The National Institute on Drug Abuse (NIDA) maintains an up-to-date guide called Principles of Drug Addiction Treatment: A Research-Based Guide. This document is intended to help both medical professionals and the general public understand addiction as a chronic brain disease and the evidence-based options that guide the best treatment plans.
The third principle listed is that treatment needs to be readily available. While there are many drug rehabilitation facilities in the US, there are more people struggling with substance abuse. NIDA found in a survey updated in 2015 that 24.6 million people, ages 12 and older, struggle with illicit drug abuse. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) found, based on the National Survey of Drug Use and Health (NSDUH) from 2015, that 26.9 percent of survey respondents, ages 18 and older, reported binge drinking in the past month; 7 percent reported heavy alcohol use in the past month; and 15 million adults surveyed had a diagnosed alcohol use disorder. The Centers for Disease Control and Prevention (CDC) keeps track of the growing opioid epidemic and found that currently, 91 people die in the United States every day from an opioid overdose.
The 2013 NSDUH found that, of 22.7 million people ages 12 and older in the US who needed treatment to overcome drug addiction or abuse, only 2.5 million found help. While some people purposefully do not seek help after detox, the 2013 NSDUH found that at least 316,000 people tried to get into an inpatient program after detox but failed and ultimately relapsed.
With so many millions of people in the country struggling with substance abuse, polydrug abuse, addiction, and co-occurring disorders, it is difficult to provide treatment options immediately. Rehabilitation programs, especially inpatient or residential options, fill up quickly. Many rehabilitation facilities, especially those available for low cost, on a sliding scale, with state funding, or for free, have waitlists for entry. A news report from Indianapolis, Indiana, found that people struggling with heroin addiction in the area had to wait six weeks before entering a rehabilitation program; this was after detox, which the facilities required before becoming a resident. A report from Fox News found the same problem; people struggling with heroin addiction could get help detoxing from a hospital emergency room but getting into an inpatient treatment program was difficult.
It is possible, however, to undergo detox and then get admitted to a rehabilitation program immediately. There are special circumstances required for this rapid referral, but it is possible for those in desperate need.
Can a Person Enter Rehab the Same Day?
While it is rare to receive admission to a residential treatment program the same day, it is possible for those who experience immediate medical need. Those who experience chronic medical problems and require 24-hour surveillance to maintain abstinence receive priority admission. Often, people who experience a drug overdose will receive priority admission to these programs too.
In some states like Florida, a person in a case involving drug crimes may be ordered into a rehabilitation program by the court; depending on availability, they could be forced into an inpatient program as soon as possible. However, most court-ordered programs are short-term, and the person may be required to attend an outpatient rehabilitation program if an inpatient program is not available.
Same-day inpatient or residential admittance is usually reserved for those who have the greatest medical need. The American Society of Addiction Medicine (ASAM) has guidelines regarding levels of inpatient treatment. Levels 3 and 4 are inpatient or residential services, with Level 4 being the most severe. This level is treatment for either adolescents or adults who require 24-hour nursing services and daily checkups from a physician, and who have unstable problems related to detox and side effects of the substance abuse.
Levels 1 and 2 are outpatient treatment. While there are guidelines for specific numbers of hours of therapeutic treatment, and on medication management and prescribing practices, these levels are for people who are ambulatory, meaning they are in reasonably good health. Outpatient services work best for those who have enough support at home and in their social lives to stay away from addictive substances.
Those who do not have a dire medical need to enter a rehabilitation facility may struggle to maintain sobriety after detox. If waitlists are too long, too often these individuals succumb to relapse because they are not receiving the intensive therapy needed to change their behaviors.
How to Get Same-Day Rehab Admission
People who need same-day admission to a rehabilitation program are at high risk of suffering an overdose or life-threatening outcomes if they do not receive continued support. A doctor from their detox program or the emergency room is generally responsible for this referral.
Sometimes, getting into a rehabilitation program after detox requires preparation. Friends and family can help while their loved one goes through detox by seeking out potential rehabilitation centers and beginning the application process if legally eligible to help in this manner. Working with their loved one’s case manager or a hospital social worker can make this process simpler.
The Substance Abuse and Mental Health Services Administration (SAMHSA) maintains a treatment finder online to help the search for a rehabilitation program. People who may not have gone through detox first can still use this service to search for local rehab options and speak to representatives about same-day admission. Although there may not be a dire medical need for supervision, or the rehab may not focus on this kind of necessity, expressing deep commitment to the process can sometimes help the intake counselor or case manager to narrow down treatment options. The goal of rehabilitation is to provide group and individual therapy to help change behaviors around intoxicating substances, which supports sobriety; inpatient and residential drug rehabilitation programs provide a safe environment to practice these behavioral changes and examine outcomes. Explaining the need for a change in environment to stay sober may help the staff find space, or they can at least refer the individual to a different service.
What if Same-Day Admission Is Not Possible?
Unfortunately, same-day admissions may simply not be available. This does not mean there are no options for treatment or support. Even if residential or inpatient treatment would suit one best, finding support to stay sober and change behaviors is available in other, less intensive forms. If same-day admission is not possible, take the following steps:
Step 1: Work on steps leading to admission.
There are a lot of steps to consider before entering a residential treatment program, and the time between detox and entering the program may be a good time to settle everything. This time can be spent gathering financial resources to pay for the full cost of treatment, including asking friends and family, doing some fundraising, contacting one’s insurance company, and asking about state resources.
Notifying friends and family of the intention to enter rehab can take some time. Also, taking time off work or school can require specific arrangements. The Family and Medical Leave Act (FMLA) means that employers cannot discriminate against employees who need to take time off to care for themselves or loved ones, but there is paperwork involved in this transition.
Many residential treatment programs provide specific complementary services. These include a focus on a specific religion or spirituality; herbal remedies; nutritional oversight; vocational training; and more. Using the time after detox to find the perfect program to suit all of one’s individual needs can mean the program is more effective overall.
The rehabilitation center may have admissions paperwork that needs to be completed, so time between detox and admission can be spent gathering necessary information for the program.
Step 2: Participate in support groups after detox
If there is a treatment gap between detox and rehabilitation, regular attendance at a support group can help maintain the individual’s focus on sobriety. SAMHSA provides a list of self-help organizations, as does the National Council on Alcoholism and Drug Dependence (NCADD). There are also forums online that offer support all hours of day for those who may not be able to leave home or who are not close enough to attend an appropriate support group in person.
Step 3: Attend individual therapy or outpatient treatment.
If there are no beds available at residential or inpatient drug rehabilitation facilities, it may be time to consider outpatient options. Psych Central and Psychology Today both offer search tools for therapists and behavioral treatment facilities, which can be narrowed down by specialty. Searching these databases for nearby counselors, therapists, and outpatient treatment options can get a person needed support and an introduction to behavioral treatments.
People who struggle with co-occurring disorders will benefit from therapy for their mental health problem too. Between detox and rehabilitation, this form of therapy can start, which can improve substance abuse struggles too.
Step 4: Call a crisis hotline, if needed.
People who are struggling with severe addiction, who are in crisis but cannot get the help they feel they need, should call a crisis hotline. SAMHSA runs a national helpline, which is confidential and available 24 hours a day; help is available in both English and Spanish. The helpline provides those struggling with substance abuse, and their friends and family, with information on rehabilitation programs, support groups, and community organizations. Operators may be able to offer information on treatment and support options to help for the time between detox and residential rehabilitation.