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Understanding the basics of addiction treatment.
Most people looking help a loved one with an addiction problem have no idea what treatment really is, how it works or how much it will cost. If you look on the internet most of the time its a jungle of garbage advertising content. So on this part of the website we want to give a solid overview of addiction treatment including levels of care, specialized services and potential costs.
Public/State Funded Treatment
Because many of our readers are most concerned with the Marchman Act in Florida we will start by discussing the differences between private programs and state funded or public programs. Under each county we have listed at least one “State Funded or Public” program that serves as the designated program for which people are evaluated, detoxed and sometimes treated under the Marchman Act.
- The Good: Most of these programs do receive state funding and are the magnet facilities for the medicaid , indigent, uninsured and homeless population. We should be thankful for these programs and push for more funding for them. If the facility still has state funding (many have been cut) they will usually work off of a sliding fee scale charging anywhere from a several hundred to several thousand dollars for services rendered. Some programs will allow the you to reserve a bed for 3,000-7,000 per month which often moves the client to the front of the line.
- The Bad: There is almost always a waiting list for a bed anywhere from a few weeks to a few months. This makes it tricky when timing an Intervention or a Marchman Act using public programs. The quality standards aren’t always up to par with private treatment in terms of service, cleanliness, caliber of staffing, medication etc. And maybe one of the most disappointing facts is that they don’t all offer detoxification (detox) or long term residential treatment. Its more cost effective to stabilize a patient quickly, put them on medication management and then sign them up for Intensive Outpatient (IOP) or day treatment (PHP) (see levels of care below)
Faith Based Programs
Faith Based Treatment is usually long term residential treatment where the addict or alcoholic can stay for up to a year. Many of them are year long commitments to begin with. As you might imagine these programs are funded by donors and religious organizations as well as the physical labor performed by the recovering addicts.
- The Good: Most of these are free and as stated they are long term residential. This model has worked for many people whether coming out of prison or just needing help bad enough to commit to it. For those who have a Christian background already or are open to the faith as part of their recovery its also a win. Typically during this time clients are learning some skills and are working jobs or volunteering which is healthy for anyone in recovery.
- The Bad: Most of these programs have a long waiting list, because they are long term it takes time for clients to phase out and make room for more clients. These are not medical model 12 step programs and normally dont have licensed therapists on staff. Clients always have to be detoxed prior to admission. They do not have medical staff and cannot oversee or dispense medication for clients with dual diagnosis etc. Treatment often consists primarily of Bible studies and manual labor which really isn’t classified as treatment at all. Additionally some have been known for religious abuse and forcing a certain religion on the clients.
Private treatment programs are owned by individuals or companies and are usually For Profit agencies. They take cash, checks, credit cards and usually private health insurance. There are more of these programs than any other and they are competitive with one another. They are not all created equal and the buyer must beware.
- The Good: When a patient is accepted clinically and payment arrangements are made you can reserve a bed and be assured that services will be delivered accordingly. This is the primary benefit on an case involving intervention or Marchman Act is AVAILABILITY. Also the quality if services are almost always greater than the above mentioned program types. They have nicer amenities, more qualified staff, more individualized care plans and targeted services such as treatment for co-occurring issues such as Trauma, Bi-Polar, Pain etc.
- The Bad: Because there is big money involved in operating these programs sometimes there is deception, fraud and other unethical practices. Its often hard to tell if the company’s website and/or salesman is telling the truth. There are probably too many examples to list here but you get the point.
Understanding Levels of Care
In addiction treatment there are multiple levels of care that we will list from highest to lowest.
Hospitalization: This can be temporary detainment in a psychiatric unit, hospital based detox and even intensive care (ICU). This level of care is anywhere costs anywhere from 750.00 per day to 2,000 per day on average depending on the hospital. However most health insurance will cover this because its usually acute care and short term.
Detoxification: This can be freestanding, hospital based, or part of a treatment center but the treatment is generally the same. This level of care if for chemical transition from heavy use of alcohol, benzodiazepines, opioids, Methadone or other drugs that are not comfortable or safe to withdrawal from without medical assistance. Detox almost always comes before therapeutic treatment if for no other reason than for “medical clearance”. This level of care usually costs 500.00 per day to 1,500.00 per day at a private program.
Residential/Inpatient: This is typically a campus style program where the clients live (eat and sleep) onsite where their treatment is done 40-50 hours per week. It consists of individual counseling, group counseling, AA/NA or other support group meetings, specialized therapies, teaching and workshops etc. During this level of care a client does work, volunteer or leave campus for anything other than what is scheduled and is entirely focused on their recovery. This level of care usually costs 15,000-60,000 per month depending on the caliber of program it is. Its the most expensive level of care because of the overhead to support the campus, the staff, full kitchen, insurances etc.
PHP with Boarding (Florida Model)
PHP stands for Partial Hospitalization and really is just a fancy insurance term that means Day Treatment. Clients live offsite but attend treatment during the day for a specified number of hours usually 5 days a week. Insurance usually authorizes more of this than residential so programs got wise and built in off-site living arrangements that are supposed to be supervised including room checks and night staff. Florida pioneered this model which is why its called Florida Model. In this level of care clients are taken to the office for treatment via cargo vans and they also shop and cook for themselves during the course of treatment. Typically this model ranges from 7,000 per month to 18,000 per month and is less expensive than campus models because of lower overhead.
PHP without Boarding
Same as the level above but where clients have their own living arrangements and provide their own meals but they come to treatment during the day. Treatment is usually 25 hours per week and may include some individual sessions. Our experience is that this level of care is rarely offered because there is a low demand for it. A program may bill insurance for PHP and either comp or bill for room and board to help extend residential days.
IOP or Intensive Outpatient
At this level patients are responsible for their own living whether that is a sober house or halfway house paid for separately or whether they live at home. Treatment typically consists of group therapy and drug testing 3 days a week or 9-12 hours per week.
This level of care is very effective but also becomes very expensive for long term treatment. Typically it is offered only after a patient has completed detox and 4-6 weeks of residential treatment. Therapeutic services vary by program but typically they are 3-12 month commitments and they allow clients to work/volunteer but the rest of their time is very structured and monitored. This level of care is great for the “chronic relapses” who has been through multiple residential programs and who has resources to pay anywhere from 3,000-10,000 per month.
This is perhaps the lowest level of care whereby someone sees a counselor or therapist individually to work on issues and maintain ongoing care. Generally this is a recovery maintenance recommendation although many start here and are referred on if they need a higher level. Cost range is 50- 250 per visit.
Sober Living/Halfway House
This is hardly considered a level of care since no medical or therapeutic services are provided. Its simply a community of recovering people where there is a house manager, a set of rules, sometimes drug testing and low weekly or monthly rent. It allows addicts in early recovery a place to stay with stipulations that mainly safeguard their recovery and the community.
If you have any questions regarding treatment programs or would like a referral please feel free to call us at 1-866-54-SOBER (76237). We’re here to help!