Author: Dan Wagener, M.A.
Outpatient programs vary in terms of the time commitment, from a few hours a week to several hours a day. The majority of treatment consists of therapies provided in group and individual settings. Programs may also offer medical care and prescribe medications.
You are likely to benefit from outpatient if have a less severe addiction, low risk of serious withdrawal, a strong support system, and reliable transportation.
Outpatient treatment is made up of different types of programs in which you visit a treatment center or counselor on certain days of the week.
The major difference between outpatient and inpatient programs is that inpatient programs offer 24-hour care, including housing, supervision, and access to medical care, if needed. Inpatient programs are also often more expensive than outpatient programs.
Outpatient programs can differ in intensity, from one session a week to several sessions a day, 5 days a week. Some forms of outpatient, such as partial hospitalization programs, have similar services to inpatient programs.
Outpatient can take place in a variety of settings, including community mental health clinics, counselors’ offices, hospitals, or inpatient/residential rehab programs with outpatient programs.
When you begin the program, you’ll meet with a staff member to develop a treatment plan. The plan will include goals for your treatment. The staff member will ask questions about your drug use, medical history, mental health issues, medications, legal problems, family problems, employment, living situation, and previous treatment experiences. Be honest so that the staff may create an effective plan that meets your needs.
At this stage, the staff will also discuss program rules that you will be expected to follow. Many programs will drug test you to make sure you aren’t using while you’re in the program. You’ll also be expected to consistently attend treatment sessions, and you may be asked to complete assignments outside the sessions.
Every outpatient program is different and will have a different schedule and structure. For example, some programs will require you to attend treatment sessions for several hours a day, 5 days a week. Others may meet only once or twice a week. It depends on how severe your addiction is and whether you need concurrent medical or psychiatric care.
Additionally, make sure you have reliable transportation so that you can get back and forth to the recovery center. You need to be able to regularly attend sessions so that you don’t have any gaps in treatment.
The 3 main types of outpatient programs are standard outpatient, intensive outpatient, and partial hospitalization programs. They may vary in intensity, structure, and types services.
The therapies you receive in an outpatient program will differ depending on the therapeutic approach of the individual rehab program, the substance or substances you abused, whether you have a co-occurring mental health disorder, and other issues specific to your situation.
However, some therapies are common to most outpatient programs. These are evidence-based, meaning they’ve been researched and found to help people achieve sobriety. They include:
Outpatient rehab can be a good choice for many people who need drug or alcohol treatment. However, some people may benefit more from outpatient than others.
Those more likely to benefit from outpatient rehab have:
People who may not be a good fit for outpatient have:
If you’re not sure whether outpatient is right for you or your loved one, you can meet with an addiction treatment professional, such as a therapist, psychiatrist, doctor, or admissions counselor, at a rehab program. If they determine that outpatient isn’t the best option, you may want to consider inpatient rehab.
In an inpatient program, you receive 24-hour care and supervision. These programs provide a safe, immersive treatment environment, housing, access to medical care, and often conduct medical detoxification at the start of the treatment duration. They use a range of therapies, activities, and support services to help you begin to live a drug-free lifestyle. Most last anywhere from 30 to 90 days or even up to a year.
Inpatient programs require the person to live at the facility, so there is little flexibility with daily schedules. They may not allow much contact between the patient and their family at the beginning of treatment. They also tend to cost more than outpatient programs.
However, they provide a high level of care and remove the person from their daily environment, which may be full of temptations and people who use drugs. They are set up to treat more serious addictions, can safely detox the person, and are also able to treat medical and mental health disorders.
Many people begin treatment in an inpatient program and transition into outpatient afterward.
Co-occurring disorders are conditions that someone struggles with in addition to a drug or alcohol addiction. When someone has both a substance use disorder and a mental health disorder, it is commonly called a dual diagnosis.
Dual diagnosis is quite common. In fact, about 8.2 million people age 18 or older, or 3.4% of this population, had a dual diagnosis in 2016.
Inpatient rehabs are generally better equipped to treat dual diagnosis, which tends to be more complicated and difficult to treat than a single condition. Substance abuse treatment needs to be integrated with psychiatric treatment so that both disorders are addressed at the same time. This process typically requires the intense level of care found in an inpatient center. If mental health issues aren’t simultaneously addressed, they can complicate the course of recovery and increase the risk of relapse.
If you need dual diagnosis treatment but are unable to attend an inpatient program, you can search for outpatient programs that can manage dual diagnosis conditions. You may want to consider partial hospitalization or intensive outpatient programs first, as they may be more likely to offer dual diagnosis care. Make sure they can treat your specific disorders, and ask about their experience treating your issues.
Many outpatient programs are able to prescribe medications. However, not all addictions have approved medications to treat them, and some programs may not be able to prescribe specific medications.
Most medications that the Food and Drug Administration (FDA) has approved are for opioid and alcohol addictions. Medications approved for the treatment of opioid addiction include:
Medications approved for the treatment of alcohol addiction include:
These medications are usually combined with therapies and other social supports.
You may also be prescribed other medications to treat mental health conditions, such as anxiety, depression, or schizophrenia. Common medications for these conditions include:
Addiction is considered a chronic, relapsing condition. The rates of relapse for addiction are similar to other recurring diseases such as diabetes, high blood pressure, and asthma. For example, the typical relapse rate for substance use disorders is 40-60%, while the relapse rates for high blood pressure and asthma are 50-70%.
Various studies have compared the relapse rates with both outpatient and inpatient treatment programs. While the results are somewhat mixed, outpatient programs—particularly IOPs and PHPs—appear to be as just as effective as inpatient programs in helping people stay sober.
A person who has become addicted to drugs or alcohol has to learn how to change certain behaviors that may be deeply ingrained, and this process can take time. They may have to try several forms of treatment or therapy before they find the one that is most effective for them. If they do relapse, that doesn’t mean they have failed; it simply means that they need to re-enter treatment or speak with their treatment team or provider to make adjustments to their rehabilitation plan.
If someone relapses during or after an outpatient program, it may mean they need a higher level of care. For instance, if they were in a standard outpatient program, they may benefit more from additional treatment at an inpatient or intensive outpatient program.
A multitude of factors will affect the cost of outpatient treatment, such as the location, the facility, insurance coverage, level of care, length of care, and other services.
That said, the following are general estimates for outpatient treatment:
The following are estimates for detox and inpatient care:
If you have insurance, it may cover outpatient care. If you don’t have private insurance, you may qualify for public insurance programs, such as Medicaid or Medicare. In addition, plans offered through the Affordable Care Act (“Obamacare”) are required to cover substance abuse and mental health services to the same extent that they cover medical needs.
Other payment options include:
Some programs may also use sliding scale fees that adjust the cost based on what you can reasonably afford to pay. You may need to meet eligibility requirements and provide proof of income.
Completing an outpatient program is an achievement worth celebrating. However, it’s only the beginning of recovery for most people.
When patients leave an outpatient program, they may be exposed to a great deal of temptation and triggers to use. Aftercare or follow-up care gives a person the opportunity to meet with a therapist or a group to continue to receive support, monitor progress, and deal with any challenges the person faces as they deal with their day-to-day lives without alcohol or drugs.
Before you leave treatment, most programs will help you set up an aftercare plan. A plan can include any of the following components:
Some people who have been in inpatient care may “step down” or transition into an intensive outpatient program or a partial hospitalization program. Another option for those who have completed treatment is a sober living home. These homes, sometimes known as halfway houses, are places where people can live in a substance-free environment. Residents support each other and may attend 12-step meetings or counseling while they search for a job, go to school, or look for a place to live.
Recovery is an ongoing process that takes effort and the support of other people. Outpatient lays the groundwork, but the person in recovery has to continue the work after treatment ends. Aftercare programs help build on the foundation of outpatient treatment and can help a person stay clean. The person can keep practicing the skills they learned in treatment while receiving feedback from others.
Twelve-step programs and group therapy also give the person the opportunity to help others with their recovery and impart some of the lessons they’ve learned on their own journey. This element of recovery can be very helpful and rewarding for some people.
Most programs recommend that people participate in aftercare for at least 1 year following treatment. However, aftercare can last as long as a person needs it. Many people decide to keeping attending 12-step meetings long after they’ve left treatment, and others become involved in the recovery community or become addiction professionals because it helps reinforce their own commitment to sobriety. It all depends on the person.
If your program doesn’t help you with aftercare planning, ask them for assistance or research options in your area. You can also see if they will give you a referral to an addiction professional in your area, such as a therapist, or help you locate 12-step programs near you.