Outpatient treatment consists of an individual attending treatment sessions in a clinic, hospital, office, etc., and then returning home to their regular life following their participation in treatment sessions. Inpatient or residential treatment differs from outpatient treatment in that the person actually lives in the facility where they receive treatment, and typically, they do not leave the facility except in special cases for other treatments or special situations.
While both inpatient (residential) treatment programs and outpatient treatment programs have strengths and weaknesses, the majority of individuals in recovery will be engaged in outpatient treatment at some point during their treatment program. This is true even if these individuals have been involved in an inpatient treatment program for a significant length of time. The reason for this is that inpatient treatments are designed to deliver very intense and specialized treatment for short periods of time. They are expensive and require a significant number of professional resources in order to be implemented. Outpatient treatment can address the majority of the needs of an individual in recovery and result in far less expense and resource recruitment.
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For practical purposes, it is most efficient to describe the instances when an outpatient program is not preferable over an inpatient program. By default, any other situation would be best suited or equally suited to an outpatient treatment program. According to a number of sources, including the?American Psychological Association?and the?American Society for Addiction Medicine?(ASAM), the treatment that best suits the specific needs and case requirements for the individual is the treatment that should be implemented. Some of the instances where outpatient treatment may not be preferred initially the following situations:
CLIENTS HAVE TO BE MONITORED FOR SIGNIFICANT WITHDRAWAL SYNDROMES
In a number of instances, people with substance use disorders who are in the early phases of recovery are faced with significant withdrawal symptoms, and in some cases, these can be potentially dangerous (e.g., withdrawal from alcohol, benzodiazepines, undergoing withdrawal when one has some other debilitating psychiatric disorder, etc.). In these instances, an outpatient withdrawal management program is not preferable. Instead, it is far more efficient and safer to have the individual in a residential program where they can be monitored around the clock, and any emergency situations can receive immediate attention. Typically, when these individuals are stabilized or through the withdrawal process, they are released into an outpatient program.
CLIENTS HAVE TOXIC HOME ENVIRONMENTS
In this context, the term?toxic environment?refers to any environmental situation that is either potentially dangerous for the individual or will significantly interfere with their success in the early stages of recovery. These can include situation like abusive relationships in the home, environments where there is significant substance abuse, environments where there are significant stressors, etc. Since the individual is extremely vulnerable in the early stages of recovery, it is often preferable to begin treatment in a residential program until the person can demonstrate that they have established enough stability in their habits that they can deal with issues outside the treatment program or until they can be placed in a more suitable home environment for their recovery.
INDIVIDUALS HAVE HAD MULTIPLE UNSUCCESSFUL ATTEMPTS AT RECOVERY
In many cases, individuals who have undergone numerous attempts at recovery and had numerous relapses will benefit from an initial period of time in a residential treatment program. Eventually, they will have to transition into some form of outpatient care; however, getting their recovery firmly established in an inpatient program can often be helpful.
INDIVIDUALS HAVE MEDICAL COMPLICATIONS OR SEVERE MENTAL HEALTH DISORDERS
Individuals who have severe medical problems or severe forms of co-occurring mental health disorders should be placed in an inpatient care unit initially. People who are suicidal or have significant cognitive impairment are better served in residential treatment until their situation can be stabilized or suitable arrangements can be made for them outside the inpatient treatment program.
CLIENTS HAVE OTHER SPECIFIC CONDITIONS
Because a good recovery program follows general established principles and attempts to adjust these to the needs of the individual, any number of other important considerations or conditions may indicate that someone would fare better in a residential treatment program, at least initially
Outpatient treatment programs are generally preferable in cases other than the ones mentioned above for a variety of reasons.
- People participating in outpatient treatment can maintain their work, school, family and other important commitments. This results in less disruption in their lives.
- Outpatient treatment programs allow individuals to immediately apply what they have learned and practiced in treatment to the real world.
- Outpatient treatment programs offer their clients far more freedom and flexibility than inpatient treatment programs.
- Outpatient treatment programs allow more privacy regarding the individual?s participation in treatment as the individual does not have to notify their work, family members, friends, etc., that they will be staying in a residential or inpatient treatment unit.
- Outpatient treatment programs provide essentially the same quality of treatment as inpatient treatment programs, though inpatient programs may offer a wider array of complementary or alternative therapy options.
- Outpatient treatment programs can sometimes provide some interventions that are not available in inpatient treatment programs.
- Outpatient treatment programs are generally far less expensive than residential or inpatient treatment. This results in a reduced financial burden. In many cases, insurance may be more likely to cover outpatient treatment.
Outpatient Treatment Services
According to?Treating Addiction: A Guide for Professionals,?with only a few exceptions (such as specific types of medical procedures and for conditions where individuals need to be monitored around the clock), outpatient treatment programs can essentially provide the full gamut of treatment services that are provided by residential treatment units. These include:
- Most medically assisted treatments and pharmacotherapies: Most of the medically assisted treatments that are recommended in the use of recovery from substance abuse can be provided on an outpatient basis. Individuals can also be prescribed medications during recovery and take these on an outpatient basis.
- All types of psychosocial interventions: There are essentially no types of therapy, support group participation, complementary and alternative treatment, etc., that can only be provided to an individual on an inpatient basis. Individuals can receive these interventions as an outpatient. It simply depends on the offerings of the chosen treatment program.
- Psychoeducation: Psychoeducational services include skill building shops, lectures, etc., that do not formally qualify as therapy or other types of interventions that are designed to help individuals learn new skills or gather new information. These can be provided on an outpatient basis as efficiently as they can be provided on an inpatient basis.
- Support services: These consist of a number of nontherapeutic services that are provided to individuals who need specific supports during their recovery. Most often, these include transportation services to treatment, mentoring services, educational and occupational supports, etc.
- Case management services: Case management refers to specific services that assist individuals who have special needs. These services are often not provided directly by recovery teams. They may include helping an individual find a job or job training, helping a person find an affordable place to live, helping an individual find a psychiatrist who specializes in their needs, etc.
- All associated benefits of recovery: Aside from the benefits of direct intervention, such as receiving medications, undergoing therapy, being involved in support groups, etc., individuals can accrue additional benefits in outpatient care, such as developing social connections, enjoying peer support, and finding personal motivation and feelings of purpose.
Intensive Outpatient Options
Because outpatient treatment can be quite varied and adjusted to the needs of the individual, there are a number of different specialized intensive forms of outpatient treatment programs that may be used in place of residential treatment for individuals who do not require a full program of 24-hour supervision.?These programs include:
- Partial hospitalization programs: These programs, sometimes referred to as PHPs, can be utilized by individuals with severe medical conditions or severe psychological issues without being fully hospitalized. Typically, these programs will meet for 3-5 days per week for periods of four hours or more per day in a hospital or clinic. Clients will receive treatment for their issues and can return home or to some other living arrangement each night.
- Intensive outpatient programs: Also known as IOPs, these programs are designed to provide the intensive forms of treatment interventions that individuals typically receive on an inpatient basis but in an outpatient program. In general, they must deliver a minimum of nine hours a week of intensive treatment. Many of these programs offer significantly more treatment time. They typically meet 3-5 days a week for individuals with severe issues, co-occurring disorders, or multiple relapses who are deemed not to need around-the-clock supervision but still need the intensive treatment that is typically delivered in residential programs.
- Florida model: The Florida model is a combination of an inpatient and outpatient treatment program. Clients live in a supervised residential housing center that is separate but connected to a treatment facility instead of actually living in the clinic or hospital.
In general, outpatient treatment for recovery from a substance use disorder can be preferable due to its flexibility and reduced expense, and it is generally as effective as the services provided on an inpatient basis. There are several situations where getting treatment as an outpatient may not be the preferred form of care initially, but most individuals in recovery from a substance use disorder will find that they eventually need to transition to outpatient treatment.