Treatment and Recovery Pathways

by | March, 2021

There is no “right” way to recover. Treatment and recovery don’t look the same for everyone. People with opioid use disorder (OUD) must be able to get accurate and unbiased information about the effectiveness of different treatment pathways. Accurate information allows you to choose what’s right for you, which might change over time – and that’s okay. Your route to recovery might be made up of different services and supports from clinical and non-clinical pathways. 

Clinical Pathways or Clinical Treatment for Opioid use Disorder (OUD) 

Clinical pathways are treatments that involve the services of a trained clinician. The American Society for Addiction Medicine has developed levels of clinical care that, based on their intensity, range from 1 to 4. These levels create a universal standard and are also used by insurance companies. Some clinical pathways are:

Medication for Opioid Use Disorder (MOUD) 

Medication is an effective treatment for opioid use disorder. MOUD, sometimes called medication-assisted treatment or medication for addiction treatment (MAT), is the use of the FDA-approved medications to treat OUD. These medications include methadone, buprenorphine, and naltrexone. Naltrexone can also be used to treat alcohol use disorder. All of them help reduce cravings and withdrawal symptoms. People take them differently and in different settings, so which medication you take is a decision you should make with your provider. MOUD is most often used with outpatient counseling or other recovery support services, but medication alone can be effective for some people. MOUD can be a short-term treatment option or a long-term one (known as maintenance). 

Where to access Medication for Opioid Use Disorders (MOUD) services 

Opioid Treatment Programs (OTPs), Office-Based Opioid Treatment Programs (OBOTs), and bridge programs provide MOUD and offer other counseling and support services. You can find treatment locations in Massachusetts that offer MOUD through the Massachusetts Substance Use Helpline.  

Medication for Opioid Use Disorder (MOUD) Rights and Advocacy Tips: 
  • It is illegal to discriminate against people because they are receiving MOUD. Federal laws that prohibit discrimination against people with disabilities protect people receiving MOUD.  
  • Know what to look for when it comes to discrimination in health care settings. It can be subtle and difficult to name. Examples may include: 
    • Doctors minimizing your pain or need for treatment. 
    • Being turned away from medical treatments, care settings (like nursing homes), or addiction treatment services including residential care or sober living because you are treated with MOUD. 
    • Having probation, parole, child welfare, or drug court require one type of treatment or not allow you to stay on MOUD. 
    • Recommending treatment that you can’t access, and not referring you to other options when you ask.  
    • Treatment providers not considering the treatment you prefer and prescribing you something you don’t want.  
    • Treatment providers discharging you (releasing you from a program) before you say you are ready.  
    • Providers denying you your right to see your medical records. 
    • Providers not respecting your pronouns, name, and gender identity in treatment settings, or not working with you to find gender-affirming substance use disorder (SUD) treatment. Fenway Health in Boston has many LGBTQ+ affirming support groups, treatment programs, and resources. Sunshine Behavioral Health provides an overview of SUD treatment best practices for trans patients.  
    • Any comment or action that discriminates against you because of your race, sex, sexual orientation, class, or age. These can be subtle, but remember: if it feels wrong, trust that and report it to the Bureau of Substance Addiction Services complaint line, or to the Massachusetts Attorney General’s Civil Rights Division. 
  • You have a right to privacy. Personally identifiable health information relating to SUD and alcohol treatment needs to be treated more confidentially than other medical information. 
  • If you have MassHealth, there is no copay for SUD treatment, including MOUD.  
  • Treatment centers must provide interpreter services when asked, so that people who speak any language can get services. If the service or program can’t provide an interpreter, the Bureau of Substance Addiction Services (BSAS) at the MA Department of Public Health must work with you to find a treatment center that can. If they do not, you can report it to the Bureau of Substance Addiction Services complaint line. 
  • The Americans with Disabilities Act (ADA) and state public accommodations laws protect your right to request “reasonable accommodations” for a disability that impacts your ability to access a treatment center. If your treatment center is not wheelchair accessible or can’t accommodate your needs, BSAS must work with you to find another treatment facility that can. If they fail to do so, you can report it to the Bureau of Substance Addiction Services complaint line. 
Medication for Opioid Use Disorder (MOUD) Resources 
Resources for families, loved ones, and providers supporting people seeking treatment 
  • Shatterproof’s “How to Support a Loved One in Recovery” provides many simple tools to keep in mind as you help your loved one navigate treatment and recovery.  
  • You can learn more about how to talk with a loved one, and the types of treatment options you can share with them, with Health Care Resource Center’s Helping a Family Member with Opioid Addiction. 
  • The Massachusetts Organization for Addiction Recovery (MOAR) provides a detailed list of the types of treatment options available in Massachusetts in their mini guide
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Walk-In Services (Opioid Urgent Care Centers)

Opioid Urgent Care Centers (OUCC) are walk-in programs that assess a person’s medical, behavioral health, and substance use treatment needs. Other services include medication, opioid overdose education, naloxone kits, community-based support services, program referrals, and follow-up care. Program staff include doctors, nurses, addiction counselors, recovery coaches, case managers, and social workers. 

  • OUCC Resources: 
    • You can find an OUCC by calling the Massachusetts Substance Use Helpline at 800-327-5050 or on the Helpline website. 

Inpatient and Residential Withdrawal Management (Detox) Treatment Options 
People who also use alcohol or sedatives or people who need to be in a structured inpatient setting may get medical management for withdrawal (sometimes called “detox”) in a residential setting. Withdrawal management is also known as Acute Treatment Services (ATS). It can be a first step toward stabilization and starting longer-term treatment options for some people. Withdrawal management services provide 3 to 5 days of 24-hour care and monitoring for withdrawal. This time frame is based on the patient’s individual needs. Medical management might be needed because the symptoms of withdrawal from alcohol or benzodiazepines can be dangerous and even deadly. Inpatient settings can also be a structured space to initiate (start) medication for opioid use disorder (MOUD) and allows a person to be closely monitored and given medication to manage withdrawal. For people who also have mental health disorders, Enhanced Acute Treatment Services (E-ATS) are available. 

It is important to know that withdrawal management alone without additional supports can be difficult and may not work for everyone. If a person uses opioids or other substances after withdrawal management, the risk of an overdose is high. A person’s tolerance is lower after going to detox, so ongoing treatment and support is important to help prevent overdose.  

Inpatient Treatment Resources: 

You can find inpatient treatment options by calling the Massachusetts Substance Use Helpline at 800-327-5050 or on the Helpline website. You can search for inpatient treatment options for yourself or someone else at the Helpline website.  

Residential Treatment Options

Residential treatment can provide short-term intensive care (less than 30 days) or longer-term support. Some residential treatment options are: 

  • Clinical Stabilization Services (CSS): These “step down” services offer 24-hour treatment for people who need a safe and structured setting to support their recovery after detoxification. Services include nursing support, case management, education and counseling, and aftercare planning. These programs help to bridge services between detoxification and rehabilitation programs, such as sober homes. 
  • Transitional Support Services (TSS): Like clinical stabilization services, transitional support services provide up to 30 days of residential services for people who need a safe and structured setting to support their recovery after withdrawal management. The provider will work with the patient to decide the length of the stay based on the person’s needs. Services include nursing support, case management, education, and aftercare planning. Programs also provide intensive case management to prepare people for longer term residential care, such as sober homes. 
  • Residential Treatment Over 30 Days: Residential Treatment Over 30 Days are programs for people who have recently stopped using drugs or alcohol, are medically stable, and can be in a structured residential recovery program. Options include recovery homes, social model homes, therapeutic communities, specialized residential services for women, specialized residential services for families, co-occurring enhanced residential rehabilitation services (RRS), and youth residential treatment programs. You can read more about these different types of residential recovery programs on the Bureau of Substance Addiction Services (BSAS) website.  
  • Sober Homes accredited through Massachusetts Alliance for Sober Housing offer sober living environments where people pay rent. In Suffolk County, people leaving in-patient treatment can use Housing First programs that link people in treatment to housing. You can call the Helpline 800-327-5050 or search for services here. 
  • All of these residential settings can be combined with MOUD. 
Residential Treatment Options Rights and Advocacy Tips 
  • Residential programs and Sober Homes cannot deny you because you are treated with medication for opioid use disorder (MOUD). 
  • Not all residential programs are equal, and sometimes programs “target” people. It’s important to make sure you are getting quality treatment. Some programs offer very little or poor care but try to get as many people as possible to come to their treatment centers. They are often outside of Massachusetts and will use predatory practices to recruit new patients. Here are some ways to recognize when a program may not be legitimate: 
    • They use “patient brokers” to recruit people to their program. A patient broker (sometimes called a patient marketer) is someone who is paid a fee to get people into a program. They might approach you in person or they might contact you by phone, text, or social media. 
      • Paying someone to refer people to a program is illegal in Massachusetts. 
    • The program offers to pay for your travel. 
    • The program offers to pay your health insurance costs. 
    • They focus on luxury services or accommodations, instead of treatment. 
You can protect yourself from addiction treatment scams: 
  • Be careful of giving anyone your personal information, including your social security number or health insurance information.   
  • Ask up front about billing and how treatment “add-ons” will be billed. Often, predatory treatment centers will provide additional services that are billed separately and at very high costs.  
  • Be aware of how often drug tests are given. Some treatment centers drug test very often, which can be expensive. Ask how often testing is done and how much each test costs so you don’t incur surprise costs.   
  • Every treatment center should have a grievance procedure, which is a way of making a formal complaint to the provider. Ask the facility if they have a grievance procedure, how to file one, and the timeframe for a resolution.   
  • Be sure to ask about whether family can be involved in your treatment. Often, treatment scams will discourage and prevent the support of loved ones. 
  • If someone offers to pay your travel costs, call the treatment program or your insurance company to make sure they’re an employee. If you accept a program’s offer to pay for your travel, make sure you have a plan and money to get back home.   
  • Be very careful about a program that offers to pay your insurance costs. They may stop paying at any time, and your insurance can be cancelled.   
  • It is not legal to advertise statistics for marketing purposes. For example, a treatment center cannot make statements such as:  
    • “We accepted 100 clients into our CSS program in 2020. 89% completed treatment and 75% remain drug- free according to a survey sent to those completing treatment in 2020.”  
    • “Our program guarantees lifetime sobriety.”  
  • These statements are probably false and might mean that the center should not be trusted.  
  • If you think you are the victim of an addiction treatment scam, file a health care complaint with the Massachusetts Attorney General’s office or call the Massachusetts Attorney General’s Health Care Helpline at 1-888-830-6277 or 617-727-4765 (TTY).  
  • Programs that provide any type of residential service cannot discharge (release) you to a homeless shelter or the street as part of your treatment plan.  
  • The law protects your privacy in residential treatment programs. Providers cannot disclose (share with others) your substance use disorder without your consent.  
Other Outpatient Treatment Options 

Outpatient programs provide assessment and counseling services while you live at home. Services are in a community-based setting, like a medical office. Depending on your needs and the level of services you get, you might participate in counseling weekly or many times per week. Counseling can be for individuals, families, couples, or groups. The most basic level of care for outpatient counseling is Individual Outpatient Counseling Level 1. At Level 2, Day Treatment/Intensive Outpatient Treatment/Partial Hospitalization is available. 

Outpatient Treatment Resources: You can find outpatient counseling services by calling the Massachusetts Substance Use Helpline at 800-327-5050 or on the Helpline website. 

Non-Clinical Pathways or Peer-Based Recovery Support

Non-clinical pathways to recovery focus on community and peer-based supports, and some people find other activities like acupuncture, exercise, and meditative practices helpful, too. Peer-based recovery is about people with similar experiences offering support to one another. Some examples of peer-based recovery support options are: 

Mutual/Self-Help Options:

Mutual and self-help groups either have a religious or spiritual lens (like 12-step groups) or are secular (non-religious).  

Mutual/Self-Help Resources: Find self-help/12-step groups: MA Substance Use Helpline, 12step.org, Faces and Voices of Recovery Mutual Aid Resources 

Peer Recovery Support Center/Multi-Service Recovery Centers: 

These centers focus on recovery and offer drop-in services, peer- and 12-step-based support, and other recovery services. 

Recovery Coaches 

Recovery Coach Resources: Find recovery coaching and Peer Recovery Support Centers: MA Substance Use Helpline 

Recovery Support Navigators (RSNs) are people who can provide care management and support people as they navigate the treatment system. You are eligible for RSNs if you have a diagnosed SUD. The RSN can help you develop a wellness plan for your recovery. This is a covered benefit that does not need prior authorization from MassHealth, and other health insurance may cover RSNs. Ask your provider or call your health insurance to find out. 

Recovery High Schools:

Recovery high schools are public high schools for youth ages 14-21 that provide educational environments to support youth recovering from SUD. They serve 30 to 50 students per school and are supported by the state, local school districts, and educational collaboratives. Students receive support for their recovery within an academic setting consistent with Massachusetts State Standards. Students with a diagnosed SUD can choose to attend a recovery high school. A referral from a student’s sending district is not needed. 

Community Recovery Programs: There are many programs across the state that focus on running, CrossFit, yoga, and other wellness activities run by people in recovery for people in recovery. You can find a list of these programs at the Massachusetts Substance Use Helpline.  

Harm Reduction Services

Harm reduction is a person-centered approach and a set of practical strategies to reduce the negative consequences of drug use. Harm reduction recognizes the dignity and autonomy (ability to make one’s own choices) of people who use drugs. Harm reduction supports and embraces any positive changes that people want to make in their drug use and health. Harm reduction recognizes that there are safer and less-safe ways to use drugs and provides nonjudgmental services that meet people who use alcohol or drugs where they’re at. These services help people stay safe, improve the quality of their life and health, prevent and manage disease, and prevent fatal overdoses. Some harm reduction services are: 

  • Overdose Prevention Training/Naloxone Distribution 
    • Narcan® (also known by its generic name naloxone) is a medication called an “opioid antagonist” used to reverse an opioid overdose. Narcan works quickly and reverses an opioid overdose in 3 to 5 minutes. Rescue breathing and another dose of naloxone are sometimes needed. The one-step nasal spray is the most common form of Narcan in Massachusetts. People at risk of an overdose can get Narcan and training on how to use it at Overdose Education and Naloxone Distribution (OEND) sites. You can also get Narcan at most pharmacies without a prescription, and the pharmacist can show you how to use it. MassHealth and many other health insurers cover Narcan. 
  • Syringe Services Programs/Needle Exchanges 
    • These programs provide new needles (syringes) and can take back used ones, too. Syringe/needle exchange programs often offer other services such as HIV counseling and testing, referrals to substance use treatment, Hepatitis C education, harm reduction strategies, and bleach kits. 
  • Supervised setting for observation and drug use 
    • Overdose prevention sites are used in many countries and offer supervised settings for people who use drugs to be monitored and to prevent overdose. While these are not available now in Massachusetts, SPOT (see below) can help to keep people who are over-sedated from substance use stay safe. 
  • Drug checking 
    • The drug supply changes without warning and dealers often mix in synthetic fentanyl and other adulterants that can cause overdose and other harm. Drug checking allows people who use drugs to test what they are using so they can know what’s in the drug and stay safe from overdose or other accidental harm. Drug checking can be done with fentanyl test strips or with special devices like handheld testing devices that tell people exactly what is in a drug. 
  • Safer smoking services 
    • These programs offer supplies for safer smoking of drugs, which reduces the risk of infections that can happen with injection drug use and also reduces the risk of overdose. 
Harm Reduction Rights and Advocacy Tips: 
  • If someone is overdosing, don’t be afraid to call 911 for help. The Good Samaritan law in Massachusetts protects a person having an overdose and the people who call for help. The laws protect you from arrest when you’re trying to help in an emergency, but they don’t cover everything. You can be arrested for the W’s: weapons, warrants, or weight. If you have an unregistered weapon, an open warrant out from your arrest, or enough drugs on you that it is clear you are trafficking drugs instead of just using them, the laws do not protect you. 
  • You can get Narcan® (naloxone) at many pharmacies in Massachusetts without a prescription. At the pharmacy, tell the pharmacist you would like Narcan. MassHealth covers the whole cost, and many other health insurers cover Narcan. If you don’t have MassHealth, there may be a copay depending on your insurance. Be sure to ask the pharmacist. 
Harm Reduction Resources: 
  • Learn more about how to respond to an overdose and how to get Narcan. 
  • Find an Opioid Overdose Education and Naloxone Distribution (OEND) site on the Helpline website or call 800-327-5050. You can find a Syringe Services Program/Needle Exchange through the Helpline too. 

Treatment and Recovery General Resources 

  • The Massachusetts Department of Public Health’s Bureau of Substance Addiction Services (BSAS) provides a complete description of each service type on their website. 
  • You can learn more about the levels of care created by the American Society of Addiction Medicine on the Recovery Research Institute’s website. 
  • You can learn more about Harm Reduction as a set of practical strategies and a social justice movement on the national Harm Reduction Coalition website.