RECOVERY & TREATMENT OPTIONS
Detoxification: Inpatient or Outpatient [1, 4]
Detoxification is the clearing the body of toxins and substances of abuse, usually under medical attention to manage withdrawal symptoms. It is a form of palliative care for those seeking abstinence. Detoxification can be the first step to entering recovery, but does not constitute recovery. Thus, detoxification should always be followed by entrance into a substance abuse treatment program. This process involves: evaluation, stabilization, and finally fostering patient readiness for entry into long-term substance abuse treatment. There are a number of medical interventions and medications that can be used to help alleviate withdrawal symptoms. Methadone is the most frequently used medication; other medications include: buprenorphine and clonidine. Duration is usually 3-14 days.
- Inpatient detoxification is held within a medical facility, where individuals are often provided with constant medical support and supervision to manage withdrawal symptoms. Rockland County, one of the requirements for admittance is that the individual is in acute withdrawal.
- Outpatient detox requires individuals to complete regular visits to a facility as an outpatient. It entails less supervision and, thus, is not recommended for those suffering from severe addiction. Most outpatient detox programs require that the individual identify a friend who will be willing and available to support them throughout the process.
Rehabilitation: Outpatient and Inpatient 
Outpatient rehab provides a variety of programs, requires patients to visit facility on a regular basis for individual and/or group counseling, geared towards supporting individuals throughout their recovery. Such programs are more commonly utilized during later stages of recovery and often provide a variety of therapeutic approaches (e.g., cognitive behavioral therapy, support groups, family therapy, etc.). Inpatient rehabilitation requires that individual live in the treatment facility and provides 24- hour structured and intensive care.
Residential Treatment: Short or Long-Term 
Provides long-term, live-in rehabilitation for those in recovery. Provides 24-hour structured care in a non-hospital setting, often focusing on lifestyle changes and coping methods. Long-term programs can last 6-12 months. Short-term programs can last 3-6 weeks, followed-up by outpatient therapy.
- Therapeutic communities: long-term (usually 6-12 months) drug rehabilitation with structured programming. Therapeutic communities like to take a comprehensive approach to recovery by also focusing on personal development, overall health, and taking accountability.
Medication: Buprenorphine/Suboxone, Methadone, Naltrexone 
Used for opioid, tobacco & alcohol dependence, in combination with counseling and behavioral therapies. Medications can reduce the cravings, block the effects of a substance, and reduce symptoms of withdrawal.
- Methadone maintenance (full opioid agonist): Methadone is a medicine taken daily to block the effects and urges for opioid-dependent individuals. It comes in a liquid or tablet form and can even have pain relieving effects for individuals suffering from chronic pain. Individuals can be on methadone from a few months (if the individual wishes to use methadone solely to wean off opioids with reduced withdrawal symptoms) to a lifetime. Methadone is highly regulated, thus, individuals are expected to visit a methadone clinic 6-7 days a week to receive their daily dosage of methadone. With high compliance to treatment, individuals can earn the opportunity to receive weekly take-home doses, allowing participants to come into the facility less frequently. For some folks, it is possible to develop a methadone dependency.
- Buprenorphine (partial opioid agonist): Like methadone, buprenorphine is a medicine taken daily to block the effects and urges of opioid-dependent individuals. It often comes in a tablet form or sublingual strips. Brandname versions of buprenorphine are called Suboxone or Subutex. Buprenorphine are prescribed by a licensed buprenorphine physician and does not require daily visits like methadone; instead, individuals are expected to take buprenorphine daily, on their own. Like methadone, buprenorphine maintenance duration can range from a few months to a lifetime, depending on the needs and desires of the user. In addition, risk for opioid overdose is dramatically reduced while on buprenorphine (more so than methadone). It is less possible to develop a dependency on buprenorphine than on methadone; Suboxone adds naloxone to buprenorphine to further reduce these odds of dependency.
- Naltrexone (opioid antagonist): Naltrexone is an opioid substitution therapy that is used to treat opioid and alcohol dependence. It comes either in a tablet form (brandnames: Revia, Depade) or long-acting, monthly injectable form (brandname: Vivitrol).
Twelve-Step Programs 
Programs such as Narcotics Anonymous, Alcoholics Anonymous and Cocaine Anonymous provide a supportive community focused on the daily practice of guiding principles to live a drug-free life. These fellowship-based programs focus on maintaining abstinence through regular meetings where members can share their experiences of addiction and support one another in their recovery. Twelve-Step programs often require that member seek about a mentor, or “Sponsor,” to support them through the process.
 National Institute of Health;  American Society of Addiction Medicine;  American Addiction Center,  Substance Abuse and Mental Health Services Administration
Adapted from the Boston Public Health Commission
It is also important to evaluate and understand treatment readiness when discussing or deciding on treatment options. Not everyone is ready for treatment, and while the desire to act is understandable, options for involuntary treatment are limited and controversial. Evidence indicates that long term success of involuntary programs may be limited. One way that many people think about quitting using drugs or alcohol and readiness is as a cycle.
One might be familiar with the Stages of Change model, which outlines the different stages of addiction and recovery. The stages include: pre-contemplation, contemplation, preparation, action, maintenance, and relapse. There are several important points about this Stages of Change model:
- The stage that the person is at is up to the person: There are ways to influence behavior change, but interestingly, the most effective seems to be supporting the person to be in the stage they are in and not trying to push them to a different stage.
- There are different points where different messages, encouragement, advice and treatment options will and can be heard by someone making behavior change such as stopping using substances. Someone who is thinking about change (second stage) is in fact thinking about it– that means not ready for acting on the change (fourth stage). He or she may not react well to being encouraged to act (like go into treatment)- it may be better to encourage the person to think about the pros and cons of the behavior change.
- Relapse/sliding backwards/recycling is built into the model. It is part of what is expected sometimes.
For individuals not ready for treatment and their loved ones, there are a number of services available to help keep these individuals safe until they are ready to begin treatment. These programs, typically referred to as harm reduction programs, offer education and supplies around safer substance use including needle exchange and overdose prevention using nasal narcan. These services are particularly important for people who are in these stages: not ready yet; thinking about it; preparing for action, and; sliding backwards or relapse.
Realistic Expectations for Treatment and Recovery
Because recovery is a process and addiction, like other chronic diseases, involves periods of relapse, having realistic expectations will reduce some frustrations and disappointment for everyone involved. A concrete example is to change the words we use from unrealistic to realistic. Consider these suggestions from the Centers for Disease Control and Prevention (CDC): Fig. 1.
RECOVERY SERVICES IN ROCKLAND COUNTY
Download our Quick Sheet for Treatment Resources in Rockland:
Nyack Hospital Recovery Center, Nyack
Nyack Hospital, 160 N Midland Ave, Nyack, NY 10960
7 North Main Street, Spring Valley, NY 10977 (Satellite Clinic)
(845) 348-2075 Information & Admission
(845) 356-0081 Spring Valley Outpatient Site
Russell E. Blaisdell Addiction Treatment Center, Orangeburg
Good Samaritan Regional Medical Center, Suffern
255 Lafayette Avenue, Suffern, NY 10901
Inpatient Chemical Dependency Programs & Detox
outpatient treatment & rehabilitation programs
Daytop Village, Blauvelt
620 NY-303, Blauvelt, NY 10913
Lexington Center for Recovery, Haverstraw & Airmont
45 S Route 9W, West Haverstraw, NY 10993
100 Route 59 #117, Airmont, NY 10901
Mental Health Association, Valley Cottage
140 NY-303, Valley Cottage, NY 10989
Nyack Hospital Recovery Center, Nyack & Spring Valley
Nyack Hospital, 160 N Midland Ave, Nyack, NY 10960
TWELVE-STEP PROGRAMS & SELF-HELP GROUPS
Narcotics Anonymous: Search for meetings here.
Families Anonymous: Hosted by RCADD every Monday, 7:30-8:30PM. Search all meetings.
Rockland Alcoholics Anonymous: For those living with alcoholism. Search meetings.
Al-Anon: For family members of those living with alcoholism. Search meetings.
Alateen: For young/teen family members of those living with alcoholism. Search meetings.
Marijuana Anonymous: Search meetings.
Overeaters Anonymous: Search meetings.
Grief Recovery After a Substance Passing: for those who have lost a loved one to substance abuse or addiction. Search meetings.
Nicotine Anonymous: Search meetings.
Gamblers Anonymous: Search meetings.
Reaching All Potentials (RAP) Session: Opiate recovery meeting, hosted by RCADD every Wednesday, 6-7PM. Learn more.
Walk By Faith: Christ-Centered Restoration Ministry
Risen King Alliance Church, 190 New Hempstead Road, New City, NY 10956
Celebrate Recovery: Monday 7-9pm
Gracepoint Gospel Fellowship, 384 New Hempstead Road, New City, NY 10956