Are you considering whether you or a loved one needs treatment? Do you feel overwhelmed by all the dizzying and confusing medical terms associated with going to rehab?
When locating the best rehab treatment, it’s reasonable to have many questions or concerns. After all, treatment for addiction may be an emotional, physical, and financial consequence. Of course, you want to make sure that you are making the right decision.
WHAT IS OUTPATIENT TREATMENT?
Outpatient treatment provides clinical structure and support for clients recovering from substance use disorders. There may be different levels of outpatient care including:
- Partial hospitalization (PHP): This is often known as “day treatment,” where clients attend several hours of treatment throughout the day and return to their homes at night.
- Intensive Outpatient (IOP): This level of care involves several hours of clinical services each week, though it is less intensive than PHP
- Outpatient (OP): Outpatient is known as the least-restrictive level of care. Clients receive a few hours of clinical services each week.
Outpatient treatment may be a standalone treatment- some clients admit directly into these programs depending on their substance use histories and individual needs. Others will transition into this treatment as part of a ‘step down’ from inpatient or partial hospitalization treatment.
Outpatient treatment is intended for individuals who are ready to launch and utilize their coping skills into the “real world.” While each program’s requirements vary, most facilities require a few hours of structured clinical services several days per week. These clinical services typically include group and individual therapy and case management.
WHAT IS THE DIFFERENCE BETWEEN OUTPATIENT VS. INPATIENT TREATMENT?
Inpatient treatment refers to a highly structured treatment that includes 24/7 monitoring, evaluation, and support. Patients live in the facility and must adhere to the facility’s rules throughout their care. Inpatient treatment varies in length, although most programs vary between 28-90 days.
Inpatient treatment is recommended for individuals with severe substance use disorders. Many of these clients have tried lower levels of care (such as outpatient treatment), but have not been able to stay sober successfully.
Inpatient treatment is also beneficial for people who need physical and geographical separation from their current environments. If people live in triggering homes (i.e., where other people use), this situation can be an obvious deterrent for recovery.
Inpatient treatment provides a variety of clinical, medical, and social services that include psychotherapy, group therapy, peer support, medical evaluation and treatment, and aftercare services. Patients spend the majority of their days in mandatory, structured care.
Outpatient care, on the other hand, allows people to live on their own while receiving treatment. This can be incredibly advantageous to working professionals or parents of young children. Most programs require only partial clinical services during designated times. Thus, clients usually work or attend school while still receiving clinical care.
The clinical services are similar to those of inpatient care. Most facilities provide therapy, case management, and medical services. However, the focus of outpatient care is largely about successful societal integration. Clinical services often focus on maintaining work-life balance, identifying potential relapse triggers, and improving interpersonal relationships.
WHO IS MOST SUITABLE FOR OUTPATIENT TREATMENT?
Outpatient treatment can be a viable option for people with mild or moderate substance use disorders. If people will not (or cannot) risk disruptions in their daily routines, outpatient treatment allows for flexibility with managing work and family schedules.
Patients are typically advised against entering outpatient care if they are entering treatment with severe addictions. Most facilities will recommend a formal, medical detox with a transition into inpatient care. That’s because severe addictions require extensive monitoring and support. Individuals may face higher risks for relapse. They may also warrant additional attention for consequences related to their addictions (i.e., managing legal issues, physical health concerns).
Eight million Americans struggle with co-occurring disorders, which refers to the presence of both a substance use disorder and a mental illness. Effective treatment provides recovery resources in treating both conditions. That said, severe mental illness symptoms (psychosis, suicidal ideation, self-harm, acute disordered eating) may require inpatient treatment. The individual will often need acute psychiatric care until these symptoms can be stabilized.
Finally, people with weak or nonexistent social support may not be suitable for outpatient treatment. One’s living environment can be a ‘deal breaker’ when it comes to a successful recovery plan. This is why it is so crucial for clients to have stable and safe housing when seeking treatment.
WHAT ARE THE SUCCESS RATES OF OUTPATIENT PROGRAMS?
All treatment success rates vary. Unfortunately, there is limited research on the long-term efficacy of how treatment impacts recovery. That said, research does show that entering formal treatment and staying longer in treatment yields positive recovery outcomes.
A 2014 study measuring intensive outpatient program efficacy rates revealed that such IOPs were equally effective when compared to inpatient or residential treatment. When summarizing their findings, the researchers did indicate that more research was needed to determine the appropriate length of treatment. They also stated a need for more research examining differences in such programs (i.e., the program requirements, duration of care, and intensity of services).
Most experts will agree that successful treatment includes integrative and multidisciplinary care. As mentioned, that includes appropriate, evidence-based treatment for co-occurring disorders like depression and anxiety.
Treatment should also focus on the following core tenants:
- Providing education on addiction and relapse triggers
- Fostering community support and positive peer modeling
- Enhancing and rebuilding healthy family relationships
- Increasing medication compliance
- Improving satisfaction in work, academics, and relationships
- Managing stress and uncomfortable emotions
- Defining a sustainable and positive definition of a working recovery
- Developing a viable short-term and long-term aftercare plan
That said, recovery rates can seem frustratingly appalling. One large-scale study examining nearly 1200 people entering treatment found that only about one-third of people who are abstinent less than a year remain abstinent. However, recovery rates do appear to improve with time — those who achieve 5 years of sustained sobriety face less than a 15% chance of relapse.
Of course, it can be challenging to discern the terms, relapse, and recovery. Does a single slip indicate a complete relapse? Moreover, can (and should) relapse be a healthy and expected part of most recovery processes?
Even professionals often disagree on what constitutes successful treatment. It may not necessarily mean complete abstinence. For some people, it may mean long-term medication management under supervised care.
Moreover, it is important to understand that relapse alone does not mean that treatment has failed. It also does not mean that a treatment center is “bad.” It may merely indicate that a particular mode of care did not work for that patient at that time. Rather than perceiving such incidents as failures, it is usually better to look at them as critical learning lessons.
WHAT IF OUTPATIENT TREATMENT DOES NOT WORK?
Outpatient treatment is not a foolproof answer for recovery. Even the best treatment in the world cannot guarantee the end of suffering from addiction.
That said, the following red flags may reveal problems in treatment efficacy:
- Chronic relapse (despite the desire for abstinence)
- Decline in cognitive or emotional functioning
- Exacerbated or new mental health issues
- Apathy or resistance for improvement/change
- Severe interpersonal issues within the community (with either peers or staff)
- Continuous rule-breaking and lack of compliance
Any of these warning signs may indicate either a problem within the client or within the treatment center itself. That’s why having a positive relationship with your treatment team is so essential during your care. These are your professional cheerleaders- the people who are there to encourage you, push you, and hold you accountable for your actions.
You should feel safe and encouraged to voice your concerns with them. It is their job to ensure that your needs are getting met in a timely and appropriate manner. Unfortunately, if you do not feel supported your team, it’s easy to feel unmotivated in your treatment.
If treatment continues to falter, patients may be recommended for a higher level of care (such as inpatient treatment). This should never be viewed as a punishment. Instead, it is a way to improve the likelihood that the individual receives the care he or she needs.
Patients may also be encouraged to integrate other recovery methods into their daily routines. Such suggestions vary, but they may include increased 12-Step attendance, individual, couples, or family therapy, life coaching, or nutrition counseling.
Outpatient alcohol or drug rehab can be a beneficial choice for clients looking to transition into real life without being completely on their own. In some ways, this choice represents the ‘best of both worlds.’ Patients can navigate life stressors related to work, school, and interpersonal relationships while also receiving professional support and monitoring for their substance use disorders.