Residential programs are often highlighted as the go-to method for addiction treatment, offering a wide range of amenities and comprehensive treatment methods. However, in many cases, putting an entire life on hold to enter into a treatment program for a period of time is not feasible or practical. The U.S Department of Labor reported on the Substance Abuse and Mental Health Services Administration (SAMHSA) study in 2007 that indicated that at least 60 percent of American adults battling substance abuse or dependency were employed fulltime, for example. Still others have family obligations to attend to on a daily basis.
In 2013, the National Survey on Drug Use and Health (NSDUH) published that 22.7 million adults in America aged 12 and older needed treatment for a drug or alcohol abuse or dependency, and only 2.5 million actually received it, leaving 20.2 million Americans without specialized treatment for drug or alcohol abuse issues. One of the potential barriers to treatment may be a perception that a drug or alcohol program will negatively impact employment. More than 10 percent of those who didn’t get help, despite feeling like treatment would be helpful, cited concerns surrounding their job as the reason, NSDUH reported (based on combined 2010-2013 data). About another 10 percent didn’t make an effort to receive treatment despite their acknowledgement of needing it because they were worried about what neighbors or their community might think, data from the 2010-2013 NSDUH showed. Perception and fear of what others think may be a real barrier to treatment. An outpatient program can help people continue to keep up a semblance of normal life until they choose to share information about their recovery with others.
Outpatient rehab is much more flexible than residential treatment. It can offer individuals and families treatment options that may be scheduled around jobs, family obligations, or school classes. In an outpatient treatment program, sessions, meetings, and trainings are scheduled during the day, and individuals return home each night.
Outpatient treatment programs generally fall into two main types: general outpatient treatment and intensive outpatient programs. The latter may provide all of the comprehensive services and structure of residential treatment program, except that no one has to leave home for longer than a day at a time. Environmental surroundings and personal support networks need to be conducive for healing and recovery for outpatient treatment programs to be most beneficial. Ideally, family members can take an active role in treatment and recovery as well. Outpatient substance abuse and addiction treatment can be a great option for those with strong family support systems who may benefit from flexibility in a rehab program.
Services Provided
Outpatient programs may offer a host of services that vary in structure and intensity, depending on the needs of the individual. The level of dependence on drugs or alcohol plays a role in determining what treatment programs are best. When drugs or alcohol are abused for a long period of time, chemical changes are made in the brain, and that may cause a physical and emotional dependency to the substance. When this happens, people may not be able to control their drug abuse, and behavioral changes may occur that may indicate an addiction.
The National Institute on Drug Abuse (NIDA) reports that generally speaking, the optimal treatment for addiction likely employs both pharmacological and behavioral approaches that may be performed across a variety of settings, including in outpatient rehab. Outpatient services may include:
- Detox services
- Educational opportunities
- Occupational or life skills training
- Behavioral therapies
- Group and individual counseling
- Family services
- Co-occurring disorders treatment
- Holistic methods
- Recovery programs
- Pharmacological treatment
Outpatient programs may offer help with transportation and childcare in addition to working around a person’s work or school schedule. Therapy and counseling sessions can be arranged accordingly.
Use of Medications in Outpatient Rehab
Some substances of abuse like alcohol, opioids including prescription painkillers (OxyContin, hydrocodone, morphine) and heroin, and prescription benzodiazepine sedatives (Valium, Xanax, Ativan) may cause difficult or even dangerous withdrawal symptoms when removed from the body. An individual who is chemically dependent on one of these substances may benefit best from a medical detox program that provides around-the-clock medical monitoring and support.
Individuals battling less severe dependencies may be able to detox on an outpatient basis.
Detox often uses medications to help manage withdrawal. Antidepressants and anti-anxiety medications may be helpful for managing the emotional side effects of withdrawal, for example. Vitamin supplements, under the guidance of a medical professional, can help build up nutrient levels that may be deficient due to substance abuse.
Mental illness and drug abuse often go hand in hand, as each issue may exacerbate the other. The American Psychological Association (APA) estimates that six out of every 10 individuals battling a drug use disorder also suffer from some form of mental illness. These two conditions together – substance abuse and a mental health issue – are referred to as co-occurring disorders. Generally, a combination of medication and therapy is necessary to treat a dual diagnosis.
There are several medications approved by the U.S. Food and Drug Administration (FDA) to treat addiction to specific substances. These medications may be used during treatment and recovery to combat cravings, reduce withdrawal symptoms, and prevent relapse.
For example, methadone has been available to individuals battling opioid addiction to help individuals wean off heroin and prescription painkillers for a number of years. Methadone is a long-acting opioid agonist that is prescribed once a day in a liquid, wafer, or pill form through federally regulated clinics as a part of medication-assisted treatment (MAT), SAMHSA reports.
In 2002, the FDA approved the use of buprenorphine products, such as Subutex and Suboxone, to be prescribed on an outpatient basis for the treatment of opioid addiction, the Drug Enforcement Administration (DEA) publishes. These products can be prescribed by a doctor and picked up at a local pharmacy, potentially making access easier for individuals in outpatient treatment programs.
Buprenorphine is an alternative to methadone and also a long-acting opioid agonist; however, it may have a plateau effect when taken at high doses, helping to diffuse its abuse potential. In the case of Suboxone and Zubsolv, buprenorphine is combined with naloxone, which is an opioid antagonist, and blocks receptor sites in the brain. When someone attempts to inject or use these products in a way other than intended, the naloxone takes effect and withdrawal may be precipitated, making them great tools in helping to prevent relapse. Other antagonist drugs like naltrexone may also be used during addiction treatment and recovery.
Traditional and Alternative Outpatient Addiction Treatment Methods
Virtually all addiction treatment will include therapeutic methods. Behavioral therapies, like Cognitive Behavioral Therapy (CBT) and Motivational Interviewing (MI), are commonly used, and these therapies often include education and life skills training sessions as part of the overall program. In CBT, individuals are taught new ways to manage anger and stress, and discover underlying triggers and how to cope with them. Negative thoughts and emotions are modified and in turn behaviors are improved. MI helps a person to find the inner drive and motivation to desire change for the better without pressure or confrontational methods.
During outpatient treatment, therapy and counseling sessions generally occur in both group and individual sessions. A person may attend weekly, or more frequent, sessions of both forms, lasting around an hour or so. Many outpatient programs may offer integrated co-occurring disorders treatment that involves treating professionals working together to provide support and care for both substance abuse and mental illness.
Peer support, or 12-Step, groups can provide a healthy support network and a sympathetic and safe environment for individuals to turn to when needed. These groups meet frequently, and individuals are usually paired up with a sponsor who is available to them 24 hours a day to offer support and guidance. Support groups are often an important part of recovery and help prevent relapse. Family counseling, education, and support are also vital during outpatient rehab, as the family and loved ones may know best when a person needs extra guidance. Family members can also help ensure that all meetings and sessions are attended and that medications are being taken as prescribed.
Holistic, or alternative, methods can be beneficial in recreating a healthy balance between the mind and body. Nutritional planning, fitness training, massage therapy, acupuncture, yoga, meditation, art or music therapy, and chiropractic care may all be beneficial during outpatient rehab, as they all can enhance a person’s overall wellbeing. NIDA reports that outpatient services may be able to provide many of the same services as residential treatment and may be a viable option for individuals with families and careers that need to be attended to during rehab. Outpatient treatment can provide families a more flexible alternative for rehab, and the resulting recovery can be just as successful for many individuals.