Episode 6 – How To Choose The Right Rehab

by Dr. Ashish Bhatt |  ❘ 

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HAYLEY: Hello, this is Hayley, and this is another episode of Straight Talk with the Doc. A podcast that takes a real look at addiction, mental health, and treatment. I’m joined by our content director Jeff and, of course, our medical director Dr. Bhatt. How are you two doing

JEFF: I’m doing just good today, Hayley. How are you?

DR. BHATT: I’m good I’m good. How are you guys doing?

HAYLEY: I’m doing great. So, in previous episodes we’ve talked a lot about different substances, addictions, mental illnesses and how professional treatment can help. Today, I want to look at it from the angle of someone who’s made that decision to seek treatment. They’re ready to go to rehab and get the help they deserve. But if you just do an internet search for rehab, there are millions of results. There are so many options, so many facilities that offer different things.

So, Dr. Bhatt, as someone in this field I want to ask you today how does somebody find the right rehab? What types of things should they take into consideration before making their decision?

DR. BHATT: I think it can be complex if you overthink it, but the first part is to look as you mentioned. If someone’s ready, the best step is to start researching and looking online. Obviously, we have websites like our own, Addictioncenter.com that can offer a wide variety of treatment centers based on location and services offered. Essentially, first you need to look at something proximal, closer to you. If there’s specialized programming that you’d like to address. If the substances of abuse that you’re using are specifically tailored to within that program. There’s multiple nuances in a treatment center that somebody can look at, you just have to match it up based on what you’re looking for.

HAYLEY: Okay. Are there different facilities and different rehabs for different substances? Are there ones that focus on alcoholism and others that focus on cocaine for example?

DR. BHATT: Most treatment centers around the US tend to be quite comprehensive. Most of them are capable of treating addiction as a whole, regardless of what substance you’re using. There are some programs that are out there that may be specific to certain substance use disorders. But in general, most of the treatment centers that are licensed and accredited, they do tend to be broad in terms of their ability to treat substance abuse as a whole.

JEFF: I would just like to add that, while obviously addiction to different substances does take different forms and exhibit in different ways, treatment of the underlying issues that can lead to addiction is pretty much the same regardless of the substance.

DR. BHATT: That’s a good point Jeff, that’s exactly right. When we seek treatment, we’re hopefully trying to obtain an understanding of the underlying problem that’s led to the substance use disorder. In essence, that approach is what we’re looking for. That understanding, the professional training that can address addiction as a whole opposed to the substance as an individual, unique thing. And I think Jeff, you explained that quite well.

HAYLEY: At the beginning of treatment, depending on the addiction and the severity of the addiction, you may have to go through a detox process. Do all rehab facilities offer that detox service, or sometimes do you have to go to two different places for that?

DR. BHATT: Many places do offer that continuum. Detox being that medical treatment that helps you safely come off of substances that have pretty significant withdrawal. Not all facilities have that component. Some facilities will help coordinate that for you, maybe with an affiliated facility treatment center. Both are out there.

HAYLEY: Can you break down some of the differences between inpatient and outpatient rehab?

DR. BHATT: Well inpatient, as it sounds, it’s where you stay at the treatment center and receive treatment. Outpatient is where you live at home or in a structured environment and tend to receive treatment on a part-time basis. Part-time being – it could be like going on an outpatient doctors visit or therapy visit, or you could go to an intensive outpatient, which is like 9-12 hours a week. Then you have these inpatient or residential programs where you’re staying there, you’re eating there. You’re attending your groups and therapies and evaluations and assessments are all conducted while you’re living within the facility.

Depending on the needs of the individual and where they’re at within the recovery. Those two different venues or different structures exist.

HAYLEY: Okay, and are there certain people where one would be a better option for? Does it depend on the severity of the addiction?

DR. BHATT: Yeah for sure. I’m going to take a step back and give an overview of how people are assessed. We have this criteria and it’s been established by the American society of addiction medicine and it’s the criteria that’s been standardized by both healthcare treatment centers and insurance companies as a way to help determine what level of care a person would need. And that’s really determined by looking at 6 dimensions of an individual’s life.

I’m not going to laundry list them, but basically, we look at how badly someone is intoxicated or what potential they have for significant withdrawal. Or if they have any other medical complications or psychiatric, mental health, emotional problems. Depending on all of those, “is there a high relapse potential”, or “they don’t have a place to stay”. Then those people would be pointed more – better suited for a residential or inpatient environment.

Those people that may have other components intact, they have a stable living environment, they’re motivated to change, they’re using a substance that doesn’t have an acute life-threatening withdrawal. They might be able to commence treatment on an outpatient basis.

Depending on the characteristics or dimensions these people are demonstrating or have, they would be appropriately placed in an inpatient versus outpatient setting.

HAYLEY: So, I know some people go for 30 days, some for 90 days, how do you know how long you should stay in rehab?

DR. BHATT: That’s often best answered with the treatment team that helps establish your treatment plan. I think a lot of people see this whole numerical thing and that’s going to be fixed in stone. As professionals and as treatment providers, it’s hard to determine how quickly or how well somebody’s going to respond before they’ve entered treatment.

I think looking at a numerical value is okay, but keeping in mind that that’s just a general frame of how long somebody’s able to come int. Hopefully somebody understands that being in treatment or seeking treatment for a chronic illness, that’s going to be something that you deal with and cope with your entire life. The longer you engage in something and solidify it early on, the longer the time in treatment, the increase likelihood you’re going to have for doing better once you leave.

I think sometimes people get fixed on “hey how can I get the shortest amount of treatment?” But I think that speaks to being able to anticipate the future. The answer on how long you should be there, that should be determined by the treatment provider, the positions, the therapists that are in the treatment center who are able to look at your entire life and then determine what treatment plan fits best for you and how long that will take to achieve.

JEFF: Sometimes you may initially start treatment under the impression that it’s a 30-day stay, and you may find out that you really do need more time to work through things as you go through treatment.

DR. BHATT: Yea, that happens a lot. People are often – it’s hard to go to treatment. To be separated from you family, your loved ones, and your work. It can be a scary time. Like you said Jeff, once you’re in it and you find out “hey there’s things progressing” or “I’m solving problems,” “I’m being enlightened about why I’m using in the first place.” I often see people be a lot more motivated to stay longer because they’re accomplishing something.

HAYLEY: So if I was looking at different options, different facilities, are there certain types of treatments or therapies that I should for or look into?

DR. BHATT: I think we said it at the beginning, we mentioned it somewhere. Some substance abuse centers are rehabs. They focus strictly on substance abuse treatment. Some treat both underlying mental health conditions and substance abuse treatment. Then there’s some treatment centers that focus just on mental health conditions. The first way I would look at it is “what am I looking to achieve?” So, If somebody feels that they have a combined depression and alcohol use disorder, I would definitely look into a treatment center that offers or focuses on treatment for both.

Then you want to look at if it’s a credited facility, if it’s a licensed facility. Do they have the proper licensing to function and operate? That can be found often on their websites or often if they make a call to them. There are governing bodies, accrediting bodies like Joint Commission, maybe the listener might not know these, but these are standards that treatment centers need to achieve. I would want to know if my treatment center that I’m looking for has achieved these standards.

Also looking at their website, checking out what are the credentials on some of the staff members. Are there licensed therapists? Are there board certified physicians? And how are their reviews, what are patients saying about the treatment they’ve received. Are they good reviews for the most part? Speaking with other people – reputation is there for a reason. A lot of times those places that have been around for a long time or that have catered to a lot of people and have had good outcomes, people are going to talk about it.

And again, this can keep going. There are things you need to focus on if you are specifically dealing with depression or anxiety. Are there therapies like CBT or medication management? If you’re dealing with trauma are there things that focus on those things?

To answer your question in short, you kind of want to match up what you’re suffering with, what you’re going through and look for that within that program. And often it takes that phone call and that correspondence with them and asking that question directly to the program.

HAYLEY: Okay, so you can pretty much call any facility, and ask them these questions, and get your answers.

DR. BHATT: I would definitely – if I was seeking out a treatment center, I would want to talk with that treatment center and ask them, “Hey, this is what I’m dealing with. Can you guide me through this? Help me out.” I know we’re speaking about going to treatment, but Addictioncenter.com has a lot of information out there that can actually help answer those questions and help provide characteristics of treatment centers like a comparative analysis looking at different ones.

Looking online, talking to people, calling the treatment center directly, definitely.

HAYLEY: I want to talk about amenities a little bit, because you see stuff all the time. Some places have horseback riding, some even have opportunities to swim with dolphins. How – are these things important in treatment? What are the benefit of those?

DR. BHATT: I don’t want to negate anybody that offers those types of treatments. There’s therapeutic value in many different types of these therapies, but as long as they’re therapeutic in nature. When you’re staying in a treatment center for a long period of time, obviously you’re focusing on developing and achieving recovery, and abstinence and working out, and processing those underlying issues that have plagued someone. If this happens also through these experiential type therapies and treatments, that’s there and there’s a lot of evidence that exists in having these therapeutic environments.

Amenities is different. I look at it as aesthetics and other type of non-therapeutic accommodations. And that really depends on the individual. I’ve met many patients and worked in many environments that, if you had compared or looked at them purely full of amenities or not, I have had great outcomes with patients that don’t have other non-therapeutic amenities and done really well. They focused on just the curriculum, they focused on their recovery, they focused on themselves.

But, as human beings sometimes we do need to have other resources available to us depending on if we’re engaged in business, or our job requires us to be in contact with them. So, having a facility that might allow computer or personal devices while they’re monitored or whatnot.

I think amenities really depends on who you are, what you need to accomplish while you’re in there, and if they can keep you from being distracted, from staying engaged in treatment and getting a good outcome, then those amenities might be beneficial.

JEFF: Do you feel like there are any amenities that are generally more beneficial than others?

DR. BHATT: Like I said, I don’t want to speak that might negate somebody’s offerings – that a treatment center might have. Definitely if there are some things that offer some sort of exercise or physical outlet. As we get beyond the detox phase if someone needs that, and they’re physically up to it, I think physical activity or something that helps promote physical wellbeing, it’s a very important part of our health in general, regardless of if you are suffering from addiction or not. That one thing I would say is important. That one thing I would say is very important. Your diet, your nutrition, your overall physical health. Programs that allow you to engage in those type of things, that’s an important aspect that I think one should consider.

HAYLEY: There are obviously treatment centers all over the country and even all over the world. How should somebody decide on whether to attend a local rehab or travel to one?

DR. BHATT: In the treatment industry, sometimes you need to be – we see that sometimes patients need to be away from the environment that they’re using within. I think that’s a big factor. A local treatment center might be good in terms of its proximity, but sometimes that could be a temptation or a distraction because it’s too close to home. It’s too close to people someone was involved with in terms of using or the psychological proximity of the trigger or temptation of their drug dealer or their supplier.

In those situations, it might be better to move yourself from the environment and seek treatment further away. Or being local – if that’s not the situation because you have a secure environment, you’re engaged in certain support groups, but you had a shorter relapse and you have other things that are intact, or you have other obligations that might not allow you to travel, then local treatment programs might be better if you have that structure in place.

Sometimes working individuals who have families, have commitments, but want treatment might not be able to travel. Local treatment is an option for them. It really depends on your individual situation and condition if you should travel further away.

And let’s be frank, also financially. If you have health insurance, depending on which treatment center accepts your insurance or cost if you’re private pay. These are practical things that people consider and often guide them when you’re comparing 2 things that are similar, which one is going to be financially less of a burden. Those practical things, all of them make a difference.

HAYLEY: How do you find out what insurance might cover or what might need to be paid out of pocket.

DR. BHATT: I often would insist that somebody would speak to their insurance company and their treatment center both just so they’re getting a comprehensive picture. Looking at your benefits, speaking to your insurance company, and asking them “hey, what will be covered? What will be my responsibility if I choose an out of network program vs an in-network program?” Again, depending on what insurance benefits that an individual has. And also posing those same questions to a treatment center, “what’s covered? What are things I’d have to pay out of pocket? Are my medications covered if I want to buy cigarettes?” All of these different things, if you’re in lab screens is that going to come out of a different place?

It’s hard, I know. All of us, we’ve had to seek healthcare and then we get bills after the fact and we’re like “where did this come from? Why did this happen? Who’s sending me this?” And when we’re in desperate need, we don’t always have an opportunity to ask these questions. Sometimes this needs to be vetted for us by someone else. A loved one, a spouse, somebody who – a person whose insurance we’re covered under can ask these questions for us.

The key thing is trying to get as much information up front, so you’re not taken by surprise. And it’s sad that we have to think about cost when we talk about life or death in healthcare, but it’s the reality that we live in. But these are questions that need to be posed to your insurance company and treatment center both.

HAYLEY: I know you kind of talked about a couple things earlier, but could you kind of summarize or give some questions to ask a treatment center? Some ways to determine if a place is a good treatment center. Are there questions you should ask? Things you should look for.

DR. BHATT: Yea, I think we went over it a little bit. Are they licensed, their certifications, what’s the credentials of the therapists and the doctors and the nurses and the people that are going to be caring for them? Are there people from multiple disciplines? Are there social workers, nurses, physicians, psychiatrists that are on board? What’s the outcomes? Hopefully people are able to provide that type of data. How long people stay sober once they leave their facilities.

These are real, important questions that I would have. Also questions about, if I need to come back what happens? If I relapse what happens? And after completing is there an alumni program, do they stay in contact with you? There are multiple things you need to look at and think about when making that decision, but definitely the ones I just mentioned. Those are things I’d highlight.

HAYLEY: Are there any last bits of advice that you have for someone who’s about to start their journey through treatment?

DR.BHATT: It can be a daunting task and experience just to even go to treatment. Often, we see treatment only when we’ve hit that “rock bottom” place. You know, making that first step is always difficult, but it’s needed. There are resources out there, there are treatment centers out there. There are multiple different things that people can look at when seeking a treatment center but making that step and getting as informed as possible.

The more information you know, the less intimidating sometimes it can be. We can get caught up in our mind with all of these unexpected things in our minds that tell us “No. I don’t want to go because of things.” And we let them stay there as a form of resistance. Asking those questions, getting clarifications, looking online, making those calls, speaking to other people – it’s really important because the more information you have, the better.

HAYLEY: Yeah, absolutely. And thankfully we live in a time where you can go online and do research. You can pick up the phone and call. And you can get your questions answered. You can always go to Addictioncenter.com like Dr. Bhatt said for a ton of information on treatment options. Don’t forget to check out some other podcast episodes which are also always available on Addiction Center. Thank you to everyone who’s listened to another episode of Straight Talk with the Doc.

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Dr. Ashish Bhatt

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  • Dr. Ashish Bhatt, MD, MRO is an accomplished physician, addiction medicine specialist, and psychiatrist with over 20 years of medical and administrative leadership.

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