Outpatient Treatment: Flexible Support for Recovery

Introduction

Outpatient treatment helps you on your recovery journey during the day and allows you to return to the comforts of your home afterwards.

Outpatient drug rehab has different types of therapies that are all done during treatment sessions. Participants then return home afterwards. The amount of time each session takes, and the level of care provided differs according to the outpatient program. There are PHP (partial hospitalization programs), IOP (intensive outpatient programs) and OP (outpatient programs) that are delivered on an outpatient basis.

Benefits of Outpatient Treatment

There is a gap between people who need treatment and those who actually receive it. In 2013:

About 23 million people in the United States needed drug or alcohol treatment.

Only approximately 2.5 million Americans received specialized treatment at a facility.

Outpatient programs are a flexible option for addiction recovery because they do not require beds or sleeping quarters. The expansion of outpatient programs is made easier because of this inherent flexibility.

Outpatient Treatment Provides the Flexibility to Live Your Life

Outpatient drug and alcohol rehab uses many of the same therapeutic approaches as inpatient rehab, but the services are provided in a different type of structure. Outpatient rehab allows you more freedom of movement, because treatment is given on a part-time basis. In your time outside of treatment, you can meet your family, work and school commitments.

You’ll return home after a day or evening treatment session, so your privacy is protected. You won’t have to explain an extended absence that inpatient rehab involves to coworkers, friends or family members, because you will be home each night.

Outpatient Treatment is the Least Restrictive Recovery Setting

The highest level of safety and security found in residential rehabs are not part of outpatient programs, so there is no total isolation from negative influences. Your return home each evening after outpatient treatment means you can also have a social life, so it is important that you voluntarily avoid being around any drug or alcohol use, which takes more vigilance on your part.

When you are weighing the options of inpatient vs. outpatient treatment, remember that you will have peer support, camaraderie, counseling and family therapy that is found in residential rehab, but on a more limited basis.

What are the Different Types of Outpatient Treatment Therapies?

Outpatient treatment therapies that are part of addiction recovery programs may seem to have identical philosophies and use the same methods for everyone. In fact, comprehensive and effective outpatient treatment does use the same therapies as a starting framework, but customization is added to meet an individual’s or a group’s needs. The framework for outpatient treatment therapies include:

Psychotherapy

Also called “talk therapy,” psychotherapy is a core component of addiction treatment. Since substance abuse relates to previous experiences for many people struggling with addiction that had emotional and psychological effects, talking about these experiences can bring about healing. In psychotherapy sessions, individuals discuss their experiences, feelings and thoughts with their counselors. Through discussion, individual or group psychotherapy sessions help participants feel, think and cope in new and healthier ways.

Skills Development

Skills training teaches people the specific coping tools needed to become and stay sober. Some coping skills taught are directly related to using substances including how to avoid triggers of use, coping with urges to use, and how to refuse the offer of drugs or alcohol. Other coping skills taught are sobriety-related, such as stress reduction, problem solving and anger management.

Cognitive Behavioral Therapy (CBT)

CBT group sessions help change behaviors by changing the way people think, believe and perceive themselves and the world around them. CBT groups also help participants form a support network that promotes continued abstinence. Social support helps develop an awareness of behaviors that can cause relapse. CBT social networks also encourage the sharing of strategies for staying sober.

Expressive Therapies

Expressive therapies utilize a wide range of therapeutic activities that allow participants safe havens for expressing feelings and thoughts in nonverbal or creative ways. Expressive therapy group sessions may also focus on social interaction among participants during creative activities. Expressive therapies includes writing, art, music, drama, games, dance, poetry, working with animals, yoga and meditation.

Medication-Assisted Treatment

Medication-assisted therapy (MAT) is an important part of outpatient programs for opioid as well as alcohol addictions. Addiction can cause significant brain changes, and time is needed for healing these changes. Urges and cravings will continue to occur during healing, but medications can alleviate these symptoms and help prevent relapse. Methadone, Suboxone, Subutex and Acamprosate are just a few examples of drugs that can help relieve cravings and urges that can drive a person back to using.

Relapse Prevention

Relapse prevention focuses on helping individuals stay sober or to help them recover from relapse. Relapse prevention strategies are designed to improve the management of risky situations as well as increasing stability in life through behavior changes. Relapse prevention sessions typically use techniques drawn from different types of treatment (rather than focusing on one method) which makes it a special type of therapy.

What are Misconceptions About Outpatient Treatment?

There are two main misconceptions about outpatient treatment.

Myth #1: All Outpatient Treatment Groups are Variations of the 12-Steps

Though AA’s 12-step groups were the forerunners of group therapy, not all substance abuse treatment groups are based on its philosophies. While many outpatient treatment programs offer groups based on the 12 steps, most programs offer many other evidence-based treatment approaches such as CBT (cognitive behavioral therapy), DBT (dialectical behavioral therapy), trauma-focused therapy, mental health disorder treatment, and motivational interviewing (MI).

Myth #2: Outpatient Medication Programs are Trading One Addiction for Another

When taken at the prescribed doses, many medications (such as methadone and Suboxone for opioid addiction treatment) minimize withdrawal symptoms and cravings rather than producing a “high”. Minimizing symptoms and cravings makes it possible for the recovering person to function in daily life and participate in outpatient treatment or other recovery services to help eventually free themselves of their substance use disorders.

How Does Outpatient Treatment Compare to Other Levels of Addiction Treatment?

What is the Length of Stay in an Outpatient Program?

The length of stay in an outpatient program will vary according to an individual’s unique needs and circumstances. The following are estimations for a stay in each type of outpatient program:

A partial hospitalization program stay can range from 3 to 4 weeks and up 12 weeks.4

An intensive outpatient program can last anywhere from 9 to 12 weeks and sometimes longer.3

An outpatient program lasts for approximately 12 to 16 weeks before the participant enters a maintenance phase.

Inpatient Rehab

Inpatient rehab programs require long-term stays that can range anywhere from several weeks to several months. The average stay is about 30 days. You reside in a safe and secure facility while you attend drug and alcohol treatment counseling and therapies.

Inpatient Rehab Protects Against Stress and Relapse 

When you are residing in a highly structured setting with a set daily schedule, you are insulated from stressful life situations that can trigger urges to use substances. When stress and other negative influences are eliminated because you are in a residential treatment program, it frees you up to concentrate on rebuilding skills that were impacted by addiction without distractions or temptations. 

Inpatient rehab also provides camaraderie, empathy, and peer support from your fellow residents that is available around the clock. Whenever you need someone to lean on, there is someone available in a residential treatment setting. 

Partial Hospitalization Programs (PHP)

More than 11 million people in the United States have a substance use disorder along with a mental health disorder.1 When these two conditions exist together, it is called a dual diagnosis. People with co-occurring disorders are especially well-suited to PHP treatment because of the intensive and specialized care offered.

Substance Abuse and Mental Health Illness

In 2017, among adults in the United States ages 18 and older:

There were more than 18 million Americans with a substance use disorder.

Among these people, 8.5 million (45.6%) also had some form of a mental health illness.

A little more than 3 million (16.5%) had some form of a serious mental health illness.

Some Form of Mental Health Illness

45.6%

Some Form of a Serious Mental Health Illness

16.5%

PHP is Highly Structured

PHP treatment provides a highly structured treatment option without overnight stays. PHP provides a more intense level of care than intensive outpatient care (IOP) or outpatient treatment (OP) in order to stabilize the client’s physical, mental and emotional state.

PHP is provided on an outpatient basis, which means you can live at home or in a sober living facility while you attend the program. You go to the treatment center for an average of 5-6 hours per day and you are given a choice of the 5 to 7 days a week you’d like to attend.

PHP Often Take Places Outside a Hospital

Even though the word “hospital” is in this outpatient program’s name, partial hospitalization programs do not typically take place in hospitals but rather at treatment centers. A PHP is a good treatment alternative if commitments and responsibilities would make a 24/7 residential program a hardship regarding family and work. A PHP is also a good next step for transitioning gradually out of inpatient rehab. It’s also well-suited for those who need direct medical supervision but who do not need to stay overnight.

PHP is composed of different therapies to help your transition into a less structured recovery program. You’ll spend time participating in various evidence-based therapies which includes both group therapy and individual counseling sessions. Many PHPs also offer alternative therapies such as yoga, mindfulness, music and art therapies, as well as recreational and educational activities.

Discharge Planning for a Smooth Transition Out of PHP

A personalized discharge plan is developed during a PHP stay that is designed for a smooth transition into the next level of care. After you have finished PHP (which can last from 3 to 12 weeks) the next step can be either intensive outpatient care (IOP) or outpatient treatment (OP).

Intensive Outpatient Programs (IOP)

An intensive outpatient program (IOP) allows clients to work toward recovery while meeting their responsibilities and obligations regarding home, family, work or school. An IOP also provides a “step-down” transition from inpatient or PHP treatment programs.

While you are attending an IOP, you can live at home or in a sober living environment (SLE). Generally, IOP programs are flexible because you can customize them, but you will typically attend treatment for several hours a day, for a minimum of 3 days per week.

Recover in an IOP While Still Experiencing Daily Life

An IOP focuses on helping you recover from substance abuse problems while you experience daily life in sobriety. An IOP is also designed to prepare you for the next step in your recovery journey, which is usually an outpatient treatment program (OP). You’ll be prepared by attending individual and group therapy sessions, 12-step groups, beneficial peer support groups, and aftercare planning.

It’s important to give people who need treatment several options, as what may work for one person may not work for another. As the drug abuse epidemic rapidly grows, the urgency for addiction treatment is obvious. In 2013, more than 24 million people in the United States ages 12 or older reported they had used an illicit drug in the last 30 days.2 Outpatient treatment is only one level of care. Another level of care called inpatient rehab is available depending on the individual’s needs and circumstances.

Who is Outpatient Treatment a Good Fit For?

Outpatient treatment is a good fit that depends on the answers to several different important questions.

What is Your Level of Substance Abuse?

Your level of substance abuse helps determine if outpatient rehab is the best choice for you. The severity of substance use and if your use has progressed into an addiction are major factors. If you have a severe substance abuse issue and if an addiction is present, you will have all of the following:

Compulsions to seek and use substances regularly

Development of tolerance for substances, which means you need larger quantities of substances to gain the same effects you used to get with less

Withdrawal symptoms appear if you do not take substances, or if you take less than usual

If you have a severe level of substance abuse or addiction and go to outpatient rehab, you will still have opportunities to obtain and use drugs or alcohol. If the temptations overwhelm you, relapse is a real possibility. Consider inpatient treatment that provides 24/7 care if you need a more highly structured environment while you’re working on recovery.

What Types of Substances Do You Abuse?

The types of substances you take can also play a large part in your treatment decisions. If your addiction involves alcohol or opiates, the changes in the brain that are made by these substances can be profound, which can make it hard for you to resist compulsions to use at first. Outpatient rehab would be a good fit after you have gone through inpatient treatment and have these powerful compulsions somewhat under control.

Do You Have Any Co-Occurring Disorders?

When you have mental health disorders coexisting with substance abuse problems, it is called a dual diagnosis. The types and levels of the co-existing mental health issues are significant factors in choosing the level of outpatient treatment you would need for successful recovery.

The risks to health and safety are top priorities in your treatment decision. For example, if you have a serious case of depression along with severe substance abuse, a more controlled setting such as PHP may be the best choice for keeping you safe while you recover. Another example is a mild case of bipolar disorder along with light substance abuse that may make it more appropriate to attend OP because you are at lesser risk.

Do You Have Social Support?

Outpatient rehab is a good fit if you have friends and family to give you outside social support that is essential to staying sober. If you can live in a sober living facility, the beneficial peer support you will get from your fellow residents would also help make outpatient treatment a good fit.

What Can You Afford?

Inpatient treatment can cost more compared to outpatient treatment, and if you can’t afford residential treatment, outpatient treatment would be the best option. To help pay for treatment, buy healthcare coverage if you can, or investigate your present insurance policy to see if you can use it to pay all or part of outpatient rehab costs. Most treatment facilities will help you verify any insurance benefits to which you are entitled.

How Might Outpatient Treatment Impact My Family?

Outpatient treatment will have much less of an impact on your family when compared to inpatient treatment where you live in the facility around-the-clock. Outpatient treatment allows you to continue to meet any family obligations and responsibilities outside of your treatment sessions. Most outpatient programs will work with you to customize a schedule that has the lowest impact on you and your family commitments.

How to Succeed in Recovery

Finding and Getting the Right Help

The best way to find an addiction treatment program that is right for you is by talking to several programs to compare their methods and services. Talk with the treatment program staff about your situation and what they offer. Then an assessment is performed to determine which level of care meets your needs. Once you have a firm understanding of the kind of treatment you need, you can then commit to it with confidence and start your recovery journey.

How Can I Make My Outpatient Treatment a Success?

A major step in making your outpatient treatment a success is to go to all your appointments. Since you are living in the real world while undergoing treatment, it takes some vigilance on your part to balance your schedule to make sure you attend all your treatment sessions.

Also, since you are out in the world, you can make your outpatient treatment more successful if you reach out for help right away if you are tempted to use. Residential rehab eliminates these temptations because of the highly structured, 24/7 care setting. Outpatient treatment is less structured, so you can make this type of treatment a success by knowing when you need to reach out for help.