What Is Outpatient Drug Treatment & How Does It Work?
Addiction affects a wide array of different types of people at different levels. In fact, around one out of every 10 adults in the United States abused illicit drugs in the month leading up to the 2014 National Survey on Drug Use and Health (NSDUH).1 Because of this, addiction is considered to be a personal disease that requires specialized and individual treatment.
The National Institute on Drug Abuse (NIDA) reports that there are over 14,500 specialized facilities to treat drug abuse and addiction within the United States, with outpatient treatment being one of the common options. Outpatient programs are designed to enable individuals struggling with drug abuse to receive structured care while keeping up with their social and professional obligations. With active participation, outpatient treatment has been shown to increase the chances for lasting recovery.2
What Does Outpatient Treatment Mean?
In general, there are two main forms of drug rehab: outpatient and inpatient programs.
A Brief Overview of Inpatient Treatment
Inpatient, or residential, drug rehab programs require that individuals remain on-site for the duration of the treatment program. Individuals will live in a specialized facility receiving around-the-clock care and supervision.
This type of program is ideal for:
- Those battling significant drug dependence.
- Those who also struggle with mental health or medical disorders.
- Individuals who abuse more than one type of drug or mind-altering substance.
- Those who do not have a stable or supportive home environment.
- People who have been through a drug rehab program before.
Drugs like opioids and benzodiazepines, as well as alcohol, can cause significant withdrawal symptoms when the substance processes out of the body, even potentially becoming life-threatening. If dependence on one of these substances is present, medical detox followed by an inpatient rehab program is the optimal form of treatment. Inpatient programs provide a high level and standard of care to allow time to heal in a secure, safe, and supportive environment.
What Is Outpatient Treatment?
One of the differences between inpatient and outpatient programs is that outpatient treatment can provide more flexibility than inpatient programs, allowing individuals the opportunity to keep up with work, family, school, or other obligations as needed. When an individual is not as severely dependent on substances, and therefore may not need the same heightened level of care, outpatient rehab programs for alcoholism or drug addiction may be a good option.
For example, an outpatient treatment program is good for those who do not require medical detox or 24-hour care and supervision during treatment and who also have a supportive and healthy home environment.
There are several levels of care within outpatient drug treatment programs, which can afford individuals varying levels of structure and schedule. Outpatient programs can also be used as a step-down level of care from a residential treatment program to transition individuals back into everyday life slowly.
Outpatient programs for substance abuse may be provided in a wide variety of settings, from hospitals to community centers to the offices of treatment providers to specialized drug rehab facilities. Studies, like one published in the journal Substance Abuse, Treatment, Prevention, and Policy, show that outpatient addiction treatment can be just as effective as residential treatment programs. Overall, active participation in an outpatient drug rehab program improves success rates for addiction recovery.2
Services Offered in Outpatient Drug Treatment Programs
Just like inpatient drug rehab, the services offered by outpatient drug rehab centers vary from program to program. Generally speaking, many of the same types of services are provided at both inpatient and outpatient drug treatment programs. They just may differ in their intensity, duration, or frequency.
For example, both forms of drug rehab can provide detox services to allow users to process drugs safely out of the body. However, medical detox is a more comprehensive form offered primarily on an inpatient basis. Outpatient drug rehab may still include pharmacological tools and medication management as part of a comprehensive treatment plan. Group and individual therapy sessions are typically part of all addiction treatment programs.
Outpatient therapies may include:
- Cognitive behavioral therapy (CBT): Individuals will explore how thoughts and behaviors are connected and work to improve negative behavior patterns by modifying the way they think. Coping strategies and relapse prevention are usually addressed during CBT sessions as well.
- Motivational interviewing (MI): A person-centered and nonjudgmental approach, MI can help people decide to make changes for themselves, and the therapy reduces ambivalence toward treatment and recovery.
- Intensive family systemic therapy: Often accomplished over a weekend, this form of therapy includes the entire family unit in an effort to improve communication and the workings of the family overall.
- Contingency management (CM): This form of therapy offers small rewards for remaining drug-free as an incentive to remain abstinent.
Additionally, outpatient treatment programs may encourage participation in a 12-Step or peer support groups. Support group meetings can facilitate healthy peer interaction and encouragement with a self-help type of model.
Relapse prevention and educational programs are also often part of outpatient drug rehab. Relapse rates for drug addiction are high, between 40 percent and 60 percent, NIDA publishes. So, workshops and relapse prevention services that teach coping mechanisms for stress and potential triggers are integral parts of a drug rehab program.3 Life skills training, anger management workshops, and parenting classes may also be offered through outpatient drug rehab.
Childcare and transportation services as well as treatment for co-occurring mental health disorders may be available. Holistic and adjunctive treatment methods may also be offered through outpatient drug rehab. For more information on what a particular rehab facility has to offer, individuals should check with the specific outpatient treatment center.
Types of Outpatient Treatment
Outpatient rehab programs for addiction treatment may be desirable for those who do not require around-the-clock medical care and attention, and who need the flexibility of being able to work around their existing schedules and obligations. Outpatient programs are often more likely to be covered by insurance, at least partially, and cost less than residential treatment programs.
There are different levels of outpatient treatment, ranging from intensive to less so. Traditional outpatient services can vary greatly and will depend on each specific treatment facility and the needs of the person seeking treatment. More intensive and structured programs include intensive outpatient programs (IOPs) and partial hospitalization programs (PHP). These programs may be very similar to inpatient drug rehab programs, with the primary difference being that the person returns home each night.
Partial Hospitalization Programs
A PHP is only a small step down from inpatient drug rehab, and it will often provide highly structured programming for 4-6 hours a day, 3-5 days a week. These programs are optimal for individuals who may still require medical monitoring during the day, but are able to return home each night. Families and caregivers should be on board with the treatment plan and be able to provide a stable and supportive home environment.
Intensive Outpatient Program
IOPs typically offer sessions three days a week for approximately three hours at a time. An IOP may start out with more sessions more often and then taper off as a person progresses through rehab. These programs are designed for individuals who still need the structure and intensity of an inpatient treatment program as well as the flexibility of outpatient rehab. Support systems need to be strong and the home environment should be stable for an IOP to be most effective. The journal Psychiatric Services reports that an IOP can be just as effective as an inpatient drug treatment program in most cases.4
Outpatient drug rehab may be an initial form of treatment or be offered through a full continuum of care after completing an inpatient care program. Individuals may also progress between levels of outpatient care. Drug screenings and comprehensive assessments should be done prior to admission into any drug rehab program in order to get a better idea of what the best fit may be. With a variety of options available, outpatient drug rehab can greatly facilitate recovery for active participants.
Frequently Asked Questions
- “Continuum of care” relates to a care process through which people undergo treatment at a level suitable to their individual needs. As the treatment continues, they move up toward more rigorous treatment or, if possible, to less intensive treatment.5The American Society of Addiction Medicine (ASAM) has established five main levels in a continuum of care for addiction treatment:5
- Level 0.5: Early intervention services
- Level I: Outpatient services
- Level II: Intensive outpatient/Partial hospitalization services (Level II is subdivided into levels II.1 and II.5)
- Level III: Residential/Inpatient services (Level III is subdivided into levels III.1, III.3, III.5, and III.7)
- Level IV: Medically managed intensive inpatient services
As with most chronic health problems, successful treatment in a continuum of care requires constant and tapered interaction with treatment providers. The patient and the professional must plan for a move to less intensive care, a stage in the process that poses a high dropout risk.5
The patient should be directed to an outpatient treatment facility with a model of care that is consistent with that provided by an inpatient program. This ensures that the patient is not faced with radically different treatment priorities, methods, and concepts.5
If a patient is to be moved to a program with a different outlook, they should explore the differences so that the change is not confusing and the new program can benefit the patient.5
- In general, an individual struggling with addiction will have a consultation with a health care provider at their outpatient appointment.In order to get a clearer understanding of an individual’s condition and related issues, a professional care provider will schedule a face-to-face outpatient appointment. However, there may be instances when such an appointment can be handled remotely. During the initial consultation, the professional may explore an expected treatment course with the patient, what will occur during treatment, and the care program will be provided.
- Outpatient treatment does not require hospitalization. The annual examination with a primary care doctor and a consultation with a cardiologist are both examples of outpatient care. However, emergency cases may also be considered as outpatient care. If a patient leaves the emergency department the same day they arrive, they are considered an outpatient.6Although there is a clear distinction between inpatient and outpatient drug treatment, health professionals may assign a patient observation status while determining whether hospitalization is required in certain cases. This allows a little more time for the doctors to evaluate the user and make the most educated choice.6
- Specific therapies may depend on each treatment center and program. However, there are some approaches that have proven to be effective. In addition to the ones already discussed, some common therapy approaches may also include the following:7
- 12-Step based programs: a 12-step approach focuses on helping patients understand the principles of AA, start working through the 12 steps, achieve abstinence, and become involved in community-based groups.
- Therapeutic community: this approach sees the community as a whole, its social organization, its staff and clients, and its day-to-day activities, as a therapeutic agent. The TC model considers the substance use disorder to be a disorder of the entire person.
- Matrix model: originally known as neurobehavioral therapy, incorporates several research-based techniques (including cognitive-behavioral, 12-step, and motivational enhancement) to address behavioral, emotional, cognitive, and relationship issues among patients.
- Outpatient rehabilitation is a possible treatment option for individuals struggling with mild to moderate addictions. Outpatient drug treatment programs may bring numerous benefits, including:
- Less disruption to their daily lives.
- Maintaining employment & other obligations.
- Involving the family through counseling and therapy.
- Letting patients get family support in a familiar home environment.
However, patients who have access to alcohol or drugs in an outpatient setting are advised to consider inpatient rehabilitation.
1. Substance Abuse and Mental Health Services Administration (2014). Behavioral Health Trends in the United States
2. National Center for Biotechnology Information. Differential effectiveness of residential versus outpatient aftercare for parolees from prison-based therapeutic community treatment programs
3. National Institute on Drug Abuse. (2020). Treatment and Recovery
4. National Center for Biotechnology Information. Substance Abuse Intensive Outpatient Programs: Assessing the Evidence
5. National Center for Biotechnology Information. Chapter 3. Intensive Outpatient Treatment and the Continuum of Care
6. St. George’s University (2019). Inpatient vs. Outpatient: Comparing Two Types of Patient Care
7. National Center for Biotechnology Information. Chapter 8. Intensive Outpatient Treatment Approaches