Choosing a program
Families often choose a treatment program in a hurry, late at night, after a crisis, from whichever website showed up first. A short list of questions helps. Ask any program:
- Is it licensed by the state, and is it accredited by The Joint Commission or CARF?
- Is medical detox available on site, or will the person need to go somewhere else first?
- Does it offer medication for opioid or alcohol use disorder when that’s appropriate?
- Who are the clinical staff, and what licenses do they hold?
- What does the family program involve?
- When does discharge planning start, and who is responsible for it?
- What will insurance cover, and what will you pay out of pocket? Get the answer in writing.
Red flags
Most programs are run by people who want to help. Some aren’t. Be cautious of any program or “placement service” that offers free travel, free housing, or cash to attend, that pressures you to decide on the spot, that can’t clearly explain what insurance will pay, or that quotes a success rate without saying where the number comes from. In Florida, paying or receiving anything of value in exchange for patient referrals is a crime, and federal law also prohibits kickbacks for referrals to treatment programs and recovery homes.
Getting admitted
Admission goes more smoothly when the pieces are lined up in advance: insurance verified, an arrival time confirmed, medical information ready for the intake team, and a plan for getting there. Once someone has agreed to go, the time between yes and arrival should be as short as it can safely be. Sober transport covers the trip itself.
Discharge planning starts early
The best time to plan for leaving treatment is soon after arriving. By the last week, the plan should already answer these questions:
- Where will they live: at home, in sober living, or somewhere else?
- What level of care comes next, and is the first appointment booked with a date and time?
- Are prescriptions filled, and does someone at home know what each one is for?
- If opioids have been involved, is naloxone in the house, and does someone know how to use it?
- Who is the first person they’ll call when things get hard, and does that person know it?
- What do the first seven days look like, especially evenings and weekends?
Stepping down through levels of care
Treatment often runs in stages: medical detox, then residential care, then a partial hospitalization or intensive outpatient program, then regular outpatient care. Each step down brings less structure and more freedom. That’s the point, but plans tend to slip at the handover, when one program has signed off and the next hasn’t started. Put a specific person in charge of that stretch, with the dates written down.
If they want to leave early
Wanting to leave treatment early is common, and it often peaks in the first week or two, when withdrawal, homesickness, or a sudden sense of being fine arrives. Programs call this leaving against medical advice.
If your loved one calls asking to come home, don’t agree or argue on the spot. Tell them you love them and that you’ll call back shortly, then talk to the clinical team, who have seen this many times and can often help the person stay. Decide ahead of time, with the other adults involved, what you will and won’t do if they leave anyway, such as whether you’ll pay for a ride or let them move back home. If they do leave, the risk described in the next section applies right away.
Why the first weeks home need extra care
After a period without drugs or alcohol, tolerance drops. If someone goes back to their old amount, the risk of overdose is much higher than it was before treatment, especially with opioids and especially with a drug supply where fentanyl is common. Say this out loud to everyone involved. It’s the reason to keep naloxone at home and to plan the first weeks carefully.
How we help with transitions
We can help a family compare programs, coordinate admission and travel, and build the discharge plan with the treatment team while the person is still there, so the first day home isn’t the first day of planning. With the person’s written permission, we work directly with their clinicians.
When the plan calls for more support at home, it can include a sober companion for the first weeks and recovery coaching after that.