If you are medically unstable, if you have a history of complications, such as seizures, during detoxification, if your living environment would make early abstinence difficult, or if you have tried as an outpatient and failed before, you might need to be in a residential program.
A residential program might be for detoxification, with or without medications, or it might have group therapy, education, and a structured program to prepare you for abstinence-based recovery. Some programs are several weeks and are very intensive. Others simply provide a safe, drug-free environment where you have enough support and structure to get your life back on track.
Research has shown that the particular type of treatment is not all that important. It is important to receive therapy from a caring or empathic therapist and to stay engaged in some type of treatment for several weeks to several months.
People seem to heal better in groups. Rational Recovery®, SMART Recovery®, Women for Sobriety, Alcoholics Anonymous®, and Narcotics Anonymous® are some of the support groups available to people with a history of substance abuse or dependence. Although you might find parts of any one of these programs difficult to embrace, be patient and shop around until you find the groups that you feel most comfortable in. They offer education, support, accountability, and often a step-by-step program of behavioral, cognitive, and emotional change. Project MATCH demonstrated that alcoholics who were given "12-step facilitation therapy" by an addictions counselor were just as likely to be sober a year later as those given more intensive cognitive behavioral therapy from a PhD psychologist.
If you have alcohol or drug dependence, your safest bet is abstinence. Not all people with alcohol or drug problems are willing or able to completely stop using their drug of choice. There are programs that offer behavioral techniques, counseling, and support to help you reduce your hazardous or harmful alcohol or drug use. It is wise to engage in a behavioral contract with a counselor or physician if embarking on a controlled-use program. That way, if you try and fail, someone will be available to help you recognize the problem and make new recovery plans.
Ray Baker, MD