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1 Dual Diagnosis

2 1. Is the staff made up of a variety of professionals? Every parent wants to ensure that their child receives the best care possible. A good first step is to check the licenses and degrees of staff at the facility. The mental health professionals on staff should ideally hold Master's degrees (M.A. or M.S.). Preferably, the staff would also consist of several licensed psychologists. A psychologist has either a Doctorate of Philosophy (Ph.D.), a Doctorate of Psychology (Psy.D.), or a Doctor of Marriage and Family Therapy (DMFT). It also important to ask how often patients receive individual appointments with the mental health professionals. Licensed medical professionals should be members of the staff as well. A licensed psychiatrist and general physician are needed to monitor medications and look after all medical issues that may arise. One should ask how frequently the patient will see a doctor while in treatment. Also, it's helpful if the treatment center has a nurse on staff, to attend to day-to-day medical issues. Facilities may employ additional professionals like registered dieticians and yoga instructors. This is a good indicator that the treatment center offers a wide variety of therapy modalities. Each patient is unique and the more options he or she has will increase the odds of finding the right combination of treatment toward the recovery process.

3 2. What types of therapies and treatments does the facility offer? Onekey element to look for in a treatment center is whether or not the therapy is evidence-based. Evidence-based means that the instructions or therapy provided is grounded from research that has statistically significant results. This way you can be confident that the therapy has been proven to work for others and could quite possibly work for your loved one. For a list of evidence-based therapies and more information on them as well, you can visit the American Psychological Association's website: Holistic therapies are important to look for as well. Holistic therapy looks at the person as a whole and aims to assess all of the various parts that make up the whole person. This approach considers an individuals psychological state, social environment, spirituality, cultural background, etc. Holistic therapies seek to heal all aspects of a person and bring them back to a healthy balance. Equine therapy, massage therapy, meditation, yoga, and Pilates are just a few examples of holistic therapies that one may want to look for at a treatment center.

4 3. Are any support group meetings offered? If so, what types? Themost common forms of recovery support groups use the 12-step approach that was made popular by Alcoholics Anonymous. This approach relies on a higher power as an aid to recovery. The 12-step method involves admitting powerlessness, relying on a higher power, acknowledging past wrongs, making amends, learning to live a different lifestyle, and helping others who are struggling with addiction. This method is not restricted to those struggling with an addiction to alcohol, but has been adapted to help with many other compulsions and addictions as well. Several alternatives to the 12-step method exist for those who are not interested in relying on a higher power to help them through the recovery process. If your loved one has tried the 12-step approach before and it didn't work for him or her, then it may be wise to try a different type of support group. SMART Recovery is one of the alternatives to the 12-step approach. Groups meet both face-to-face and online in order to be more accessible. SMART Recovery is a great alternative because it focuses on self-empowerment and is based on current scientific research. Group members learn tools to help cope with thoughts, feelings and behaviors associated with their addiction to help them recover and maintain sobriety.

5 4. Does the treatment center offer detoxification services? Which other levels of care does the facility offer? Many patients struggling with substance abuse problems will require medically supervised detoxification in order to make healthy strides towards their recovery. One must also find out whether the treatment center provides inpatient or outpatient detoxification. Outpatient services may be less of an intrusion on the patient's daily life. Inpatient services are provided in a hospital setting with 24 hour care to assist in the first step toward recovery. Inpatient services would provide the patient with more access to medical practitioners for cooccurring mental health issues if required. There are several levels of care that a treatment center can possibly provide: detoxification/inpatient, residential, partial hospitalization (day treatment), intensive outpatient, and outpatient. A clinician will be able to decide which level of care is most appropriate on an individual case-by-case basis. However, it might help your search to get an idea of what each level entails. Detoxification/inpatient, and residential levels of care provide housing and food for patients in treament. These levels also allow for more supervision from medical and clinical professionals. Partial hospitalization, intensive outpatient, and outpatient levels of care do not typically include housing, but provide intensive treatment. These levels range from 7 days a week of treatment to only one hour a week of individual treatment. Oneshould consider past history and the impact of the addiction and mental disorder on the patient when looking into levels of care. If your loved one has already been through treatment once, then it might be beneficial to try the next higher level of care. Also, if the addiction is not allowing your loved one to function normally (like not being able to work), then inpatient or residential services might be the most appropriate type of care. What type of substance is being used, level of dependency, and how long the patient has been using are all aspects to think about when deciding between levels of care as well.

6 5. Where is the facility located? Thelocation of the facility can play a large role in recovery as well. Picking a treatment center away from home could get your loved one a fresh start. However, a place that is close to home might be more appealing to some. If you choose to have your loved one stay at home and go to an outpatient facility, make sure that the facility will drug test frequently. This is a very important factor because they will be living at home without professional supervision. If your loved one has any health concerns that would limit the types of climates they can live in, then this should be taken into consideration as well. Onemay want to consider looking for a treatment center that is not in the middle of nowhere. It would be a lot easier to avoid the temptation of using when the addictive substances are nowhere to be found in the area. However, the patient will not get a chance to learn how to effectively deal with these temptations when they go back to their home city. If addictive substances are around and professional supervision is provided, then one should additionally ask if graded exposure to the addictive substance is provided. This will help the patient to learn skills to avoid using even if they may be around the substance.

7 6. How much does treatment cost and how much will insurance cover? Substance abuse and mental health treatment can be quite expensive. However, many treatment centers operate on a sliding fee scale based upon income, availability of insurance, and cost of treatment. Some programs offer scholarships to help bring down the cost as well. An increasing number of treatment centers accept insurance as a primary method of payment. If you have insurance, the treatment center can help you figure out exactly how much of the treatment will be covered by your plan. It is important to figure this out before you seek treatment in order to ensure that your insurance will pay for services at that specific facility. This will also allow you to figure out if the cost will be affordable. Support groups like Alcoholics Anonymous, SMART Recovery, Narcotics Anonymous, etc. are free alternatives if you do not have insurance and payment simply is not an option. SAMSA (www.samsa.gov) also provides a list of free resources to aid individuals seeking recovery from alcohol and/or substance abuse.

8 7. How involved are families? Many family members want to hear how their loved one is progressing while in treatment. The best way to obtain this information is to allow the treatment center to provide the family with updated information. By doing so, the information provided will be the clinician's objective and professional opinion. Before the patient enters treatment it's helpful to ask how often these updates will be provided. At times, it may be helpful to distance the individual from family contact early in the recovery process. Additionally, the extent of family contact during treatment is up to the patient. Family members can ask if there are any group meetings they can attend or any special family sessions that the treatment center provides. They can also ask if Al-Anon or Nar-Anon meetings are held in their area. These free meeting provide support for family and friends of people with a substance abuse problem.

9 8. What type of aftercare does the facility provide? Recovery from addiction is an ongoing process. This makes aftercare or continuing care a highly important factor for preventing relapse. Aftercare programs can vary on their intensity and longevity. Some treatment centers offer transitional living or sober living homes, which provide the patient with a controlled living environment before they are ready to live on their own again. Many treatment centers also offer outpatient programs where the patient comes in anywhere from once a week to several times a week. The patient could come into the treatment center to receive individual therapy sessions or group therapy sessions. Additionally, many people choose to continue with weekly support group sessions for many years after they have left treatment. Weekly check-ins can help prevent relapse and are a great way to find support from others who have been through similar situations. One should ask about the facility's aftercare or continuing care program to check that they at least offer weekly sessions after the patient is out of treatment. If they do not, then one can ask for resources for other aftercare programs in the area or near one's home. After-care planning should also include random drug and alcohol tests for the first several months after treatment.

10 9.What type of licenses does the facility have? Thefacility should be licensed by the city and state in which it is located. If you can not find any information on their licensing, you should call and ask because this is a minimum requirement that a facility should meet. Facilities that receive accreditations go above and beyond the minimum requirements and ensure you that they are held to a higher standard. There are two types of accreditations that you are most likely to see. The first is CARF and the second is JCAHO or Joint Commission. CARF sets high standards for safety and quality of care. The most prestigious accreditation to obtain is JCAHO accreditation and treatment centers must meet very high standards in order to receive accreditation from the Joint Commission.

11 10. Are there any restrictions as to what types of patients the facility will accept? Many treatment centers will have a list of types of patients they can not accept into their facility. This is not meant to exclude people, but is actually in the best interest of the patient. Often times a treatment center is set up to serve a specific population like adults, women, men, adolescents, etc. Serving specific populations allows the center to tailor their services so that they are able to give their clients the best treatment possible. Examples of exclusions for Dual Diagnosis programs are if the patient is actively psychotic, actively intoxicated upon arrival, has a history of setting fire, or is actively suicidal or homicidal. Each facility will have their own unique set of exclusions based upon the services they are set up to provide.

12 209 Avenida Fabricante #100 San Clemente, California Telephone: Fax: Website:

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