9 Crucial Questions to Ask When Choosing an Inpatient Rehabilitation Program

Choosing an inpatient rehabilitation facility is not a matter of making a quick phone call. It is a matter of families who are tired, scared, and are being sold services by marketers rather than guided by medical professionals, and the way to cut through the haze is to ask the right questions.

Below are eight that cut through the noise and get to the heart of the matter: clinical quality, staffing, and what happens when the 30 or 60-day clock runs down.

Is the facility properly licensed and accredited?

Any reputable treatment center should be licensed by the state in which it operates, and that state will have an agency that oversees behavioral healthcare and will have a list of accredited facilities. Ask if the facility you are considering has accreditation from The Joint Commission or CARF (the Council on Accreditation of Rehabilitation Facilities). Both organizations offer accreditation to treatment centers that meet specific standards of care, staffing, safety, and recordkeeping.

A facility with state licensing and accreditation has been reviewed by people not beholden to the facility, which is more important than it may seem. If they cannot provide the information or are noncommittal about what organizations have accredited them, that should raise flags. This question should always be the starting point, as everything else is tied to licensing and accreditation.

Who supervises medical detox, and is it on-site?

Alcohol, opioids, benzodiazepines, and other substances require detox, which is a medical procedure. Detox should be overseen by physicians and nurses who can prescribe the medications and adjust dosages as needed based on the patient’s vitals and symptoms and who can respond to any complications that may arise.

The medical team may not be on staff 24/7, depending on the level of care. If the first week of detox is in one facility and the next three are in another, there is a risk that the two teams will not communicate effectively, which can lead to dangerous withdrawal symptoms. Is detox provided on-site, and who oversees it? A facility that has an in-house physician and nurse staff available 24/7 will be better equipped to handle the demands of detox than one that does not. Ask about the staff’s qualifications and experience.

Does the program address co-occurring mental health issues?

Substance use and mental health issues are intimately linked. According to SAMHSA’s National Survey on Drug Use and Health, nearly 9.2 million people in the US had a co-occurring mental health and substance abuse disorder in 2021. If the patient has depression, anxiety, PTSD, or bipolar disorder, and the facility has no idea what to do with them beyond admitting them to a rehab unit, they are likely to be readmitted shortly after discharge.

That is not an acceptable risk, and it is one that can be avoided by asking if the facility addresses co-occurring mental health issues during treatment. Does the staff do psychiatric evaluations? Do they have a psychiatrist on staff? Ask how mental health issues are integrated with substance abuse treatment, instead of being tacked on as an afterthought. Inquiring about dual diagnosis is an important step in choosing a rehab facility.

What does the weekly therapy schedule look like?

Ask for specifics. A facility that bases its treatment on scientific studies will be able to tell you how many hours per week are dedicated to cognitive behavioral therapy, dialectical behavior therapy, EMDR, or other individual or group therapies.

Yoga, art, and horse-assisted therapies are valuable supplements but should not be the backbone of treatment, especially if they have not been proven to be effective. Expect that the majority of hours in any given week are spent on clinically proven therapies. Ask what the staff’s qualifications are, as the facility may be making promises it cannot keep.

Is the treatment plan individualized, or does everyone follow the same regimen?

Ask what the facility’s intake assessment consists of. A responsible facility will perform a thorough evaluation that considers the patient’s substance use history, mental health, family dynamics, trauma, and other relevant factors and develop an individualized treatment plan based on the findings. Ask if the plan is reviewed and updated throughout the course of treatment, as the staff learns more about the patient’s needs.

Some facilities offer a one-size-fits-all approach, in which everyone follows the same treatment plan, regardless of individual needs. It may be cheaper and easier to staff, but it is not as effective. Ask how the individual needs of the patient will be taken into account and how often the treatment plan will be reviewed. If the staff cannot give you a satisfactory answer, keep looking.

How does the facility involve the patient’s family?

Addiction does not take place in a vacuum and will affect the patient’s family, so ask if the family is involved in the treatment process. Does the facility offer family counseling and education? Many families are unaware that they play a role in the patient’s recovery and may be enabling them, so it is important to educate them on their role in the recovery process.

Ask about communication with the family, as some facilities do not allow any contact with the patient for the first week or so. Others may do the opposite and allow unsupervised contact, which can be detrimental to the patient’s recovery. Both approaches are understandable, but make sure you understand the reasoning behind them.

What is the facility’s stance on medication-assisted treatment?

Medication-assisted treatment (MAT) for substance use disorders is the most effective form of treatment, as it combines behavioral therapy with FDA-approved medications. Those medications can help ease withdrawal symptoms, cravings, and other discomfort while minimizing the harmful side effects of substance use and normalizing brain function. MAT has been shown to reduce the risk of overdose, relapse, and the spread of infectious diseases, as well as improve social functioning and treatment retention.

MAT is an effective treatment option for people with opioid use disorders, alcohol use disorders, and other substance use disorders. It can also be used to help people with mental health disorders, such as depression and anxiety, and can be combined with other treatments, such as counseling and psychotherapy. Most patients who are on MAT need to stay on the medications for at least 12 months, although some may need to take them for longer.

What happens after discharge?

Leaving an inpatient facility is not the end of the road but rather a transition to a different level of care. Patients who are discharged too soon are likely to relapse, as they are not yet ready to return to their everyday lives. They may benefit from a less intensive but still clinical level of care, such as outpatient treatment, which will allow them to reacclimate at a slower pace. This is especially important for patients who have been in an inpatient facility for a long time, as they may need more time to adjust.

There is research to back this up. The National Institute on Drug Abuse reports that treatment for fewer than 90 days is largely ineffective, as the brains of recovering addicts continue to change for years after they enter treatment. This is not a matter of willpower but rather biology, and it is why long-term treatment is so important. This is a good time to bring up accreditation again, as some facilities that advertise themselves as “rehab centers” may not have the proper licensing or accreditation to provide the level of care that the patient needs.

Continuity of care is another important consideration, and facilities that offer a full continuum of care, from detox to inpatient to outpatient, will be better equipped to handle the transition than those that do not. Legacy Healing NJ is one such facility, offering a full spectrum of services that are designed to help patients transition from one level of care to another. This is an important consideration, as the transition from one level of care to another can be as stressful as entering treatment for the first time.

Are you paying for luxury accommodations or clinical services?

Having a pool, chef, and five-star hotel amenities are nice, but they do not necessarily indicate the quality of care. Some of the best treatment facilities are housed in unassuming buildings and offer few, if any, amenities. Conversely, some of the most beautiful treatment facilities have minimal staff and offer few hours of therapy per day. Ask about the staff-to-patient ratio, as that is a good indicator of the level of care. The lower the ratio, the more one-on-one time the patient will spend with the staff.

Ask about the staff’s qualifications, rather than the amenities. A good rule of thumb is to ask how quickly the staff can tell you about the pool during a tour versus how quickly they can give you details about the qualifications of the people who will be providing your therapy.

Bringing it all together

None of these questions require a medical degree to ask, but they all require a willingness to be honest with yourself. Families choosing a rehab facility are often in a vulnerable place and can be taken advantage of, so it is important to know what to look for. A responsible rehab facility will not be afraid of any of these questions and will be able to answer them with confidence, rather than trying to talk you out of asking them. That confidence will give you the information you need to make an informed decision.