consider.
The cost for residential rehab ranges from $7,500 to $50,000 per month in Canada (and more in the U.S.).
Outpatient options are generally cheaper but still out of reach for many. BetterHelp and Monument are two of many companies that now offer virtual therapy for people struggling with substance use disorders and/or mental health challenges.
Online addiction counselling is considerably more affordable and easily accessed. The cost for BetterHelp is $80-$100 (USD) per week and allows you to speak with your therapist via live chat, telephone, or video conference. Monument offers a free membership, providing 24/7 access to an online community and support groups. Their $250 per month membership option includes four therapy sessions, and unlimited access to a physician if medication management is needed.
The convenience and affordable access to these services make online addiction counselling a great option for those who previously had very few resources to get recovery support. In Victoria, Vancouver and many cities across Canada you can do a Google search for therapists, counsellors or Psychologists offering support online.
Home Based Recovery in British Columbia and Across Canada
There is a lot more online support available today than there was a few years ago.
Myself and a few partners designed a program out of Victoria BC called Home Based Recovery that is offered virtually across Canada. We felt there was a gap in service offerings and asked ourselves the question “do people really need to spend tens of thousands of dollars on treatment and leave everything behind to get good treatment?” The answer in many cases is — no!
Home Based Recovery (HBR) took into account cost, program content, length of time, and 1:1 contact with a recovery coach as a main component of the program (which offers more 1:1 contact than any program available currently). There is no 1:1 or group therapy component to the HBR program which has brought the cost down a lot, although if one needs a therapist we’d be able to identify that need during the admission process with our Program Director, Dr. Michael Berry R. Psych.
HBR as it is known runs 30 days and offers educational content one would find at expensive treatment centres that is been presented in daily modules pre-taped by experts and professionals in the field of mental health and substance use.
Each module is presented through an online Learning Management System that is easy to use and provides opportunities to reflect on and work through each topic on one's own but also with their recovery coach several times weekly.
How to Stop Drinking Without Residential Rehab
There are many reasons that residential rehab isn’t the best option for people who want to change their relationship with drugs and alcohol.
If you, or someone you love, needs support with substance misuse but doesn’t meet the criteria for a high level of care such as in-patient rehab, there are ways to weave recovery-based services into your life.
If your absence would negatively impact your career and family life then there are options that are less disruptive. Support groups like SMART, LifeRing, Women for Sobriety, and Recovery Dharma give you access to other people who are facing the same challenges that you are. These groups are available in person and accessible online.
Without stepping away from your life, you can engage in conversations with people who understand where you’re at and can offer support that others in your life may not be able to.
Recovery coaching is also a good option for busy professionals who need to build a support system that can fit seamlessly into the schedule and obligations you need to maintain. There are many ways to build a custom treatment plan that works best for you.
When I start working with a new client, we develop an individualized plan that identifies what kind of support, and on what schedule, will be most beneficial for your needs.
There’s no one size fits all plan for changing your relationship with alcohol and drugs. You are the centre of the treatment plan that we build around you.
A plan that works toward the goals that you want to achieve and provides personalized support along the journey.
Get Help Creating Your Personal Roadmap
It can be really scary to arrive at the realization that you have a drinking problem, no matter how big or small.
But it’s a lot less scary when you have an experienced guide to help you sort things out.
I’m an accredited Addiction Recovery Coach offering worldwide virtual support, and in-person support across Canada. If you’re interested in exploring 1:1 recovery coaching to help you cut back your drinking or stop drinking entirely, I’m happy to answer your questions.
I offer a no-charge consult call to anyone who has questions about their own substance use, or the substance use of a family member. These calls are completely confidential with no pressure to make a decision before you feel entirely ready.
I’d also like to invite you to read more about my personal story here.