Treatment for an alcohol or drug problem entails removing the client from the parts of their life that contribute to the desire to abuse illicit substances.
For some clients, they have some things that work in their favor to the point where a clean break is not necessary. Outpatient treatment centers are a way for these clients to control and manage their addictive impulses while still being a part of the outside world.
For substance abuse treatment, a doctor might recommend inpatient care if the client is so physically and psychologically dependent on a particular drug (or drugs) that they are at too much risk if they tried to break their addiction while living at home. The process of removing toxic substances from the body – especially a body that cannot function without them – is complicated, painful, and sometimes dangerous. Clients who have been addicted to their substances for a period of time, or whose addiction is quite significant, need medical help breaking the physical need for another hit. Such help is best provided over a period of time and in an area where there is constant medical supervision. Since this is unlikely to take place in a home environment, inpatient care at a specialized treatment facility or hospital is the best choice.
Another reason why a doctor might recommend inpatient treatment is if the client’s home situation is not psychologically conducive to recovery. Given that detoxification entails uncomfortable drug withdrawal, clients need to recover in stable and peaceful surroundings, preferably with people who can support them emotionally, and not cause stress or use drugs in their presence.In some home environments, where there is the open consumption of drugs or alcohol, abuse, neglect, or a high level of stress, a client who is recovering might feel compelled to abuse substances again because these could be the kinds of triggers that contributed to the addiction taking hold in the first place. If a doctor believes that relapse would be imminent if the client is discharged into that kind of situation, then inpatient treatment would be recommended.
On the other side of the scale is outpatient treatment, which could work for clients who abused their drugs of choice in small amounts or for a short period of time (for example, if a friend or family member recognized the warning signs of addiction and had a conversation, or staged an intervention, at the earliest possible moment). A client who is in this stage of an addiction will still experience withdrawal symptoms, but not nearly as severe as one who needs inpatient treatment.
A doctor might feel that the client is capable of weathering withdrawal without fear of lasting psychological or physical damage, or relapsing if the cravings become too great. In this case, the doctor might suggest outpatient treatment and recommend an appropriate facility.Outpatient treatment allows the client to resume (or continue) important parts of normal life, such as job or school responsibilities, and spend time with family while still making time for rehabilitation and counseling.
And that could mean a substantial amount of time; clients are still expected to show up for regular treatments, counseling sessions, and group meetings, participating as fully as possible, doing regular homework assignments, and otherwise engaging in the same activities than an inpatient client would. Such a schedule could account for several hours every day or even an entire day, which might require taking a day off work or sacrificing half a weekend.
The length and nature of the visits depend on the state of the client’s substance abuse. To better determine what type of therapy is required, outpatient treatment is usually broken down into categories.
According to the American Society of Addiction Medicine, initial intensive outpatient treatment should require clients to have “a minimum of nine hours of therapeutic contact per week.” This could be, for example, three hours of treatment on three days (or evenings) of the week. It could be broken up into two evenings of 90-minute sessions conducted back to back (a group meeting, perhaps, followed by a class on psychoeducation, which may involve the attendance of family members). The third evening could have 30 minutes of one-on-one counseling, 90 minutes of family therapy, and 60 minutes of skills training (like communication, social, and interpersonal skills, to learn to say “no” to the offer of a drink).
The example of the psychoeducation class is an illustration of how family involvement and the mechanics of outpatient treatment overlap. Psych Central explains that during outpatient treatment, a client is not separated from family members, as would be the case for inpatient treatment; spouses/partners, children, parents, siblings, etc., will see their loved one in the morning, at the end of the day, and during therapy. Multiple layers of involvement and engagement with the client during the treatment process is a huge component of recovery, and the education and insight that come with family members (or even close friends) coming along to treatment sessions, and seeing the effects of the treatment bear out on a day-to-day basis, can be a massive boost to the client.
Since outpatient programs place a great deal of emphasis on health and recovery in the client’s own life, the involvement of aftercare support groups is a big component of entrusting a client with outpatient care. While inpatient clients would be expected to join and attend groups like Alcoholics Anonymous, regular involvement with such groups for outpatient clients takes on extra dynamics. A post-treatment world can be confusing and frustrating, even for a client whose addiction was not severe enough to warrant inpatient therapy. Psychology Today calls overconfidence “addiction’s blind spot,” and many people in recovery – some of whom received outpatient treatment – have relapsed because they felt that they were in complete control of their impulses and temptations. Outpatient clients are no less prone to relapse than inpatient clients, and aftercare support groups are there for both.
This means that outpatient therapy is a big responsibility because the freedom to go home means that the client has to stay firm on the lessons learned in rehab. The doctor has to trust that the client will be able to live cleanly on their own (albeit with a little help). The likelihood of relapse is a significant factor in determining whether a client can safely live at home, without jeopardizing the pharmacological and psychological treatments of therapy. Any problems or deviation, especially if the behavior becomes consistent, could see the outpatient status being terminated and the client encouraged to check into a residential treatment center for inpatient care.
By their nature, outpatient treatment centers charge less for their services than inpatient facilities; there is no question of providing accommodation and meals to clients, so clients (and their families) do not have to pay for such amenities. Similarly, outpatient treatment centers typically do not offer detoxification services, such as IV drips or associated medications, although such resources may be on hand in the event of an emergency.
Instead, outpatient treatment costs mostly go toward the basics of therapy sessions, classes, and onsite drug tests. While some inpatient facilities offer services like swimming, art classes, yoga, or nature excursions, outpatient treatment centers are often not set up to go in those directions, so clients do not have to pay for those services. These facilities often focus entirely on the traditional, conventional treatment approaches, and then leave the client free to work on family, normal life, and their job and/or school. The Journal of Substance Abuse Treatment identified finances as one of the biggest barriers to entering treatment for a lot of people. The more affordable prices of outpatient therapy make it a very valuable option for families looking to help their loved one.
Notwithstanding the lower costs, some clients may still struggle to cover the bill, especially those who do not have appropriate health insurance coverage. For that reason, many outpatient treatment centers will offer some form of financial assistance to clients, such as sliding scale payment plans, financing options, and other services that may be available to eligible low-income or low-urgency clients.
In 1995, the International Journal for Quality in Health Care conducted a study that identified eight characteristics of ideal psychiatric outpatient care:
The journal’s study also found the staff’s empathetic qualities (being interested in the clients, listening to them, understanding them, and respecting them) were valued the most by clients.
For many people and families, outpatient rehabilitation seems like the preferable option (compared to inpatient treatment). It costs less and is less intrusive on everyday life than inpatient treatment. For some, the thought of staying in an expensive facility, with other recovering addicts, going to meetings, and participating in group activities for as long as a month, can seem alternately intimidating and tedious.
But being a client at an outpatient treatment center is not for everyone, no matter how appealing it may seem. Regardless of inpatient or outpatient status, a client is still in recovery, and this means being prone to the temptation to relapse. Relapsing during outpatient treatment can threaten to undo weeks of progress and hard work.
Outpatient treatment centers aren’t for everyone, but for clients who do not have severe addictions, who cannot afford residential programs, or who can’t take an extended leave of absence from work or school, this method of therapy can be very effective and feasible. Outpatient rehabilitation offers simultaneous work in substance abuse recovery, as well as occupational and social functioning, that inpatient treatment does not cover (for the good of the clients who require the services of inpatient facilities). For the right kind of clients, outpatient programs can reduce the severity of co-occurring substance abuse and mental health concerns while boosting sobriety and educating family and friends on the challenges and opportunities of recovery.
Since relapse demonstrates that the client is not yet ready to be entrusted with the full benefits of outpatient therapy, admission to an inpatient treatment center is the next logical course of action.
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