It is quite common for people suffering from a substance use disorder to believe they don’t need help to deal with their problem. Or they might believe that a stay at rehab and participation in an addiction treatment program is more akin to inflicting punishment for moral turpitude than treating the symptoms of a disease. For those willing to go into recovery, the question could also be whether residential treatment is necessary or whether an intensive outpatient program (IOP) is more appropriate.

Philip Hemphill, Ph.D., LCSW, is the chief clinical officer of Lakeview Health. “People requiring residential treatment have reached a threshold where the disease of addiction has had such a severe impact on their lives that their ability to function is seriously compromised,” he says. “Their physical health has deteriorated, their social structure has crumbled around them, and there might be failure at the workplace or trouble with the law.” Dr. Hemphill reminds us that “the primary drive in addiction is survival. People in active addiction will do whatever they think they need to do to survive, ignoring signals telling them their body needs rest and that they need to take care of themselves.”

In his comprehensive report on addiction, the Surgeon General described a three-stage addiction cycle: “binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation. This cycle becomes more severe as a person continues substance use and as it produces dramatic changes in brain function that reduce a person’s ability to control his or her substance use.”

If someone has a persistent craving to use drugs or alcohol, if the loss of control over the substance use is pronounced, and if recurrent use occurs in situations in which it is physically hazardous, attending an IOP three times a week might be insufficient to achieve recovery. “If somebody is that far down the path of addiction, they require a much more intensive intervention, and that’s what residential rehab can offer,” says Dr. Hemphill. “Such patients will need 24-hour nursing and medical assistance and around-the-clock medication management with careful monitoring.”

Another advantage of a residential environment is becoming part of a community. Patients spend most of the day in the company of other residents who are also trying to overcome an addiction. The support of this fellowship can be an important tool in recovery. Very often, it is advisable to remove a person with a severe substance use disorder from their current environment to keep them away from possible relapse triggers. “Many patients actually start at the outpatient stage before it becomes obvious that their disease has advanced so much that it cannot be contained at the IOP level but requires a more dramatic intervention,” explains Hemphill.

It is not surprising that many people want to stay close to home in a familiar environment with their support network nearby. They hope to improve their condition with their lives disrupted as little as possible. And outpatient treatment might be sufficient for a person with a mild substance use disorder. People with a severe substance use disorder have a tendency to minimize their needs and can be reluctant to enter residential rehab where they might have to stay 30, 60, or sometimes 90 days to launch successfully into full recovery. Their primary care physician might have little or no training in addiction, and might not be able to provide adequate information.

If you’re not sure about the severity of your condition, you can always get in touch with Lakeview. “We are happy to discuss any issues you might have and make a recommendation,” says Robert Walters, vice president of intake services at Lakeview Health. “It’s most important not to wait for all the negative consequences of drug or alcohol abuse to happen. Seek help now before it is too late.” “When patients experience recovery in a residential setting, they get a full body-mind-spirit experience,” explains Dr. Hemphill. “Their whole sense of self, how they see themselves, and the way they function in society get a reset. All aspects of their lives are addressed, not just the substance use.” Residential treatment is much more comprehensive than attending an IOP for three hours three times a week while everyday worries and chores await outside. “In residential rehab, all those problems are taken away for a period of time and patients can focus on themselves,” says Hemphill. Recovery can be a re-calibration of the patient’s life—a new beginning.