Despite differing orientations and theoretical backgrounds, most treatment programs have similar goals:

• ? To help your child live a drug-free life. The general attitude, says Dr. David Smith of the Haight-Ashbury Free Clinic, is that “once a person has crossed the boundary into uncontrollable use, she/he may never return to controlled use. It’s as if one catches the disease for which abstinence is the cure.”
• ? To help your child grow into a different person, with a better set of values and a new self-image. (Sometimes more extensive therapy is necessary to achieve this goal once the drug is out of the picture.)
• ? To help the family function more effectively.

Inpatient programs traditionally have been twenty-one to twenty-eight days long, based on the adult model developed for the treatment of alcohol abuse. Although some insurance plans cover this type of treatment program, most managed care plans do not. An average stay today is usually two weeks. Treatment may be in a hospital (psychiatric or general) or a separate facility, and the doors may be locked or unlocked. They usually include detoxification (medically supervised withdrawal from the drug), if this is necessary. They are professionally staffed and include individual and group counseling and education about drug and alcohol abuse as well as the reestablishment of general good health with facilities for exercise and physical fitness. A child who needs this kind of setting is not necessarily sicker then one who doesn’t—he may just have different requirements. Youngsters with underlying psychiatric disorders may need hospital treatment so that both the depression, for example, and drug abuse can be addressed. Unfortunately, treatment time is often based on length of insurance coverage. Most facilities either provide continuing groups for their “graduates” or refer them to easily accessible outpatient care. Some go on to halfway houses where recovering youngsters live in a supervised setting until they are ready to return home.

Therapeutic communities provide long-term (eighteen months to two years) residential treatment using “boot camp” confrontational techniques and positive peer pressure. Some of the earlier harsh methods have been toned down and made more supportive, but staffing is still largely by recovering addicts who know what the story is and don’t fall for rationalizations. Mutual self-help, public criticism, and self-criticism characterize the approach. Time is tightly structured, and youngsters learn by living that it is possible to get through a drug-free day. The program, in essence, gives them a second chance at childhood, carefully guided and with strict but supportive substitute parents. Some well-established therapeutic communities are Daytop Village and Phoenix House, which have treatment centers in New York, California, and Texas. When you are investigating an inpatient facility of whatever type, you should:

? Be nosy. Ask questions at the facility and in the community in which it operates. What do people say about it? What do they think of the youngsters who go there?
? Not sign anything unless you are absolutely sure you have found the right place.
? Consider carefully if you are asked to pay anything in advance. Most places will accept insurance for at least part of the cost. If you are in a managed care program, check for what your plan does or does not cover.
? By wary if the common prohibition against parent-child phone calls, letters, and private meetings goes on for more than the first one or two months. Isolation from the family is often called for in the early phase of treatments, but reintegration into the family is usually one of the goals of the later phases.