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Treatment Continuum

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. The Partnership for Drug-Free Kids offers helpful tips for navigating treatment options.

Image credit: Brockton Area Opioid Abuse Prevention Collaborative
Acute Treatment Services (ATS or Detox)

Length of Treatment: generally 3-5 days.
Detoxification is also known as Acute Treatment Services (ATS). It’s the first step toward recovery for many people who need medical management or who will go through withdrawal. Detox services provide 3 to 5 days of 24-hour care and monitoring for withdrawal. Medical management might be needed because the symptoms of withdrawal from alcohol, heroin, and some opioid medications can be dangerous and even life-threatening. Inpatient detoxification allows the patient to be closely monitored and given medication to manage withdrawal.

Eligibility and priority populations: People 18 years and older who are at risk for withdrawal from alcohol and other drugs. Certain high-risk populations are prioritized for detox services, including injection drug users, homeless people, pregnant women, and people with chronic but stable medical conditions.

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.

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.

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.

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.

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.

Ongoing Support

All services of the continuum of care are available in Massachusetts, but completing every level of 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: SOAR Natick, Learn to Cope, Al-Anon and Alateen, Families Anonymous and Nar-Anon. And if attending a meeting in-person is difficult for family members, there are online supports such as Allies in Recovery, and the Parent Helpline through the Partnership for Drug-Free Kids offers support via text, phone or email. (Note: Because of a partnership with the MA Department of Public Health, MA residents can establish an Allies in Recovery online account for free by entering their zip code as their promo code when creating a new account.)

For more information about treatment and support services, call the Massachusetts Substance Use Helpline at 1-800-327-5050 or visit their website.