Outpatient treatment is made up of different types of programs in which you visit a treatment center or counselor on certain days of the week.
The major difference between outpatient and inpatient programs is that inpatient programs offer 24-hour care, including housing, supervision, and access to medical care, if needed. Inpatient programs are also often more expensive than outpatient programs.
Outpatient programs can differ in intensity, from one session a week to several sessions a day, 5 days a week. Some forms of outpatient, such as partial hospitalization programs, have similar services to inpatient programs.
Outpatient can take place in a variety of settings, including community mental health clinics, counselors’ offices, hospitals, or inpatient/residential rehab programs with outpatient programs.
- Learning about substance abuse and how it affects you.
- Developing skills in areas, such as employment, leisure, socializing, communication, anger management, stress management, time management, financial responsibility, and goal-setting.
- Relapse prevention training.
- Self-help groups, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA).
How Is the Program Structured?
When you begin the program, you’ll meet with a staff member to develop a treatment plan. The plan will include goals for your treatment. The staff member will ask questions about your drug use, medical history, mental health issues, medications, legal problems, family problems, employment, living situation, and previous treatment experiences. Be honest so that the staff may create an effective plan that meets your needs.
At this stage, the staff will also discuss program rules that you will be expected to follow. Many programs will drug test you to make sure you aren’t using while you’re in the program. You’ll also be expected to consistently attend treatment sessions, and you may be asked to complete assignments outside the sessions.Every outpatient program is different and will have a different schedule and structure. For example, some programs will require you to attend treatment sessions for several hours a day, 5 days a week. Others may meet only once or twice a week. It depends on how severe your addiction is and whether you need concurrent medical or psychiatric care.
Additionally, make sure you have reliable transportation so that you can get back and forth to the recovery center. You need to be able to regularly attend sessions so that you don’t have any gaps in treatment.What Types of Outpatient Programs Are Available?
The 3 main types of outpatient programs are standard outpatient, intensive outpatient, and partial hospitalization programs. They may vary in intensity, structure, and types services.
- Standard outpatient programs are the least intense type of outpatient program. They may only meet once or twice per week for 1-2 hours at a time. These programs typically offer very little medical supervision. They may include group therapy sessions or one-on-one counseling with a therapist.
- Intensive outpatient programs (IOPs) require participants to meet for 9 to 20 hours per week. They offer a wide range of services including group counseling, individual counseling, medication, drug testing, case management, and 12-step meetings. Some people seek initial rehabilitation via an IOP because their level of addiction severity may not warrant inpatient treatment. Others may enter an IOP program after being discharged from an inpatient program.
- Partial hospitalization programs (PHPs) or day treatment programs usually take place in hospitals or free-standing clinics. Participants may attend treatment up to 7 days a week. Treatment programming is conducted for 3 to 8 hours per day, and may consist of individual, group, and family therapy; psychiatric care; medication; on-site medical care; recreation; and social services. A PHP program can help stabilize someone, serve as a transition from inpatient, or help someone avoid full hospitalization.
What Therapies Are Used?
The therapies you receive in an outpatient program will differ depending on the therapeutic approach of the individual rehab program, the substance or substances you abused, whether you have a co-occurring mental health disorder, and other issues specific to your situation.
However, some therapies are common to most outpatient programs. These are evidence-based, meaning they’ve been researched and found to help people achieve sobriety. They include:Outpatient Program Therapy
- Cognitive behavioral therapy (CBT) — This therapy teaches you coping skills you can use to avoid a relapse. Techniques that you may learn in CBT include exploring the positive and negative consequences of drug abuse, identifying cravings and situations that may trigger them, and creating strategies to deal with cravings if they do occur. CBT is often used to treat alcohol, marijuana, cocaine, and methamphetamine addictions.
- The Matrix Model — The Matrix Model is often used to treat people with addictions to stimulants, such as cocaine or methamphetamine. It combines the elements of several different approaches, including 12-step meetings, family therapy, relapse prevention, drug testing, and drug education. The therapist functions as a coach and a teacher and strives to create a positive, encouraging relationship with the patient.
- Contingency management (CM) — A contingency management program offers rewards or incentives for positive behaviors, such as submitting a negative urine screen. You may receive vouchers that can be exchanged for goods or services, or prizes such as cash. Contingency management programs are often used to treat addictions to alcohol, stimulants, opioids, and marijuana.
- Motivational enhancement therapy (motivational interviewing) — This approach helps you clarify and work through your resistance to entering substance abuse treatment. The therapist helps you find a motivation for change and develop a plan. It usually begins with an assessment and then 2 to 4 individual therapy sessions. Motivational interviewing is often used to help people struggling with alcohol and marijuana addictions.
- Family therapy — Sessions in family therapy involve both the person in recovery and a significant other, such as a spouse or a parent in the case of adolescents. Treatment focuses on substance abuse as well as other problems that may occur in the home, such as child abuse, unemployment, conflict, and mental illness. Family therapy may also be combined with contingency management—patients set goals and receive rewards from significant others when they achieve those goals.
Who Goes to Outpatient Recovery?
Outpatient rehab can be a good choice for many people who need drug or alcohol treatment. However, some people may benefit more from outpatient than others.
Those more likely to benefit from outpatient rehab have:
- A mild to moderate addiction.
- Little risk of serious withdrawal with medical complications.
- A strong support system of friends and family members.
- A motivation to attend regular counseling sessions.
- Transportation to get to and from treatment sessions.
People who may not be a good fit for outpatient have:
- Severe or multiple addictions.
- Risk of complicated withdrawal or a history of complicated withdrawal.
- Poor support systems.
- Co-occurring mental health or medical conditions.
- A history of relapse.
- Dropped out of outpatient rehab before.
If you’re not sure whether outpatient is right for you or your loved one, you can meet with an addiction treatment professional, such as a therapist, psychiatrist, doctor, or admissions counselor, at a rehab program. If they determine that outpatient isn’t the best option, you may want to consider inpatient rehab.
In an inpatient program, you receive 24-hour care and supervision. These programs provide a safe, immersive treatment environment, housing, access to medical care, and often conduct medical detoxification at the start of the treatment duration. They use a range of therapies, activities, and support services to help you begin to live a drug-free lifestyle. Most last anywhere from 30 to 90 days or even up to a year.
Inpatient programs require the person to live at the facility, so there is little flexibility with daily schedules. They may not allow much contact between the patient and their family at the beginning of treatment. They also tend to cost more than outpatient programs.
However, they provide a high level of care and remove the person from their daily environment, which may be full of temptations and people who use drugs. They are set up to treat more serious addictions, can safely detox the person, and are also able to treat medical and mental health disorders.
Many people begin treatment in an inpatient program and transition into outpatient afterward.
Can Outpatient Treat Co-Occurring Disorders?
Co-occurring disorders are conditions that someone struggles with in addition to a drug or alcohol addiction. When someone has both a substance use disorder and a mental health disorder, it is commonly called a dual diagnosis.
Dual diagnosis is quite common. In fact, about 8.2 million people age 18 or older, or 3.4% of this population, had a dual diagnosis in 2016.
Inpatient rehabs are generally better equipped to treat dual diagnosis, which tends to be more complicated and difficult to treat than a single condition. Substance abuse treatment needs to be integrated with psychiatric treatment so that both disorders are addressed at the same time. This process typically requires the intense level of care found in an inpatient center. If mental health issues aren’t simultaneously addressed, they can complicate the course of recovery and increase the risk of relapse.
If you need dual diagnosis treatment but are unable to attend an inpatient program, you can search for outpatient programs that can manage dual diagnosis conditions. You may want to consider partial hospitalization or intensive outpatient programs first, as they may be more likely to offer dual diagnosis care. Make sure they can treat your specific disorders, and ask about their experience treating your issues.
Can Outpatient Facilities Prescribe Medications?
Many outpatient programs are able to prescribe medications. However, not all addictions have approved medications to treat them, and some programs may not be able to prescribe specific medications.
Most medications that the Food and Drug Administration (FDA) has approved are for opioid and alcohol addictions. Medications approved for the treatment of opioid addiction include:
- Buprenorphine — helps to control cravings and withdrawal symptoms. It is a partial opioid agonist meaning it interacts with and activates opioid receptors in a manner similar to many abused drugs, but to a lesser degree. Buprenorphine has a ceiling to its effects, meaning that its opioid effects will peak even if the person takes a higher dose, which helps to lower the risk of dependence and overdose. Physicians who have met certain requirements can also prescribe buprenorphine out of their offices, so it may be more accessible than other medications such as methadone.
- Methadone — reduces withdrawal symptoms and alleviates opioid cravings. Methadone has been used for decades to help people recover from opioid addictions. But methadone itself can be addictive and must be taken as prescribed. It can only be prescribed through opioid treatment programs that are certified by the Substance Abuse and Mental Health Services Administration (SAMHSA).
- Naltrexone — blocks the effects of opioid drugs and can help lessen cravings and discourage continued use. Unlike methadone and buprenorphine, which activate opioid receptors in the body and brain, naltrexone binds to these receptors and blocks their activation. This medication has no potential for abuse and can be prescribed by any health care provider.
Medications approved for the treatment of alcohol addiction include:
- Disulfiram (Antabuse) — helps people remain abstinent from alcohol by producing unpleasant reactions (nausea, headache, vomiting, chest pain) when someone drinks. It is best suited for people who have already gone through detoxification and are in the early stages of recovery.
- Acamprosate — can help reduce the lingering symptoms some people may experience after the acute stage of alcohol withdrawal, such as anxiety, insomnia, restlessness, and depressed mood. It can also help people maintain abstinence from alcohol.
- Naltrexone — blocks the effects of alcohol intoxication. It helps people reduce their drinking, avoid relapse, and stay in treatment.
These medications are usually combined with therapies and other social supports.
You may also be prescribed other medications to treat mental health conditions, such as anxiety, depression, or schizophrenia. Common medications for these conditions include:
- Antidepressants — treat depression, but may also be used to treat anxiety or insomnia.
- Antipsychotics — used to treat symptoms of psychosis, such as delusions or hallucinations.
- Anti-anxiety medications — help reduce symptoms of anxiety disorders, such as panic attacks or severe fear or worry.
- Mood stabilizers — can help control the mood swings associated with bipolar disorder.
Do Outpatient Programs Have Higher Relapse Rates Than Inpatient?
Addiction is considered a chronic, relapsing condition. The rates of relapse for addiction are similar to other recurring diseases such as diabetes, high blood pressure, and asthma. For example, the typical relapse rate for substance use disorders is 40-60%, while the relapse rates for high blood pressure and asthma are 50-70%.
Various studies have compared the relapse rates with both outpatient and inpatient treatment programs. While the results are somewhat mixed, outpatient programs—particularly IOPs and PHPs—appear to be as just as effective as inpatient programs in helping people stay sober.
- One study found that an outpatient program for alcoholics had a 58% abstinence rate and a 79% improvement rate in patients at a 2-year follow-up.
- Another study found a 67% abstinence rate for inpatient participants and a 75% abstinence rate for outpatient participants at a 6-month follow-up, and a 60% abstinence rate for inpatient participants and a 68% abstinence rate for outpatient participants at a 1-year follow-up.
- A study in the mid-90s found that the abstinence rate for problem drinkers at 6 months was 16.3% with no treatment, 41% with Alcoholics Anonymous, 29% with outpatient treatment, and 52% with inpatient treatment.
- A review of 12 studies and 1 review published between 1995 and 2012 found that IOPs and PHPs produced similar reductions in drug and alcohol use and increases in days abstinent compared to inpatient or residential programs.
A person who has become addicted to drugs or alcohol has to learn how to change certain behaviors that may be deeply ingrained, and this process can take time. They may have to try several forms of treatment or therapy before they find the one that is most effective for them. If they do relapse, that doesn’t mean they have failed; it simply means that they need to re-enter treatment or speak with their treatment team or provider to make adjustments to their rehabilitation plan.
If someone relapses during or after an outpatient program, it may mean they need a higher level of care. For instance, if they were in a standard outpatient program, they may benefit more from additional treatment at an inpatient or intensive outpatient program.
What Is the Cost for Outpatient Care?
A multitude of factors will affect the cost of outpatient treatment, such as the location, the facility, insurance coverage, level of care, length of care, and other services.
That said, the following are general estimates for outpatient treatment:
- Partial hospitalization: $350-$450 per day (private pay rate without insurance)
- Intensive outpatient care: $250-$350 per day
The following are estimates for detox and inpatient care:
- Supervised medical detox: $500-650 per day (private pay rate)
- Inpatient care in a rehab center: $500-$650 per day (private pay rate)
If you have insurance, it may cover outpatient care. If you don’t have private insurance, you may qualify for public insurance programs, such as Medicaid or Medicare. In addition, plans offered through the Affordable Care Act (“Obamacare”) are required to cover substance abuse and mental health services to the same extent that they cover medical needs.
Other payment options include:
- Payment programs through the facility.
- Crowdfunding sites.
- Health care credit cards.
- Private loans.
Some programs may also use sliding scale fees that adjust the cost based on what you can reasonably afford to pay. You may need to meet eligibility requirements and provide proof of income.
Is Outpatient Enough?
Completing an outpatient program is an achievement worth celebrating. However, it’s only the beginning of recovery for most people.
When patients leave an outpatient program, they may be exposed to a great deal of temptation and triggers to use. Aftercare or follow-up care gives a person the opportunity to meet with a therapist or a group to continue to receive support, monitor progress, and deal with any challenges the person faces as they deal with their day-to-day lives without alcohol or drugs.
Before you leave treatment, most programs will help you set up an aftercare plan. A plan can include any of the following components:
- Individual therapy
- Group counseling
- 12-step programs (Alcoholics Anonymous, Narcotics Anonymous)
- Non-12-step programs (SMART Recovery)
- Alumni programs
Some people who have been in inpatient care may “step down” or transition into an intensive outpatient program or a partial hospitalization program. Another option for those who have completed treatment is a sober living home. These homes, sometimes known as halfway houses, are places where people can live in a substance-free environment. Residents support each other and may attend 12-step meetings or counseling while they search for a job, go to school, or look for a place to live.
Recovery is an ongoing process that takes effort and the support of other people. Outpatient lays the groundwork, but the person in recovery has to continue the work after treatment ends. Aftercare programs help build on the foundation of outpatient treatment and can help a person stay clean. The person can keep practicing the skills they learned in treatment while receiving feedback from others.
Twelve-step programs and group therapy also give the person the opportunity to help others with their recovery and impart some of the lessons they’ve learned on their own journey. This element of recovery can be very helpful and rewarding for some people.
Most programs recommend that people participate in aftercare for at least 1 year following treatment. However, aftercare can last as long as a person needs it. Many people decide to keeping attending 12-step meetings long after they’ve left treatment, and others become involved in the recovery community or become addiction professionals because it helps reinforce their own commitment to sobriety. It all depends on the person.
If your program doesn’t help you with aftercare planning, ask them for assistance or research options in your area. You can also see if they will give you a referral to an addiction professional in your area, such as a therapist, or help you locate 12-step programs near you.Citations National Institute on Drug Abuse. (2018). Treatment Approaches for Drug Addiction. National Institute on Drug Abuse. (2018). Types of Treatment Programs. Substance Abuse and Mental Health Services Administration. (2008). What Is Substance Abuse Treatment? A Booklet for Families. Substance Abuse and Mental Health Services Administration. (2006). Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. McCarty, D. et al. (2014). Substance Abuse Intensive Outpatient Programs: Assessing the Evidence. Psychiatric Services, 65(6), 718-726. Nebraska Department of Health and Human Services. Partial Hospitalization – MH – Adult (Managed Medicaid Only Service). National Institute on Drug Abuse. (2018). Cognitive-Behavioral Therapy. National Institute on Drug Abuse. (2018). The Matrix Model. National Institute on Drug Abuse. (2018). Contingency Management/Motivational Incentives. National Institute on Drug Abuse. (2018). Motivational Enhancement Therapy. National Institute on Drug Abuse. (2018). Family Behavior Therapy. Substance Abuse and Mental Health Services Administration. (2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. (2016). Buprenorphine. Substance Abuse and Mental Health Services Administration. (2015). Methadone. Substance Abuse and Mental Health Services Administration. (2016). Naltrexone. Substance Abuse and Mental Health Services Administration. (2015). Medication and Counseling Treatment. National Institute on Drug Abuse. (2018). Alcohol Addiction. National Institute of Mental Health. (2016). Mental Health Medications. National Institute on Drug Abuse. (2018). Treatment and Recovery. Soyka, M. and Schmidt, P. (2009). Outpatient alcoholism treatment – 24-month outcome and predictors of outcome. Substance Abuse Treatment, Prevention, and Policy, 4:15. White, W. (2012). Recovery/Remission from Substance Use Disorders. Philadelphia Department of Behavioral Health and Intellectual Disability Services and Great Lakes Addiction Technology Transfer.