Category Archives: Recovery

What is a PHP Program?

What is a PHP? A Partial Hospitalization Program (PHP) is a type of outpatient treatment program that has been found effective in treating addiction. These programs are designed to help people who can benefit from structured treatment but who do not need medical assistance or supervision 24 hours a day. PHP programs can be modified or customized to fit the requirements of the patient, and treatment can be delivered at varying care levels.

The treatment in this sort of program is intensively focused on the patient’s recovery, and it takes place in an environment that fosters the patient’s transition out of addiction and into a responsible, productive life. PHP programs are an alternative to residential or inpatient treatment options, and they may be more intense than other outpatient treatments.

What Is the PHP Treatment Model?

A Partial Hospitalization Program might make use of a number of different therapies to achieve its goals. Among the options commonly employed by these programs are:

Individual therapy

Addiction counselors or other health professionals consult with the patient to explore the triggers and causes of drug or alcohol use. The goals of this type of therapy are to address the patient’s denial and the underlying causes of the addiction so that they can focus on the recovery process.

Group therapy

Sessions in group therapy involve an addiction treatment counselor and a group of people who are recovering from addiction. The people in the group are encouraged to discuss emotions, experiences, coping mechanisms, aspirations and anything else that could be related to overcoming drug or alcohol addiction.

Family therapy

In this sort of therapy, members of the patient’s family, along with an addiction therapist, meet together to help the patient see the reality of the situation and to guide him or her to recovery. In some cases, a family member can be an enabling factor or even the cause of the addiction, but family therapy can provide a safe environment to address these issues.

History of Partial Hospitalization Programs

Partial Hospitalization Programs were originally developed in the 1960s with a focus on the treatment of mental illness. They were designed to help people who needed an intensive level of care but who would also benefit from being part of the community. It was also meant to help people who were struggling with mental disorders but who had safe, stable homes to return to the following treatment.

The Medicaid regulations changed in the 1980s, making Partial Hospitalization Programs more viable for health care and recovery centers. The number of partial hospitalization options nationwide increased significantly through the 1990s until restrictions were placed on them. Around that same time, the idea began to take hold that addiction was tied to mental and behavioral illness rather than being simply a question of willpower.

Partial Hospitalization Programs are still primarily designed to help individuals who have mental health issues, but there is significant overlap of this group with those who want to stop using substances or alcohol. The programs developed into a method of helping those people who want to overcome addiction without joining an inpatient program.

Who Can Benefit From a Partial Hospitalization Program?

Partial Hospitalization Programs are often recommended for people who have already gone through inpatient addiction treatment and who can benefit from transitional coaching as they reintegrate into the community. They are also recommended for people who need more structure and supervision than is available in traditional outpatient treatment programs.

On the other hand, a PHP might not be right for people who need constant monitoring or who do not have transportation or housing. Inpatient treatment may be a better option for people who:

  • Will be tempted to do drugs if they return to their homes and social circles
  • Are homeless
  • Are victims of domestic abuse or other violence
  • Have learning disabilities or structural brain issues and will not benefit from PHP therapy sessions
  • Require 24-hour medical supervision or care following an overdose
  • Might become dangerous due to withdrawal symptoms
  • Need a methadone treatment program
  • Lack community or family support

Primary Functions of Partial Hospitalization Programs

A taxonomy has been proposed for PHP options. Three primary functions of partial hospitalization treatment have been identified.

First, it is an alternative to more restrictive inpatient treatment. Second, it is a supplement to traditional vocational rehabilitation or outpatient treatment. As an outpatient supplement, a Partial Hospitalization Program can provide added intensity periodically throughout the treatment without requiring admission into the hospital or treatment center. Third, a Partial Hospitalization Program can provide an opportunity for functional maintenance while the patient remains part of the larger community.

Variations of Partial Hospitalization Programs

The ways in which medical appointments and therapy can be scheduled and structured might vary widely among different PHP options. They are often flexible enough to change with the needs of the patient. The number and structure of the therapy sessions required might range from as little as two hours each day for three days a week up to eight hours each day for five days a week.

Different Partial Hospitalization Programs might make use of many different types of mental health and other health care professionals. Among those who could be involved are:

  • Social workers
  • Occupational therapists
  • Recreational therapists
  • Psychiatrists
  • Psychologists
  • Nurses
  • Pharmacists
  • Peer support workers

Most Partial Hospitalization Programs require between four and five days of therapy each week, and each therapy session can range from four to eight hours. The day will have breaks scheduled in to break up intense therapy sessions. Typically, a minimum of 10 hours per week is required, and it is rare for patients to attend therapy sessions for more than 50 hours per week. On average, patients attend treatment for 20 hours a week.

PHP Versus Inpatient Treatment

Inpatient treatment for substance or alcohol abuse requires patients to live in a treatment facility 24 hours a day. Patients in this type of treatment program are separated from their previous lives. This means the patient has barriers between themselves and the outside world of influences, both positive and negative. The idea with an inpatient program is to provide a safe environment so that a patient can focus solely on sobriety and overcoming the issues that led to addiction.

Therapy sessions during inpatient treatment might make use of many of the same techniques and professionals that Partial Hospitalization Programs use. Typically, an inpatient program lasts at least 30 days, and some programs last as long as a year. The length of the program depends on a number of factors, including the patient’s specific plan of treatment, the severity of the patient’s addiction and the patient’s other obligations.

People who are in an inpatient addiction treatment program typically go through the phases of detoxification, hospitalization and residential treatment. All of these components take place while the patient lives at the treatment facility. A Partial Hospitalization Program, by contrast, allows the patient the freedom to move between the treatment facility and the outside community. In a partial hospitalization scenario, the patient shows up to the hospital at scheduled times for therapy and returns home after the session is over.

PHP Versus Outpatient Treatment

Outpatient treatment is a strong option for people who are dealing with substance or alcohol use but who do not meet the diagnostic criteria for inpatient or residential treatment. It can also be useful in providing continued support for patients after they’ve been discharged from an inpatient program.

This type of therapy is less costly than inpatient options and works well for people who have a solid support structure and other obligations outside of therapy. While they are less intensive than inpatient treatment options, many outpatient programs are effective because of their drug education components.

Partial Hospitalization Programs, by contrast, are a high-intensive treatment option. While outpatient addiction therapy might call for only weekly or biweekly sessions totaling less than eight hours of treatment, PHP options usually demand a minimum of 10 therapeutic hours per week.

The popularity of Partial Hospitalization Programs

Nationwide, Partial Hospitalization Programs have grown tremendously in popularity in recent years. This growth might be a reflection of certain benefits offered by partial hospitalization methods over other treatment options. According to the findings of a research study, 2.5 percent of non-disabled adults and 5.4 percent of disabled adults chose PHP options for treatment of addiction. The study covered a group of 32,037 people.

The authors of the study said the low percentages of people choosing PHPs might be due to a lack of public knowledge about the existence or effectiveness of these programs. As they are becoming more popular, though, PHPs are likely to draw increased attention from researchers and addiction patients alike. This sort of therapy has also shown promise in treating eating disorders.

PHP Benefits

A Partial Hospitalization Program can be the ideal way for a patient dealing with addiction to transition from inpatient treatment, which is the most intense and highest level of treatment, to outpatient treatment, where there is significantly less supervision and structure. Generally, PHPs are significantly more affordable than inpatient programs, which means more people can afford to get help.

All forms of addiction treatment were made more widely available to Americans by the Affordable Care Act, and insurance companies are more likely to approve payment for PHP options than they are for inpatient treatment. Because PHPs offer a longer treatment period at a reduced cost, insurance funds are likely to last longer for people in PHP treatment.

These programs also allow people who need addiction treatment but also have another home, work or family obligations to get treatment on terms that don’t demand all of their time or attention. The flexibility of PHPs and the reduced hours they require leave time for the patient to schedule and address other commitments. Participants in Partial Hospitalization Programs also have the chance to develop new or existing support communities with people who are not part of the treatment.

Conclusion

PHPs offer something of a middle ground between inpatient and outpatient addiction treatment options. They are typically utilized by people who have been hospitalized for substance use and who have been discharged following some level of treatment for addiction. They might be effective for people who:

  • Have a current diagnosis of a substance or an alcohol use disorder
  • Need regular monitoring by medical professionals but are stable enough to spend significant time without supervision
  • Are not at risk for self-harm
  • Are mental, physically and emotionally capable of going through several hours of intensive therapy at a time for several days each week
  • Have symptoms of detox that are moderate or mild and manageable without constant medical oversight
  • Are not currently capable of daily functioning but who have sufficient family and community support to avoid relapse

Partial Hospitalization Programs commonly offer detox support, but it is also common for patients to go through detox in an inpatient program and then join a PHP following inpatient treatment. Withdrawal symptoms only rarely rise to the level of threatening the life of the patient, but they can. Withdrawal from a severe addiction to alcohol or benzodiazepines can be life-threatening and may require 24-hour supervision to watch for heart attacks, seizures or other dangerous side effects until the patient has cleared the initial withdrawal period.

PHPs can be a good option for people who are tapering down their alcohol or substance use or who can make use of intensive therapy to alter their behaviors. These programs also act as an effective transition plan between inpatient and outpatient therapy options. People who believe they might benefit from addiction therapy should consider and discuss their options with medical professionals or trusted friends and family so that they can make an informed decision about the treatment option that may be the most effective for them.

What to do if an addict refuses treatment

Confronting the fact that a friend or a family member doesn’t really want to enter a recovery program in order to treat an addiction may leave you wondering what to do next. Just as treating an addiction is a process that needs to be very structured, it’s also important to take a structured approach to talk with anyone who might refuse treatment. More importantly, regardless of how an attempt to help them might turn out, you need to continue to be supportive to ensure that when the time comes for them to enter recovery, they’ll have people there to assist them.

Step 1: Acknowledge the Situation

When someone chooses to refuse treatment, it may raise some questions about whether they’re really an addict. People coping with drug or alcohol use disorders often can present very compelling arguments that they’re not in trouble. They may explain that they:

  • Only drink or get high to let off steam on the weekend
  • Insist that they’re highly functional
  • Are already cutting back their usage
  • Have fears they’ll lose their job if they are admitted to a treatment center
  • Need to be around to take care of their family
  • Will enter recovery after some big event, such as the holidays, a wedding, etc.
  • Won’t be able to afford rehab
  • Are worried about exposure to criminal charges

Rarely does a rational argument win out in these situations, so try to not dig in and make the discussion into a fight. The big thing is to recognize that you’re dealing with an addicted individual and you need to begin to take other steps to help them toward recovery. With the idea clearly framed, you’ll be able to confront other situations that might come up, such as if they beg you for money or need help making bail. This will ensure you don’t contribute more to the current problem.

Step 2: Learn More

Especially when dealing with an addict who refuses to seek help, it’s prudent to get educated about dealing with substance use disorders. You may also want to learn more about treating an overdose and obtain a supply of an antidote like Narcan if a loved one is using heroin or another opiate. It’s also wise to take a CPR course if you haven’t already been certified.

If you’re concerned that the person you care about is headed toward being charged with a crime, it’s also a good idea to talk with a drug law attorney. Conducting a consultation will give you a sense of how to address the situation if an addict is arrested. You can ask questions about things like the following:

  • Does your state offer any diversion programs?
  • Can someone charged with an offense still refuse treatment?

You’ll also want to get up to speed on the symptoms of different types of drugs, particularly if you’re not quite sure what the individual you’re dealing with is actually using. This is especially important to know if you’re worried that they’re engaged in mixed drug use, such as using cocaine to dial back the effects of heroin. Develop a written list of signs that your friend or family member is dealing with the misuse of specific drugs.

Step 3: Start Identifying What’s Going On

Having attained some degree of education about drugs and their symptoms, you should begin to figure out precisely what sort of situation your loved one is coping with. The first order of business is determining what drugs they’re actually using. Every drug has its own list of effects.

Someone who is using heroin, for example, might:

  • Seem out of it at times
  • Struggle to remember commitments
  • Withdraw from social life, especially interactions with non-users
  • Display medical issues, such as seizures or decreased breathing

On the flip side, a cocaine addict may be more likely to act:

  • Confrontational
  • Energetic
  • Twitchy
  • Violent
  • Panicky
  • Paranoid

You’ll also want to keep an eye for indicators that your loved one’s life is being disrupted by their misuse of alcohol or drugs. Regardless of the specific substance that might be abused, you may notice that they:

  • Aren’t grooming their hair as well as they used to
  • Haven’t bathed recently
  • Neglect to change their clothes
  • Try to hide their eyes by wearing sunglasses at inappropriate times
  • Disappear into the bathroom for unexplained reasons
  • Start forming friendships with people who use drugs

You may also begin to spot physical changes that are occurring, such as the phase that meth and cocaine users go through when they’re losing excess weight. As the addiction cycle continues, they’re likely to hit a point where they go from looking thin to downright scrawny.

By identifying the specific indications of a particular drug problem, you can start looking into treatment options tailored to the unique situation, such as dealing with someone who has a dual diagnosis. Even if they currently refuse treatment, it’s a good idea to have a recovery center in mind for when they come around. This will improve the chances they’ll get on board quickly during the period where they’re receptive to getting help.

Step 4: Get Them Medical Attention

Visiting a doctor and conducting a checkup may serve to give an addict a clearer picture of what they’re actually up against with a substance use disorder. This can frame the conversation in ways they might not have previously considered, such as learning about:

  • How much weight they’ve lost
  • Declines in motor skills
  • Diminished cognitive abilities
  • How their condition might continue to get worse
  • Toxicology reports
  • The effects of different drugs

It’s a good idea to give the doctor a heads-up about the situation before bringing an addict in for an exam. This will allow them to focus on a conversation that points your family member or friend toward recovery options. The experience may also provide better guidance regarding what specific drugs are being used.

Step 5: Stop Contributing to a Substance Use Problem

One of the more insidious aspects of addiction is that it compels people to seek money to fund their use. An addict may come straight out and ask for money, but they’ll often frame it as needing to cover rent or utility bills. Don’t assume that a presentation of bills is a legitimate reason for giving an addict money. It’s normal for a person with a substance use disorder to pay for drugs first, ask for money to cover bills and only then pay to keep the lights on. People with extreme addictions may be tempted to just buy more drugs.

An especially tricky aspect of this problem is that a user will often find ways around attempts to not contribute to their situation. You may try, for example, to directly buy something they need only to watch them turn around and sell it to convert into cash for drugs or alcohol. Friends and family often end up cutting addicts off completely in these situations.

It’s essential to make it known that you still care and that you’ll gladly help them if they need a ride to a recovery center. You don’t, however, want to put yourself in a situation where your finances are endangered because of their substance use disorder.

Step 6: Make a Clear Offer of Help

By this point, you should have collected a lot of information about the condition your loved one is in, what they’re using and which nearby treatment facilities are likely to offer suitable programs. At this stage, having acknowledged what the situation is and stopped contributing to it, you need to clearly state that you’re willing to help them get drug and alcohol counseling.

It’s normal for an addict to be emotional under such circumstances. You may be subjected to an outburst from them, or they might withdraw in the hope that non-engagement will kill the conversation. No matter what turn the discussion takes, you should:

  • Avoid being angry
  • Stay focused on the topic of recovery
  • Offer support
  • Refrain from being judgmental
  • Avoid escalating the situation with threats, such as saying you’ll call the police
  • Not use guilt
  • Remain encouraging

You should also try to avoid emotionally overcommitting to this moment. Many people with addiction issues don’t immediately jump in the car and go straight to rehab. With a little luck, they’ll understand, and you won’t eventually need to conduct a full-on intervention. You should, however, be prepared to provide steady friendship and support while they come to the conclusion themselves rather than being shocked if they refuse treatment. Knowing that you’ll be there to assist them in the process when the time comes will make it easier if they have a rock-bottom moment and decide to get help.

Step 7: Assess the Situation

Whether they refuse treatment or decide to go to rehab, you’ll need to assess where the situation stands. If they elect to go into recovery, you’ll need to make calls, set up an intake and provide transportation. Should they decide against entering rehab, you’ll need to start thinking about how to conduct an intervention.

Bear in mind that interventions don’t work the way they do on TV. A group of people don’t dramatically present an ultimatum and then watch as an addict emotionally caves. It’s often prudent to talk with a counselor at a treatment center, and it may be necessary to have a professional present to regulate the discussion during the intervention.

Step 8: Conducting an Intervention

Staging an intervention should take a couple weeks. You should be especially serious in thinking about who you invite to it. It’s critical that everyone who participates will be someone who can remain focused on the goal of directing the person to seek treatment. You don’t want to end up with people digging up old emotional wounds, screaming about unpaid debts and derailing the effort by providing anger or tears as conversational direction. If you have any doubts about the capacity of a potential participant to stay on point the entire time, do not include them.

Sort out everyone’s schedules to ensure they can be present. If possible, try to reserve a space that’s neutral, such as a conference room in a community center, in order to avoid reminders of emotional moments with the person you wish to help. You should also conduct a rehearsal in order to hear what everyone will say and place an emphasis on taking turns and staying on a defined script, even if your loved one tries to knock the intervention off course. Have contingencies in place in case the person decides to enter rehab right away, but be willing to accept that they may still refuse treatment.

Step 9: Following Through on Support

Helping someone get to a treatment center doesn’t mean your job is done. If they’re there on an outpatient basis, they may need rides back and forth. If they’re doing inpatient treatment, it will be helpful for visitors to come by regularly to check up on them. Someone should also be prepared to collect them when they’re done, and it’s important to have transportation for follow-up work, such as going to counseling sessions after completing treatment.

Recovery is a process, and it continues for years after the end of rehab. Don’t allow something that might feel like a major slip-up discourage you or your loved one, even if they’ve been clean for months. Remain supportive and keep a clear focus on what’s important: finding a path to a healthier and more stable life.