Outpatient Treatment FAQ

In an outpatient rehabilitation program, patients reside at home and report to the facility for care.

The time commitment for outpatient programs ranges from a few hours per week to several hours per day. The majority of treatment is comprised of group and individual psychotherapies. Programs may also include medical care and drug prescriptions.

Outpatient treatment is likely to be beneficial if you have a less severe addiction, a low risk of severe withdrawal, a strong support network, and reliable transportation.

What Is Outpatient Rehabilitation?

Outpatient treatment consists of many sorts of programs that need weekly visits to a treatment center or counselor.

Inpatient programs provide 24-hour care, including lodging, supervision, and access to medical treatment as necessary, whereas outpatient programs do not.

Additionally, inpatient therapies are sometimes more costly than outpatient programs.

The level of outpatient programs might range from one session per week to multiple sessions per day, five days per week. Some forms of outpatient care, like partial hospitalization programs, offer comparable services to inpatient care.

Outpatient treatment can occur in a variety of venues, such as community mental health clinics, counselors’ offices, hospitals, and inpatient/residential rehabilitation programs with outpatient programs.

The majority of programs offer group and/or individual counseling.

Other activities permitted during outpatient treatment include:

• Understanding substance misuse and its effects on you.
• Developing competencies in areas such as job, leisure, socialization, communication, anger management, stress management, time management, fiscal responsibility, and goal-setting.
• Training for relapse prevention
• Self-help groups, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), are available to those in need (NA).

How is the structure of the program?

At the beginning of the program, you will meet with a member of the staff to build a treatment plan. The strategy will include therapeutic objectives. The member of staff will inquire about your drug usage, medical history, mental health difficulties, prescriptions, legal issues, family issues, work, living circumstances, and prior treatment experiences. Be truthful so that the team can build a strategy that effectively matches your needs. [3]

At this time, the staff will also discuss the program guidelines that you must adhere to. Many programs will conduct drug tests to ensure that you are not using while in the program. You will also be expected to attend therapy sessions regularly, and you may be given homework outside of sessions.

Every outpatient program is unique and has its own schedule and structure. Some programs, for instance, may require you to attend treatment sessions for several hours every day, five days per week. Others might only meet once or twice per week. It depends on the severity of your addiction and whether or not you require concomitant medical or mental treatment.

Additionally, ensure that you have reliable transportation to go to and from the recovery center. You must be able to attend sessions consistently in order to avoid treatment gaps.

Which Types of Outpatient Programs Exist?

Standard outpatient, intense outpatient, and partial hospitalization programs are the three basic types of outpatient treatments. Intensity, organization, and types of services may vary.

• Standard outpatient programs are the least intensive form of outpatient treatment. They might just meet once or twice a week for one to two hours. Typically, these programs offer minimal medical monitoring. They may consist of group treatment sessions or individual sessions with a therapist.
• Participants in intensive outpatient programs (IOPs) are required to meet for 9 to 20 hours each week. They provide a variety of services, including group and individual therapy, medicine, drug testing, case management, and 12-step meetings. Some individuals seek first therapy through an IOP since the intensity of their addiction may not necessitate inpatient treatment. Others may enroll in an IOP after being released from an inpatient program.
• The majority of partial hospitalization programs (PHPs) and day treatment programs occur in hospitals or freestanding clinics. Participants may attend up to seven times each week. 3 to 8 hours per day are devoted to treatment programs, which may include individual, group, and family therapy; psychiatric care; medication; on-site medical care; recreation; and social services. A PHP program can assist with stabilization, serve as a transition from inpatient care, or aid in avoiding hospitalization.

Which Therapies Are Used?

The therapy you get in an outpatient program will vary based on the therapeutic approach of the individual rehabilitation program, the substance or substances you abused, the presence of a co-occurring mental health illness, and other situation-specific factors.

However, several therapies are shared by the majority of outpatient programs. These are evidence-based, which means they have been studied and found to aid in sobriety. They consist of:

Outpatient Treatment Program

• Cognitive behavioral therapy (CBT) – This therapy provides relapse-prevention coping techniques. CBT techniques may involve examining the positive and negative effects of drug abuse, identifying cravings and situations that may cause them, and developing coping mechanisms for when cravings do occur. CBT is frequently used to treat addictions to alcohol, marijuana, cocaine, and methamphetamine.
• The Matrix Model is frequently used to treat individuals with stimulant addictions, such as cocaine or methamphetamine. It includes 12-step meetings, family therapy, relapse prevention, drug testing, and education on drugs. The therapist acts as a coach and instructor and seeks to establish a supportive relationship with the patient.
• Cognitive management (CM) – A contingency management program provides rewards or incentives for positive behavior, such as passing a urine test. You may earn certificates redeemable for products or services, as well as cash awards. Alcohol, stimulants, opioids, and marijuana addictions are frequently treated through contingency management programs.
• Motivational enhancement therapy (motivational interviewing) – This method assists you in identifying and overcoming your resistance to substance misuse treatment. The therapist assists you in identifying a reason for change and developing a strategy. Individual treatment often begins with an examination, followed by two to four sessions. Motivational interviewing is frequently used to assist those battling alcohol and drug addictions.
• In family therapy sessions, both the individual in recovery and a significant partner, such as a spouse or parent in the case of adolescents, are present. The treatment focuses on substance misuse as well as other domestic issues, such as child abuse, unemployment, conflict, and mental illness. Family therapy may also be mixed with contingency management, in which patients create goals and are rewarded by significant others for achieving them.

Who Attends Outpatient Rehabilitation?

Many individuals who require drug or alcohol therapy may benefit from outpatient rehab. Nevertheless, some individuals may benefit more from outpatient care than others.

Those who are more likely to profit from outpatient rehabilitation have:

• A moderate to mild addiction.
• There is a low possibility of significant withdrawal problems.
• A solid network of friends and family members.
• A reason to regularly attend counseling sessions.
• Transportation to and from therapy appointments.

People who may not be suitable for outpatient treatment have:

• Multiple or severe addictions.
• Risk of withdrawal complications or a history of withdrawal complications.
• Weak support structures.
• Mental health and medical conditions co-occurring.
• A track record of relapse.
• Previously dropped out of outpatient treatment.

You can consult with an addiction treatment specialist, such as a therapist, psychiatrist, doctor, or admissions counselor, at a rehabilitation center if you are unsure whether outpatient treatment is appropriate for you or a loved one. If they determine that outpatient treatment is not the best option for you, you may wish to pursue inpatient rehabilitation.

Inpatient programs provide care and supervision around the clock. These programs offer a secure, immersive therapy setting, housing, access to medical care, and medical detoxification at the beginning of the treatment period. They use a variety of therapies, activities, and support services to assist you in kicking your drug habit. The majority last between 30 and 90 days or even up to a year.

Inpatient programs require the individual to reside at the institution, therefore daily regimens are rigid. Initially, they may limit the amount of interaction between the patient and his or her family. They are also typically more expensive than outpatient programs.

However, they provide a high degree of care and remove the individual from their normal surroundings, which may be filled with drug users and temptations. They are equipped to treat severe addictions, can safely detox the individual, and can also treat medical and mental health concerns.

Many individuals begin treatment in an inpatient facility and then transfer to outpatient care.

Can Outpatient Treatment Treat Cooccurring Disorders?

In addition to a drug or alcohol addiction, a person may also deal with co-occurring disorders. Dual diagnosis is the usual term for the occurrence of both a substance use problem and a mental health disorder in the same individual.

Dual diagnosis is extremely prevalent. In 2016, around 8.2 million adults, or 3.4% of this population, had a dual diagnosis.

Dual diagnosis, which tends to be more complex and challenging to treat than a single ailment, is typically better suited for treatment in inpatient rehabs. Psychiatric and substance abuse treatment must be coordinated so that both problems can be addressed simultaneously. This procedure often necessitates the level of care provided in inpatient facilities. Mental health concerns can hinder treatment and raise the likelihood of relapse if they are not addressed concurrently.

If you require dual diagnosis treatment but are unable to attend an inpatient program, you can search for outpatient programs that handle dual diagnosis disorders. Partial hospitalization or intense outpatient programs may be more likely to offer dual diagnosis treatment. Verify if they are able to treat your specific illnesses, and inquire about their experience treating your condition.

Can Outpatient Facilities Write Prescriptions?

Numerous outpatient programs can prescribe medication. Nevertheless, not all addictions have approved drugs, and certain programs may not be allowed to give certain medications.

The majority of drugs licensed by the Food and Drug Administration (FDA) treat opioid and alcohol dependence. Among the approved medications for the treatment of opioid addiction are:

• Buprenorphine – helps to manage withdrawal symptoms and cravings. It is a partial opioid agonist, which means it interacts with and activates opioid receptors to a lesser extent than several commonly misused substances. Buprenorphine has a maximum impact, indicating that its opioid effects will peak even at higher doses, which reduces the danger of dependence and overdose. Buprenorphine may be more accessible than other drugs, such as methadone, because physicians who have satisfied specific qualifications can prescribe it from their offices.
• Methadone lowers withdrawal symptoms and reduces the desire for opioids. Methadone has been utilized for decades to aid in the recovery from opiate dependence. However, methadone is itself addictive and must be taken as directed. It can only be prescribed by approved Substance Abuse and Mental Health Services Administration opioid treatment programs (SAMHSA).
• Naltrexone is a medicine that inhibits the effects of opioids and can help reduce cravings and discourage continuing usage. Unlike methadone and buprenorphine, naltrexone binds to and inhibits the activation of opioid receptors in the body and brain. This drug has no misuse potential and can be prescribed by any medical professional.

Among the medications authorized for the treatment of alcoholism are:

• Disulfiram (Antabuse) – helps people remain alcohol-free by causing unpleasant symptoms (nausea, headache, vomiting, chest pain) when they consume alcohol. It is most appropriate for individuals who have already undergone detoxification and are in the initial stages of recovery.
• Acamprosate — might help lessen the lasting symptoms, such as anxiety, sleeplessness, restlessness, and depressed mood, that some people may experience after the acute stage of alcohol withdrawal. It can also aid in the maintenance of alcohol abstinence.
• Naltrexone — inhibits alcohol’s intoxicating effects. It aids in reducing drinking, preventing relapse, and maintaining therapy.
  Typically, these drugs are used alongside treatments and other social supports.

In addition to antidepressants, antianxiety drugs, and antipsychotics, you may be prescribed additional medications to address mental health issues such as anxiety, depression, and schizophrenia. Common treatments for these ailments include:

• Antidepressants are used to treat depression, as well as anxiety and sleeplessness.
• Antipsychotics are used to treat psychotic symptoms like delusions and hallucinations.
• Anti-anxiety drugs – aid in reducing symptoms of anxiety disorders, such as panic attacks, extreme fear, or worry.
• Mood stabilizers are able to help manage the mood swings caused by bipolar disorder.

Are outpatient programs associated with a higher rate of relapse?

Addiction is seen as a chronic, relapsing disease. Relapse rates for addiction are comparable to those for other recurrent disorders such as diabetes, hypertension, and asthma. For instance, the normal relapse rate for substance use disorders is between 40 and 60%, but the relapse rate for high blood pressure and asthma is between 50 and 70%.

Numerous studies have evaluated the rates of relapse between outpatient and inpatient treatment programs. Outpatient programs, notably IOPs and PHPs, appear to be as effective as inpatient programs in assisting people to remain sober, although the outcomes are somewhat varied.

• A two-year follow-up study of an outpatient program for alcoholics revealed a 58% abstinence rate and a 79% improvement rate.
• At a 6-month follow-up, another study reported a 67% abstinence rate for inpatient participants and a 75% abstinence rate for outpatient participants. At a 1-year follow-up, the rates were 60% for inpatients and 68% for outpatients.
• According to a research conducted in the mid-1990s, the abstinence rate for problem drinkers at six months was 16.3% without treatment, 41% with Alcoholics Anonymous, 29% with outpatient treatment, and 52.5% with inpatient treatment.
• IOPs and PHPs generated comparable decreases in drug and alcohol use and increases in days abstinent when compared to inpatient and residential programs, according to an analysis of 12 studies and one review published between 1995 and 2012.

A person who has developed an addiction to drugs or alcohol must learn how to alter behaviors that may be deeply established, which can be a lengthy process. They may need to try multiple forms of treatment or therapy before discovering the most successful one. If they relapse, it does not indicate that they have failed; rather, it indicates that they need to re-enter treatment or speak with their treatment team or provider about modifying their recovery strategy.

Relapse during or after an outpatient program may indicate the need for a more intensive degree of care. For example, if they were enrolled in a conventional outpatient program, they may benefit more from inpatient or intensive outpatient care.

How Much Does Outpatient Care Cost?

Numerous factors, such as location, facility, insurance coverage, degree of care, length of care, and other services, determine the cost of outpatient therapy.

Consequently, the following are estimates for outpatient care:

• Partial hospitalization: $350-$450 per day (private pay rate without insurance)
• Intensive outpatient care: $250-$350 per day

The following are estimates for detoxification and hospitalization:

• Supervised medical detox: $500-650 per day (private pay rate)
  $500 to $650 per day for inpatient rehab center care (private pay rate)
• If you have health insurance, you may be covered for outpatient care. You may be eligible for public insurance programs, such as Medicaid or Medicare, if you lack private coverage.

In addition, plans issued under the Affordable Care Act (Obamacare) must cover substance abuse and mental health services to the same extent as medical requirements.

Other methods of payment include:

• Programs for payments through the facility.
• Fundraising websites
• Healthcare-related credit cards
• Private loans.
• Self-pay.

Some programs may also have a sliding scale that adjusts the cost based on your ability to pay. You might be required to meet qualifying conditions and produce income documentation.

Is Outpatient Sufficient?

The completion of an outpatient program is a worthy accomplishment. However, for most people, this is merely the beginning of their recovery.

When patients leave an outpatient program, they may face an abundance of temptations and relapse triggers. Aftercare or follow-up care allows a person to meet with a therapist or a group to continue receiving support, check their progress, and address any issues they face as they navigate their daily life without alcohol or drugs.

Before leaving treatment, the majority of programs will assist you in establishing an aftercare plan. Plan components may include any of the following:

• Individual counseling Group psychotherapy
• 12-step programs (Alcoholics Anonymous, Narcotics Anonymous)
• Non-12-step (SMART Recovery) programs
• Alumni programs

Some inpatients may “drop down” or transition to an intensive outpatient program or partial hospitalization program. A sober living home is another alternative for those who have completed treatment. These residences, often known as halfway houses, provide a substance-free environment for residents. Residents encourage one another and may attend 12-step meetings or therapy while searching for employment, enrolling in school, or seeking housing.

Recovery is a continuous process that requires work and the assistance of others. Outpatient treatment lays the foundation, but the individual in recovery must continue the effort after treatment concludes. Aftercare programs assist individuals maintain sobriety by building on the foundation of outpatient therapy. The individual can continue to practice the abilities acquired throughout treatment while obtaining feedback from others.

Twelve-step programs and group therapy also provide the individual the chance to aid others in their recovery and share some of the lessons they’ve learned along their own path. For some individuals, this aspect of recovery can be very beneficial and fulfilling.

Most programs advocate at least one year of aftercare participation following therapy.

However, aftercare can continue for as long as a patient need it. Many people decide to continue attending 12-step meetings long after they’ve left treatment, and others become involved in the recovery community or become addiction experts because it reinforces their personal sober commitment. It depends on the individual.

If your program does not assist you with planning for aftercare, ask for assistance or research local options. You might also ask whether they can recommend you to a local addiction specialist, such as a therapist, or assist you identify local 12-step programs.

Sources

National Institute on Drug Abuse citation (2018). Treatment Approaches for Drug Addiction.

National Institute on Drug Abuse citation (2018). Variations of Treatment Programs

Administration for Substance Abuse and Mental Health Services (2008). What Is Drug Addiction Treatment? A Brochure for Families

Administration for Substance Abuse and Mental Health Services (2006). Substance Abuse: Clinical Issues in Intensive Outpatient Treatment.

McCarty, David, et al (2014). Intensive Outpatient Programs for Substance Abuse: An Evaluation of the Evidence 718-726 in Psychiatric Services, 65(6).

[6] Department of Health and Human Services of Nebraska. Partial Hospitalization – MH – Adult (Managed Medicaid Only Service).

National Institute on Drug Abuse, cited: [7] (2018). CBT.

[8] Institute for Drug Abuse Research (2018). The Matrix Design.

National Institute on Drug Abuse citation (2018). Management of Uncertainty and Motivational Incentives.

National Institute on Drug Abuse, cited: (2018). Enhancing Motivation Therapy.

National Institute on Drug Abuse, cited: (2018). Family Behavior Counseling.

Administration for Substance Abuse and Mental Health Services (2017). Principal Indicators of Substance Use and Mental Health in the United States: Results from the 2016 National Survey on Drug Use and Health

Administration for Substance Abuse and Mental Health Services (2016). Buprenorphine.

Administration for Substance Abuse and Mental Health Services (2015). Methadone.

Substance Abuse and Mental Health Services Administration, citation number 15. (2016). Naltrexone.

Substance Abuse and Mental Health Services Administration, citation number 16. (2015). Treatment with medication and counseling.

National Institute on Drug Abuse, cited: (2018). Alcohol Dependency

National Institute of Mental Health, cited: (2016). Psychiatric Medication.

[19] Institute for Drug Abuse Research (2018). Treatment and Healing

[20] Soyka, M. and Schmidt, P. (2009). Outpatient alcoholism treatment: 24-month outcomes and outcome factors. Treatment, Prevention, and Policy for Substance Abuse, 4:15.

[21] According to White, W. (2012). Remission/Recovery from Substance Use Disorders Great Lakes Addiction Technology Transfer and the Department of Behavioral Health and Intellectual Disability Services of Philadelphia.

American Addiction Centers (22). What are the costs associated with alcohol rehabilitation?