Outpatient Rehab

Outpatient drug and alcohol rehab is an ideal treatment option for individuals who have either completed an inpatient stay at a residential treatment center, or who suffer from mild form of substance abuse identified in the early stages. While outpatient rehab programs require discipline and motivation, they generally allow patients the freedom and flexibility of being able to work around employment and other external obligations.

What is Outpatient Rehab?

Outpatient drug and alcohol rehabilitation programs offer a wide assortment of addiction treatment services that may be scheduled at times which are convenient for the patient. The length and nature of these visits is usually tailored to the needs of the client, often based on recommendations from medical professionals familiar with the client’s case history.

Outpatient rehab levels of care are broken down into the following categories:

Day Treatment / Partial Hospitalization Program (PHP)

PHP outpatient treatment is typically recommended as a step down for patients who require intensive ongoing medical observation following treatment in an inpatient program. Additionally, a counselor might advise this kind of program in lieu of inpatient treatment if the individual is already living in a stable environment and doesn’t require detox services. Clients attending PHP are generally expected to check in five days a week (Monday through Friday), with programming generally running 7 to 8 hours a day.

Intensive Outpatient (IOP)

IOP addiction treatment shares a few similarities with the services and structure of PHP without being as rigorous or time-consuming. Often the next phase in a patient’s recovery following PHP or inpatient, IOP is focused primarily on relapse prevention and enabling the patient to learn coping skills for successful re-integration into society. Clients in IOP usually check in at least 3 days a week, for two to four hours at a time, for a total of 9 hours or more at a treatment center per week.

Outpatient Treatment / Continuing Care

Therapy and counseling (sometimes also referred to as “Aftercare”) tend to be utilized as ongoing follow-up services after completion of other levels of outpatient treatment. Less structured and demanding than PHP or IOP, these programs generally require fewer than nine hours a week, usually requiring the client to check in one to three times a week for three-hour sessions which generally involve an hour of one-on-one counseling with a therapist and the remainder of the time spent in group therapy activities.

Outpatient Rehab

Components of Outpatient Treatment

Outpatient services are customized to the needs of the client and generally include several or all of the following:

  • Intake/Processing – This is the step during which the patient’s needs, eligibility and readiness are assessed and a personalized treatment plan is rendered.
  • Substance Abuse Monitoring – Periodic drug screening is administered to verify whether the patient has remained free of any addictive substances.
  • Individual Counseling – Sessions are scheduled one-on-one with a trained addiction treatment expert to address any issues the patient may be experiencing in his or her attempts to re-assimilate into the outside world without the use of intoxicants.
  • Group Counseling and Therapy – The patient participates in group therapy/support meetings, ideally with other clients with similar substance abuse issues. Periodic meetings may also be scheduled with the patient’s family members and/or significant others.
  • Pharmacotherapy (Medication Management) – Trained specialists are responsible for the organization and management of any prescribed medications for co-occurring disorders.
  • Behavioral Therapy –  The patient attends sessions as necessary for learning about applicable behavioral modifications which may assist in maintaining his or her recovery. Examples may include Cognitive Behavioral Therapy (CBT), diet management and exercise coaching.
  • Clinical and Case Management – Personnel are tasked with compiling and maintaining a file of all relevant data pertaining to the patient’s case so that the course of treatment may be modified as needs dictate.
  • Referral Services – Specialists are available as necessary to provide the patient with referrals to affiliated providers of services not offered by the outpatient program.

Does Outpatient Treatment for Addiction Work?

A number of studies have concluded that outpatient services significantly increase clients’ chances of maintaining long-term recovery and successfully reintegrating into society.

  • A popular study cited within “Substance Abuse: Clinical Issues in Intensive Outpatient Treatment”, an abstract published in the U.S. National Institutes of Health’s National Library of Medicine (NIH/NLM), found that outpatient programs “improve clients’ occupational and social functioning, and ameliorate their psychiatric symptoms” and “have been found to be a low-cost enhancement that improve(s) client retention in some publicly funded, mixed-gender substance abuse treatment programs.”
  • Another NIH/NLM study concluded that IOPs “are as effective as inpatient treatment for most individuals seeking care.”
  • In “A Randomized Controlled Study of the Effectiveness of Intensive Outpatient Treatment for Cocaine Dependence” conducted by doctors affiliated with the Department of Psychiatry and Human Behavior at Jefferson Medical College, Thomas Jefferson University, it was concluded that “patients improved significantly from intake to follow-up with respect to drug use [and] severity of problems associated with drug use. Remaining in treatment longer was associated at follow-up with fewer drug problems, a smaller proportion of positive urine drug tests, a better employment status, and fewer psychological problems.”

Additionally it has been found that outpatient services, when combined with patients residing in a sober living home, resulted in a significantly better outcome. A study published in the Journal of Substance Use concluded that the “average scores for legal problems, employment, peak density (average number of days of substance use per month), abstinence and arrests improved over time compared to baseline.” The study found that, even after 18 months, subjects in both outpatient and sober living were 6.52 times as likely to be abstinent as those in neither environment.

Benefits of Outpatient Services

As previously mentioned, one of the greatest aspects of outpatient treatment is the fact that it can accommodate busy schedules. Additional benefits include the following:

  • Continuity of Care – While the average length of stay in inpatient rehabilitation is typically between 28 days and six months, outpatient services are generally retained for anywhere from three months to over a year.
  • Customizability – Whereas inpatient services tend to be uniform for all residents of a particular facility, outpatient services may be tailored to the unique needs of the client, with the ability to eliminate certain aspects of care which are deemed redundant or unnecessary.
  • Lower CostBecause outpatient services do not involve the often exorbitant costs of fully-supervised residential treatment, and because acute medical care is usually not needed within an outpatient setting, the costs are almost always significantly lower than inpatient services.
  • Maintenance of Privacy – One of the most difficult obstacles that people with chemical dependency often face is admitting they have a problem, and embarrassment can sometimes prevent potential patients from seeking recovery services. Outpatient service providers ensure that patients are afforded an environment of privacy, confidentiality and discretion.
  • Immediacy of Results – Patients have the freedom to apply what they learn in treatment to real life situations and begin making changes right away.
  • Ability to Select One’s Own Support NetworkWhereas in an inpatient setting residents are confined to a recovery network consisting of fellow residents and support personnel employed by that particular facility, outpatient services allow clients the freedom to organically establish and maintain contact with individuals of their choosing.

Choosing the Right Outpatient Drug & Alcohol Rehab

In addition to determining which level of outpatient care would most appropriately address a patient’s needs and circumstances, selecting the right program is the most crucial decision that can be made concerning his or her recovery. The following are important considerations to be taken into account in the selection process:

How Reputable is the Outpatient Rehab? 

Be sure to Google the organization to see if there have been any awards or accolades – or perhaps any scandals or unsavory accusations. Speak with professionals in the treatment field (particularly those who have been in the industry a long time) to find out if they have any caveats. Online review forums such as Yelp may provide meaningful insight as well, and conversations with former patients (or their family members) can be useful in painting a picture of what sort of treatment experience a potential patient may be able to expect.

How Qualified are the Staff Members?

Professional credentials of the personnel employed by the treatment provider are among the most reliable metrics of how capable that provider may be.  Ideally a program should have at least one psychiatrist on staff to address any prescription needs the patients may have. Certain job titles and professional acronyms may be are unfamiliar; it is a good idea to make note of these so that they may be researched. Websites for some programs will feature the names of key staff members, which you may choose to cross-check on LinkedIn to get a more in-depth view as to their work histories and number of years in their respective fields.

Is All (or Part) of the Program Covered by Insurance?

Thanks to the Mental Health Parity and Addiction Equity Act (MHPAEA), many insurance plans now cover outpatient services, particularly those plans obtained within the Affordable Care Act (ACA) Marketplace. It is important to note, however, that in many cases only certain services and durations of care are covered, so it is important to speak with the plan provider prior to enrollment in order to avoid any unpleasant surprises later on.

How Much Will the Program Work with My Schedule?

As previously noted, one of the best aspects of outpatient services is that they offer the ability to work around employment, social and domestic obligations; however it is still a good idea to determine the extent of that flexibility and find out if services are provided during evening or weekend time slots.

Does the Program Offer a Pre-Formulated Recovery Plan with Well-Defined Goals?

Since needs can vary greatly from one individual to another, there will never be a set weekly schedule for all patients to adhere to; however, a legitimate outpatient services provider will devise a patient-specific recovery plan consisting of any number of the components of outpatient treatment listed above. Such a plan should also allow for modification in the event that treatment progresses more quickly or slowly than expected, or if unforeseen circumstances arise (such as relapse) or diagnoses are rendered.

Outpatient Treatment vs. Inpatient Treatment

In choosing an outpatient rehab over inpatient addiction treatment the most important consideration may be whether it can meet all of your recovery needs. Other important factors to consider are:

  • Level of addiction: Outpatient treatment may be appropriate if you have mild drug addiction. It is also more practical for those who are reluctant to enter into residential treatment. Persons with mild addiction tend to manage withdrawal symptoms without needing round-the-clock supervision.
  • Risk of relapse: People who are severely addicted to drugs have a tougher time withdrawing and overcoming substance abuse. They also have a higher risk of relapse during and after treatment. If you have chronic addiction but strongly believe an outpatient program is best for you, you could reconsider your options. An inpatient program may be able to give you the level of care needed to successfully recover.
  • Prior commitments: If it is necessary for you to maintain your job or keep other important commitments such as attending school or caring for children, then outpatient treatment may be more suitable for you. You will continue to live at home during this time.
  • Self-discipline: Outpatient clients with mild addiction or who already received inpatient or intensive outpatient levels of care may possess the self-control and self-discipline needed to manage substance use triggers on their own.

Support network: You may be committed to staying sober, but having a support network can improve your chances of sobriety since you may be continually exposed to behavioral or environmental triggers. A strong support network helps to keep you accountable during and after treatment. Being willing to turn to loved ones, a mentor, or your therapist when tempted to use drugs helps to reduce the risk of relapse.

How Much Does Outpatient Treatment Cost?

Specific costs of outpatient treatment can vary extensively between treatment centers and also depend on the level of service a patient needs. As a rule, the more elaborate and time-consuming the treatment plan, the more expensive it will be. According to recent estimates, the average cost is $250-350 per day for IOP and $350-450 per day for PHP, but rates could vary substantially depending on the program selected.

Certain insurance plans cover the cost of outpatient rehabilitation at many treatment centers, so it is important to contact one’s insurance provider to see which options may be available as well as the length or duration of coverage provided. Some community organizations are dedicated to funding all or part of treatment in an effort to alleviate some of the financial strain on low-income individuals and families.

For those with insufficient insurance coverage, many treatment centers provide financing options, many with favorable interest rates. Additionally, an increasing number offer creative options such as assistance with setting up crowdfunding campaigns (e.g., GoFundMe), as well as limited full or partial scholarships.

The Long Road Ahead
How much one gets out of the outpatient experience depends on how much work one is willing to put into it. The most extravagant outpatient services available will be of little use if the patient is not fully committed to his or her own recovery. As is often heard in 12-step meetings, recovery is a journey and not a destination; it is a lifelong affair to those truly afflicted with the disease of addiction to alcohol and other drugs. The most effective outpatient programs are those whose personnel instill in their patients positive habits and attitudes which last long after the final phases of the program, but ultimately it is up to the patient to ensure that the lessons learned during outpatient treatment remain for a lifetime.
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