The Recovery Process – Continuum of Care

A continuum of care is a system of care in which a person receives the type of service that is most appropriate for the intensity of their addiction at each stage of their recovery. Understanding the continuum helps individuals and families focus on a long-term strategy, think about future needs, and recognize progress. The goal of the continuum is to keep the appropriate levels of support in place as the loved one stays motivated and works toward recovery.

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Acute Treatment Services (ATS or Detox)

Length of Treatment: generally 3-5 days. Detoxification is the medical supervision of withdrawal from alcohol, opioids or benzodiazepines. Medical management is sometimes necessary because the symptoms of withdrawal from certain drugs can be dangerous and even life threatening. For example, withdrawal from alcohol can cause seizures and convulsions which can be fatal. Detoxification takes place in an inpatient or overnight program that provides around the clock evaluation and management of withdrawal symptoms. Counselors work with clients to develop a treatment plan and find services to guide them through the next phase of treatment and recovery.

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Clinical Stabilization Services (CSS or Rehab)

Length of Treatment: usually around 14 days, but can be longer. Clinical stabilization services (CSS) provide short-term inpatient treatment, stabilization and referral services for clients who don’t qualify for medically monitored detoxification or who have already completed a detoxification program. Stabilization programs include a comprehensive assessment, individual and group counseling, health education, some medical support and planning for longer-term support services.

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Transitional Support Services (TSS or Holding)

Length of Treatment: often between 2 and 4 weeks, but varies depending on personal need and availability at the next level of care. Transitional Support Service (TSS) programs, also known as “holding”, are short-term residential programs that accept clients from detoxification, clinical stabilization services (CSS) programs, or from homeless shelters if the individual is not at risk for medical withdrawal complications. In order to enter a TSS program, the person seeking services must plan on moving on to a Residential Treatment program, otherwise known as a halfway house.

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Residential Treatment/ Halfway House (HWH)

Length of treatment: approximately 4-6 Months, but can be longer based on need and the type of program. Residential treatment programs or “halfway houses” are licensed and overseen by the Massachusetts Department of Public Health, Bureau of Substance Abuse Services. The goal of treatment is to help the person gain a deeper understanding of addiction, recovery, and the practical skills need to live alcohol and drug free with a better quality of life Examples of residential treatment include recovery homes, social model programs, and therapeutic communities (TC). Residential treatment programs provide:

• An alcohol and drug free living environment with meals

• Case management services

• Recovery support meetings in the house and in the community where members can find mutual or “peer” support as they focus on recovery.

Residential programs serve different populations. Some admit men or women only, some are for adults only, some are for families, and others are for youth under 18. In Massachusetts, some women’s halfway houses allow children to live with their mothers, and a small number are geared for women who are dealing with domestic violence or sexual abuse. At many programs, the staff supports clients’ effort to find and keep a job, to enroll in programs with services to aid in their recovery, and help them create an aftercare and post-treatment plan.

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Alcohol and Drug Free (ADF) Housing or Sober Homes

Length of stay: varies Alcohol and Drug Free (ADF) Housing, also known as “Sober Homes” are an option after completing a halfway house. Sober homes are not regulated or licensed by the Commonwealth, therefore their quality varies dramatically. When considering a sober home, it is critical to visit the site and interview other clients to determine if the culture is supportive to someone in recovery. Sober homes should offer an alcohol and drug-free living environment that is less structured than a halfway house. Most sober homes require that residents be employed, pay rent, remain in recovery and undergo regular drug screenings. They do not offer treatment services.

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Outpatient Services

Length of treatment: varies, but often 1 year or longer When a patient has completed a course of treatment in one or more residential programs, ongoing support through outpatient services will help them stay sober as they return to a healthier pattern of life. Outpatient treatment programs often include case management, individual and group counseling, support groups and psychiatric services. Intensive Outpatient Programs (IOP’s) offer group support sessions that meet several times a week provide structure, discipline and motivation to maintain progress. Some outpatient programs are designed for adolescents; others provide child care. Many providers offer morning and evening hours so that clients can keep jobs, look for work, and honor family commitments. Medications such as Methadone, Suboxone, Vivitrol and Naltrexone may be offered for individuals recovering from opiate addiction.

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Ongoing Support

All services of the continuum of care are available in Massachusetts, but competing the continuum is not always necessary to maintain recovery. Everyone is different and people recover through many different paths. Support to end the isolation of addiction is key for individuals and families. Narcotics Anonymous or Alcoholics Anonymous can be enormously helpful at every point along the journey. Both organizations maintain excellent websites with up-to-date information. Other support services include Rational Recovery, Smart Recovery, Women for Sobriety and Recovery Coaching. Others benefit by joining a faith-based community that is supportive of their personal recovery. In addition, there are meetings to support families who have a loved one with a history of addiction including: Learn to Cope, Alanon and Alateen, Families Anonymous and Nar-Anon. For more information about support services, call the Massachusetts Substance Abuse Information and Education Helpline at 1-800-327-5050 or visit their website at www.helpline-online.com.

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How to Commit a Family Member for Drug Treatment in Massachusetts

Research shows that individuals who are mandated or civilly committed to receive addiction treatment have the same or higher rates of recovery than those who voluntarily seek treatment.
What is a civil commitment? A civil commitment is a legal process by which an individual has a family member or spouse involuntarily placed in a facility for addiction treatment. In Massachusetts, the civil commitment process is defined in Chapter 123 Section 35 of Massachusetts General Law. Law enforcement officials, physicians, and probation officers may also use the Section 35 civil commitment process. The person seeking to place an individual in treatment for substance use is known as the “petitioner”. In Massachusetts, the petitioner must obtain a Section 35 order from a judge. The Section 35 order is also known as a Medical Warrant of Apprehension. This process is completely confidential; it is not an arrest, does not appear on a CORI and does not disqualify an individual from employment opportunities.

When can a Section 35 be used? 

While acknowledging that voluntary treatment should be tried first, a Section 35 civil commitment is used as a last resort when a family member or spouse’s alcohol or drug use results in risk for serious harm to him/herself or others or it has become life threatening. A Section 35 can be used only when the individual is actively using drugs or alcohol. Adolescents can also be civilly committed and will be sent to a Department of Public Health licensed treatment center for adolescents where they will get age appropriate treatment.

How do I get a Section 35 Civil Commitment? 

Gathering Evidence: A Section 35 civil commitment is a stressful, emotional event for the family and for the individual suffering from the addiction, so it’s best to be completely prepared. Keep a list, diary or calendar with incidents that can be used to prove the case to the court clinician and the judge. The court is concerned only with events that have occurred during the last two weeks.

Type of Incidents to Document • Overdose  • Car Accidents  • Committing or being the victim of violent behavior • Driving while intoxicated/high • Significant infections or health conditions  • Burn marks on clothing or bedding  • Being intoxicated in the home when small children or elderly people are present • Pregnancy  • Suicide attempts or threats

Going to Court The petition for a Section 35 civil commitment must be filed at the court in the jurisdiction, or location, where your loved one lives or is staying. Most courts open at 8:30AM. It is best to arrive early since the process can take several hours. Bring the evidence you have gathered. If a warrant is granted, you will need to provide the location of your loved one.

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1.Meet with the Court Clinician
Visit the office of the court clinician. Ask for and fill out a form for a Section 35 civil commitment and then give it to the court clinician. The clinician will review the form and interview you to determine if there is enough evidence to present the case to the judge.

2. Going Before the Judge
If the clinician decides there is enough evidence to grant a civil commitment, he or she will present the case to the judge. The judge may decide to ask the petitioner a few questions. If the judge agrees with the clinician, he or she orders a Medical Warrant of Apprehension.

3.Serving the Warrant
After the judge issues the warrant, the police will be sent to pick up your loved one. The police cannot enter by force when serving a warrant for a civil commitment, so you must ensure that someone will be there to let them in. An individual can be sectioned for treatment from home, custody, or from a hospital. A Section 35 warrant is in effect for 24 hours. In order to transport your loved one to the court safely, they will be placed in handcuffs. Although this is difficult to see, it is important to remember this is not a criminal arrest and that their addiction has already trapped them in handcuffs that cannot be seen.

4.Court Hearing- Granting the Section 35 Civil Commitment

The court will appoint an attorney to represent your loved one. Most judges will rely on the evidence you documented and the opinion of the clinician. Once a judge orders a civil commitment and there are no open criminal cases, your loved one will be sent to a secure treatment center licensed by the MA Department of Public Health (DPH) for up to 90 days. In most cases, they will be admitted for 14-20 days. If DPH licensed Section 35 programs are full and the civil commitment has been ordered by the Judge, the commitment must occur and your loved one will be placed in a correctional facility.

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Medication-Assisted Treatment and Recovery

Medication-Assisted treatment for addiction includes the use of medication often coupled with counseling and other supports. Treatment that includes medication is often the best choice for opiate addiction. Medication gives a person who is addicted to opiates an opportunity to regain a normal state of mind without experiencing the drug induced highs and lows. Medication also can reduce cravings and withdrawal symptoms. Medication-Assisted treatment can give the person a chance to focus on the lifestyle changes that lead back to healthy living. Taking medication for opiate addiction is like taking medication to control heart disease or diabetes. Some people may need it for a short period of time, and some, just as with other health conditions, may need it for longer periods of time, or even for the rest of their lives. It is not the same as substituting one addictive drug for another. Used properly, the medication does not create a new addiction. It helps people manage their addiction so that the benefits of recovery can be maintained. Medication-Assisted treatment allows many to successfully work, maintain health relationships and participate in their families and communities. The three most common medications used in treatment of opiate addiction are methadone, buprenorphine and naltrexone. Cost varies for the different medications. As with all medications, discussing the pros and cons of different treatment options with trained professionals is the best way to determine which course of treatment might be best for a loved one.

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• Methadone or Buprenorphine trick the brain into thinking it is still getting the drugs the person was using (heroin, OxyContin, etc). When properly dosed, the person feels normal and does not experience intense cravings. If someone does experience intense cravings, nodding or appears high while using these medications, they may not be properly medicated. Their medical provider may need to adjust the dose or determine if there are interactions with other medications they may be taking.

  • Methadone comes as a pill, liquid or a wafer form. Methadone is taken daily. Methadone to treat addiction is dispensed only at specially licensed treatment centers. Some people go to the treatment center or doctor’s office every time they need to take their medication. People who are stable in recovery may be prescribed a supply of medication to take at home.

• Buprenorphine (or Suboxone) is taken daily at first. After time, buprenorphine is taken daily or every other day. This medication is dispensed at treatment centers or prescribed by doctors with special approval to prescribe buprenorphine. Some people go to the treatment center or doctor’s office every time they need to take their medication. People who are stable in recovery may be prescribed a supply of medication to take at home.

• Naltrexone (or Vivitrol) helps overcome addiction in a different way. It blocks the effect of opiate drugs and takes away the feeling of getting high if the problem drug is used again. Naltrexone cannot be taken until opioids are completely out of the body, usually 7 to 10 days after withdrawal begins. This medication is taken daily at first. After time, doses of naltrexone are taken up to 3 days apart. Naltrexone is dispensed at treatment centers or prescribed by doctors.

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References:

Learn to Cope. (2014). The Path to Recovery. Guide for Families Dealing with Addiction and Recovery. Massachusetts Organization for Addiction Recovery. (2015) Resources for Recovery: A Mini Guide with MOAR to Come! Substance Abuse and Mental Health Services Administration. (2011). Medication-Assisted Treatment for Opioid Addiction: Facts for Families and Friends. Retrieved from: http://store.samhsa.gov/shin/content/SMA09 4443/SMA09-4443.pdf