Guide to Outpatient Rehab

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What Is Outpatient Care?

Outpatient care is a form of treatment in which the client lives at home and comes in to a clinic or treatment center for therapy and/or medication. One nationwide data set found that outpatient care made up roughly 60 percent of substance abuse treatment admissions.[1] A subset of 12 percent received intensive outpatient treatment, in which the client receives treatment for at least two hours a day for at least three days a week.[2] An even more involved level of outpatient care is day hospitalization, where the client comes to the clinic daily.

The outpatient level of care is appropriate for clients in a number of circumstances:

  • Preventative therapy for clients who worry that they are heading toward addiction and who want to confront the problem before it escalates
  • Entry-level therapy for clients who are in the early stages of dealing with their addiction
  • Continuing therapy for clients who are stepping down from residential treatment

 

Outpatient care following residential treatment boosts rates of abstinence from substance use and lowers arrest rates.[3] However, only about 17 percent of clients who complete hospital, residential or intensive outpatient programs proceed on to get regular outpatient treatment.[4]

What Can I Expect in Outpatient Care?

In outpatient care, the client might receive a variety of therapies. Treatment should be customized based on the type of substance abused, severity of addiction, the client’s personality, and his or her financial and living situation.

  • Medications such as methadone, buprenorphine, and naltrexone can help clients quit using opiate drugs like heroin and prescription painkillers.[5]
  • Motivational Enhancement Therapy (MET) is a procedure designed to help individuals examine their feelings about addiction and commit to starting more intensive treatment.[6] It consists of three to five sessions with a therapist that focus on motivations for change and future plans.[7]
  • Cognitive Behavioral Therapy (CBT) focuses on giving clients new skills and strategies for coping with situations in which they are at high risk for addiction relapse. It also teaches clients how to deal with stress, cravings or other intense emotions that might drive maladaptive substance use.[8] Clients learn how to build, maintain, and activate social support networks in times of need. Additionally, CBT is effective at treating some mental illnesses that may co-occur with addiction, such as depression.
  • Other individual therapies such as Dialectical Behavior Therapy (DBT) or eye movement desensitization and reprocessing therapy (EMDR) may be appropriate for clients with co-occurring mental illnesses. Treating any mental conditions that underlie addiction is an important component of substance abuse treatment.
  • Contingency management offers concrete incentives for clients to stay clean. Attending meetings or passing drug tests is rewarded with vouchers, prizes, or cash.[9]
    • Twelve-step programs teach clients to accept that their substance abuse has gotten out of control and that total abstinence is the only way to recover from addiction.[10] Treatment consists of ongoing, regular attendance at structured meetings as well as additional social support from a sponsor.
    • Family therapy involves a parent, partner, spouse, or other family member coming to therapy with the client. Sometimes multiple family members attend therapy together. The pair, or group, focuses on examining how the individual’s addiction has altered their relationship and how the family member can best support the individual through the recovery process. The family member might get involved in other treatments, such as helping to offer rewards for good behavior in contingency management.
    • Group therapy allows clients to meet others who are also struggling with substance abuse. Making new friends can increase social support, and simply knowing that they’re not alone can be helpful for many recovering individuals.
    • Alternative therapies might include fitness training, meditation, yoga, massage, acupuncture, and hypnotherapy. These are not meant to serve as primary therapies but instead contribute to other treatments.
In this episode of Recovery Unscripted, Alex Dorsey and Ashley Buchanan help us take a look at the role outpatient treatment plays in the overall recovery journey. They share how they approach helping people safely and effectively step down from residential treatment to outpatient to aftercare to a sustainable life in recovery.

Outpatient Care vs. Residential Treatment

The choice between outpatient and residential care will depend on the individual’s situation. Both modes of care can offer the above types of therapy; the difference lies in whether the person lives in on-site facilities or at home.

Residential programs will likely involve more intensive therapy, longer hours of therapy and more types of therapy than outpatient programs. Candidates for residential treatment tend to be those who are at higher risk for substance use relapse. Such clients may find that the drug-free structure and supervision offered by on-site living helps to prevent substance use. They may have co-occurring medical issues that require frequent treatment or monitoring by a doctor or nurse. Residential treatment is also a good fit for clients whose symptoms are severe enough that they have difficulty living independently.

Outpatient programs can range from day hospitalization (daily treatment) to intensive outpatient care (three or more days per week) to low-impact outpatient care (fewer than three days per week). Clients in outpatient care should be medically, mentally, and emotionally stable enough to live on their own or with loved ones. Living at home provides many benefits, such as a social support network and feelings of control and familiarity. Family members can help supervise behavior, provide alternatives to drug use, and support the individual in times of stress.

Outpatient care also offers flexibility for people who need substance abuse treatment but who aren’t able to take the time to fully enter a residential program – for example, parents or caregivers who have children or aging elders at home, professionals with work commitments, or students with a school schedule.

Another major difference between residential and outpatient care is that residential care is more expensive. In residential care facilities, costs must cover housing, meals, around-the-clock staffing, and a great deal of therapy and amenities. Outpatient care generally provides fewer services and subsequently has lower costs.

Costs of Outpatient Care

The cost of outpatient care will vary based on the extent of services received. However, in 2004, the Substance Abuse and Mental Health Services Administration compiled a report of the average cost of different types of care.[11] Current costs can be extrapolated by adjusting for inflation:

(2002 number adjusted for inflation)[12]

Part of the high cost of methadone treatment is the length of stay – clients in outpatient methadone treatment continued care for an average of 520 days, compared to residential treatment, which lasted an average of 45 days.[13] Non-methadone outpatient treatments averaged 144 days.

According to the National Institute on Drug Abuse, substance abuse treatment programs should last for at least 90 days in order to be effective,[14] and long-term treatment can take as much as six months to a year.[15] This can push costs into the thousands or tens of thousands of dollars. Thankfully, there are many options available when it comes to paying for care. From insurance coverage to payment plans, most facilities can work with patients to ensure that treatment is feasible.

Public or Private Treatment?

One study from 2003 found that private outpatient treatment programs were twice as likely to offer treatment on demand – admitting clients within 48 hours – as public outpatient treatment programs; however, they were also seven times as likely to turn away clients.[16] One possible reason for this might be that private for-profit programs charge higher prices.[17] Many private programs do accept health insurance, which offsets but may not fully cover costs.

Of the nearly 20 million Americans aged 12 or older who needed substance abuse treatment in 2011 but did not receive it, 37 percent said they did not receive treatment because they had no health insurance and another 10 percent said that their health insurance did not cover substance abuse treatment.[18] Of those who were admitted to treatment programs, 60 percent had no health insurance, 21 percent had Medicaid, and 11 percent had private insurance.[19] Forty-six percent of them paid for treatment out of pocket, and 26 percent got financial help from a family member.

Getting Outpatient Care

If you think that you or a loved one might benefit from outpatient treatment, we can help. Our admissions coordinators are standing by to answer any questions you may have. Call to learn more.


Citations

[1] “Treatment Episode Data Set (TEDS) 2002 – 2012: National Admissions to Substance Abuse Treatment Services.” (2014). Substance Abuse and Mental Health Services Administration. Accessed September 12, 2014.

[2] Ibid.

[3] Dennis, M., and Scott, C.K. (December 2007). “Managing Addiction as a Chronic Condition.” Addiction Science & Clinical Practice. Accessed September 12, 2014.

[4] Ibid.

[5] “Opioid Addiction.” (December 2012). National Institute on Drug Abuse. Accessed September 12, 2014.

[6] “Motivational Enhancement Therapy.” (December 2012). National Institute on Drug Abuse. Accessed September 12, 2014.

[7] Miller, W.R., Zweben, A., DiClemente, C.C., and Rychtarik, R.G. (1999). “Motivationl Enhancement Therapy Manual.” National Institute on Alcohol Abuse and Alcoholism. Accessed September 12, 2014.

[8] “Cognitive-Behavioral Therapy .” (December 2012). National Institute on Drug Abuse. Accessed September 12, 2014.

[9] “Contingency Management Interventions/Motivational Incentives.” (December 2012). National Institute on Drug Abuse. Accessed September 12, 2014.

[10] “12-Step Facilitation Therapy.” (December 2012). National Institute on Drug Abuse. Accessed September 12, 2014.

[11] “Alcohol and Drug Services Study (ADSS) Cost Study.” (June 18, 2004). Substance Abuse and Mental Health Services Administration. Accessed September 12, 2014.

[12] “CPI Inflation Calculator.” (n/a) United States Department of Labor, Bureau of Labor Statistics. Accessed September 12, 2014.

[13] “Alcohol and Drug Services Study (ADSS) Cost Study.” (June 18, 2004). Substance Abuse and Mental Health Services Administration. Accessed September 12, 2014.

[14] “How long does drug addiction treatment usually last?” .” (December 2012). National Institute on Drug Abuse. Accessed September 12, 2014.

[15] “Types of Treatment Programs.” (December 2012). National Institute on Drug Abuse. Accessed September 12, 2014.

[16] Friedmann, P.D., Lemon, S.C., Stein, M.D., and D’Aunno, T.A. (May 23, 2003). “Accessibility of Addiction Treatment: Results from a National Survey of Outpatient Substance Abuse Treatment Organizations.” Health Services Research. Accessed September 12, 2014.

[17] Wheeler, J.R., Fadel, H., and D’Aunno, T.A. (May 1992). “Ownership and performance of outpatient substance abuse treatment centers.” American Journal of Public Health. Accessed September 12, 2014.

[18] “The TEDS Report: Health Insurance Status of Adult Substance Abuse Treatment Admissions Aged 26 or Older: 2011.” (February 6, 2014). Substance Abuse and Mental Health Services Administration. Accessed September 12, 2014.

[19] Ibid.

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