Treatment for an alcohol or drug problem entails removing the client from the parts of their life that contribute to the desire to abuse illicit substances.
For some clients, they have some things that work in their favor to the point where a clean break is not necessary. Outpatient treatment centers are a way for these clients to control and manage their addictive impulses while still being a part of the outside world.
As would be the case for medical concerns, inpatient care describes service that requires the client be admitted into a treatment facility, which could be a hospital but could also be a specialized facility. Most locations require that a client has to be checked in for more than two consecutive days for the care to be considered “inpatient”; this has a significant impact on insurance plans and the cost of treatment.Medicare.gov explains that a doctor’s note is one of the factors in determining whether a patient is eligible for inpatient treatment.
For substance abuse treatment, a doctor might recommend inpatient care if the client is so physically and psychologically dependent on a particular drug (or drugs) that they are at too much risk if they tried to break their addiction while living at home. The process of removing toxic substances from the body – especially a body that cannot function without them – is complicated, painful, and sometimes dangerous. Clients who have been addicted to their substances for a period of time, or whose addiction is quite significant, need medical help breaking the physical need for another hit. Such help is best provided over a period of time and in an area where there is constant medical supervision. Since this is unlikely to take place in a home environment, inpatient care at a specialized treatment facility or hospital is the best choice.
Another reason why a doctor might recommend inpatient treatment is if the client’s home situation is not psychologically conducive to recovery. Given that detoxification entails uncomfortable drug withdrawal, clients need to recover in stable and peaceful surroundings, preferably with people who can support them emotionally, and not cause stress or use drugs in their presence.In some home environments, where there is the open consumption of drugs or alcohol, abuse, neglect, or a high level of stress, a client who is recovering might feel compelled to abuse substances again because these could be the kinds of triggers that contributed to the addiction taking hold in the first place. If a doctor believes that relapse would be imminent if the client is discharged into that kind of situation, then inpatient treatment would be recommended.
The Benefits Of Outpatient Rehab
- Having the ability to continue with work and/or school. In contrast to a residential treatment program that requires recovering addicts to put their lives on hold while they pursue their recovery, an outpatient addiction program allows participants to maintain a presence at work and/or school.
- Access to support systems. People in recovery need a lot of support. With outpatient rehab, patients can stay in close proximity to their loved ones and their support network.
- Lower costs. Inpatient programs can be expensive and generally require a significant out-of-pocket expense. Outpatient rehab is less expensive across the board, while still providing high-quality treatment.
A solid outpatient drug rehab center understands that achieving lasting sobriety
involves more than just treating the physical aspects of addiction. In fact, many programs treat the clients’ medical needs as well as their psychological, spiritual, emotional and physiological needs.
Although inpatient drug and alcohol rehab is recommended for those who have developed severe addictions, there is a less intense alternative for those who are in the beginning stages of addiction and those who need continuing support after undergoing inpatient rehab. Many people require the extra support while transitioning back into society and the demands of daily life.
Outpatient rehab is an affordable and effective form of drug treatment, but it isn’t necessarily right for everyone. The following individuals generally do not fare best in outpatient addiction treatment:
- Those who have developed a severe addiction and need the 24-hour support of an inpatient rehab facility.
- Those who are a danger to themselves or others.
- Those who face temptation in their day-to-day life (for example, if their family members or roommates use drugs or alcohol).
- Those who have a history of chronic relapse. They tend to need more support than an outpatient rehab program can offer.
What is Outpatient Treatment?
Outpatient addiction treatment can be very beneficial for patients with substance use disorders or those who may or may not have become physically dependent on their substance of choice but are still serious about getting sober. Outpatient treatment programs come in a variety of formats and vary in terms of intensity but all generally focus on counseling, education and building a safe, supportive network of others in recovery.
Outpatient programs offer drug and alcohol treatment as well as mental health treatment which can be scheduled with a greater degree of flexibility when compared to inpatient treatment. This schedule allows patients to continue with their day-to-day responsibilities and continue living at home while being required to check into their outpatient care provider at scheduled times throughout the week for medication (where applicable), counseling and therapy sessions.
Inpatient vs. Outpatient Treatment: What is the Difference?
Drug and alcohol addiction treatment programs typically fall into two categories: inpatient or outpatient treatment. What is the difference in inpatient vs. outpatient treatment? While each type of program has its benefits – the specific type of treatment needed (in many cases, both) need to be considered based on a patient’s individual needs at that time.
***General outpatient is commonly known as outpatient in Massachusetts.
Our partial hospitalization level of care is designed to initially transition patients from inpatient to outpatient levels of care. Our patients meet daily for 6 hours a day for interactive support and self awareness relating to triggers, ongoing challenges, recovery skills & tools and work through issues to continue building a foundation for meaningful, fulfilling, long-term recovery. We provide individual & group therapy sessions, state-of-the-art techniques and alternative therapies led by an experienced clinicians designed to continue restoring confidence and applying newly learned principles to life in recovery.
Intensive Outpatient (IOP)**
Our intensive outpatient level of care is designed to reinforce the recovery concepts already learned and typically consists of (3) 3-hour group sessions per week.
**IOP is referred to as Day Treatment in Massachusetts.
General Outpatient (GOP)***
Our general outpatient level of care includes weekly group & individual therapy sessions at a frequency determined by our patients’ Primary Therapist based on determined need. General outpatient continues for an unspecified period of time until it is determined by our Primary Therapist, our patient and their families that the GOP level of support is no longer necessary and the patient is ready to begin the next phase of recovery in their life post-treatment.
Inpatient vs Outpatient Rehab
Generally speaking, there are two main types of treatment options when it comes to dealing with addiction recovery programs: inpatient rehab and outpatient rehab. In many ways, the two are similar in that they offer recovery programs that focus on the causes of addiction while offering tools to help people get out of it.
The differences between inpatient and outpatient programs lie in the intensity of the recovery program and the approaches taken. As the name suggests, an inpatient program requires staying at a facility for a period of time and working intensely with addiction counselors for extended periods each day. Outpatient programs, by contrast, deal with people on a part-time basis to help them overcome their addiction while they remain in society.
The Disease of Drug and Alcohol Addiction
According to the National Institute on Drug Abuse, addiction can be defined as “a chronic disease characterized by compulsive, or uncontrollable, drug seeking and use despite harmful consequences and changes in the brain, which can be long-lasting.” People with severe drug addiction can actually change the chemical and physical structure of their brain, leading to lasting problems with cognition, emotional control, and motor function. The effects on the rest of the body can be just as damaging, and depending on the drug in question, severe damage can be inflicted on the heart, lungs, kidney, liver, and other internal organs.
In addition to all the physical and mental problems that can develop from addiction, there are also the interpersonal ones. Oftentimes, addiction will put a heavy strain on relationships. This can include both personal relationships, such as those with family and loved ones, and professional relationships at work or school. The disease of addiction can destroy a person’s life in pretty much every way imaginable, which makes the importance of treatment and addiction recovery paramount.
Preparing for Inpatient Rehab
Inpatient programs can last anywhere from three weeks to 12 months depending on what the particular circumstances of a person’s addiction necessitate. Regardless of how much time is going to be spent in one of these residential treatment programs, preparations will need to be made ahead of time to ensure the transition is as seamless as possible. Here are some important items to keep in mind if you are preparing for long-term treatment:
- If you are employed, then talking to your employer about your situation is necessary. The Americans with Disabilities Act (ADA) offers certain protections for those who are entering a long-term inpatient program, so you don’t need to fear being fired outright for seeking help.
- Obviously, if you are a single parent or have a special living situation where you care for a parent or loved one, finding alternative arrangements is a necessity. In many cases, this help will come from family or friends who also want to see a successful recovery.
- For those who rent an apartment or own a home, finding a way to keep the bills paid will also be a necessity. Monetary support can come in the way of private loans through a bank, grants through organizations like SAMHSA, family and friends, or Medicaid/Medicare.
- An important thing that can easily get overlooked in all the craziness of preparing for inpatient treatment is finding out what sorts of personal items are allowed. Different facilities have different guidelines for what is and is not permissible for long-term patients, but everyday things such as clothes, jewelry, personal items, an alarm clock, and a personal journal will be fine.
- Finally, after all the other preparations have been made, make sure there is reliable transportation both to and from the rehab center. While some people may be able to get rides from family or friends, there are others who may need to use a taxi or some form of public transportation. If the facility is located in another state, then securing airfare or a bus ticket may be necessary.
Entering Inpatient Rehab
For people who are suffering the worst effects of alcohol or drug addiction, an inpatient program might be the best way to go. These programs are held at clinics, rehab centers, and, occasionally, hospitals that provide 24/7 care as well as intensive recovery programs.
In most cases, when someone enters an inpatient rehab, they will have to undergo a detoxification period and medically managed withdrawal before they can begin the recovery process. This is when all traces of alcohol or drugs are removed from one’s system. For those who are entering an inpatient facility, the amount of a substance in their system may be high enough that there will be a physician monitoring the detoxification process to keep the patient safe. This is especially true in the case of alcohol, which can lead to severe withdrawal symptoms such as delirium tremens, hallucinations, accelerated heart rate, and seizures. During detoxification, medical physicians may prescribe medications to help alleviate symptoms of withdrawal.
The Treatment Process
Once the detoxification process is complete, the process of recovery can begin. Treatment plans can vary to some degree depending on where you stay, but, generally they are all well-structured programs designed to promote a healthy lifestyle while abstaining from drugs and/or alcohol. The day will begin with a healthy breakfast and morning treatment sessions. Some facilities offer yoga classes, meditation, and exercise programs to help relieve any stress and get ready for the day. An important part of the addiction-recovery process is to learn new healthy routines that you can take with you when you leave.
After breakfast, there will be a morning counseling session that can last until lunch. This is usually a group session with a treatment professional leading the discussion. The session will typically focus on the direction of treatment, long-term recovery, 12-step programs, and other similar topics. There is a lot that is misunderstood about the process of recovery, so the main point of these group sessions is to have everyone work together to come to a clear understanding of how it works. Part of this process also includes group discussions of triggers and behavioral patterns to help elucidate what they are and help avoid them in the future.
In the afternoon, there is more counseling, but this time, the process is one-on-one and will delve much deeper into individual issues. Here are some of the types of programs you may encounter:
- Cognitive Behavioral Therapy (CBT) is a goal-oriented approach that uses the tools of psychotherapy to address problematic areas of a person’s life with the purpose of changing negative attitudes, thoughts, and behaviors. CBT is an excellent way of dealing with triggers and repetitive behaviors associated with alcohol and drug addiction. It is also effective for dealing with depression, anxiety, and relationship issues.
- For some people, there are specific triggers that lead to substance use. These can include anger management, overwhelming stress, and grief over some type of loss. Specialized therapy sessions can help teach coping mechanisms for dealing with these feelings and provide tools for avoiding them whenever possible.
- Family therapy is an important component because addiction is a disease that doesn’t just affect the person who is suffering from it. Families experience just as much grief and pain from addiction. Having sessions with everybody present can help the family as a whole along the process of healing while also providing the person who is addicted with extra resolve.
- Alternative methods of therapy are often implemented alongside the above-mentioned programs. Some of these alternative methods include art or music therapy, equine therapy, exercise, and dance therapy.
The Importance of Family in Addiction Recovery
Even if someone is not engaged in family therapy while in an inpatient recovery program, they are still encouraged to have regular contact with family members during their stay. Whether it comes from a parent, child, sibling, or partner, the bonds of family can be an integral part of any recovery process.
Outpatient programs serve two purposes that are very similar. They are for people who need help with their addiction or substance use disorder but have not gotten to the point where they need an inpatient program. Outpatient rehab also serves as the next step for those who are exiting inpatient care. Depending on the level of treatment and care a person may need, there are a number of different programs that fall under the rubric of outpatient rehab to choose from. Here are the most common options:
- Intensive outpatient treatment (IOP) provides a great service for those just starting the recovery process and for those who are transitioning from an inpatient program. IOP consists of both group counseling as well as one-on-one therapy sessions, and the program generally lasts anywhere from one to six months. During this time, attendees will take part in both group and individual counseling sessions multiple times a week. Each session will typically last between two and four hours.
- Partial-hospitalization programs (PHP) offer a higher level of care and management than what is found in standard outpatient programs. In addition to counseling or therapy, addiction sufferers will also receive medical monitoring throughout the day. Generally, people in PHP will attend therapy sessions three to five times a week for four to six hours at a time.
- Therapy and counseling is also available in less intense forms for people who are in the beginning stages of addiction or have a substance use disorder. These treatment options focus on what caused a person’s drinking or drug abuse in the first place and how to avoid falling into traps that can lead them further down the road into addiction. Counseling and therapy at this level are tailored to individual needs based on what both the patient and therapist/counselor feel are appropriate. The main form of treatment applied at this stage is CBT, but other treatment options are also available.
Inpatient vs Outpatient Care
If you are currently dealing with an addiction or substance use issue, you might be wondering which of these options listed above would work best for your situation. There are some general guidelines that counselors, therapists, and healthcare professionals use to determine if an inpatient or outpatient program is appropriate. Here are some guidelines to go by:
Inpatient Care Considerations
- Inpatient programs are specifically designed to help people who are heavily addicted to substances and need to detox and go through withdrawal.
- Since these facilities provide 24/7 care, there is always staff on hand to help addiction sufferers to cope with the initial stages of their sobriety.
- Every aspect of an inpatient treatment program is highly organized and structured to support the ultimate goal of continued sobriety. This is important for long-term addicts who have built up their lifestyle around addiction. These programs work at both the interpersonal and intrapersonal levels.
- There are doctors on hand to provide any medical assistant a patient might need. They can offer medications to assist with the recovery process and are available to assist in the rare event that an emergency arises.
Outpatient Care Considerations
- Living at home during your treatment is far less expensive than being at a facility 24/7. This is true not only in terms of the specific cost of the program but also in terms of other costs incurred from loss of work, bills, and childcare.
- If there is a positive network of family and friends available who are supportive, remaining at home can sometimes be a much better option. A positive support network at home is an important aspect of addiction recovery.
- Depending on one’s level of addiction, an outpatient program might not be intensive enough. Those who have been using for a long time and are likely to go through withdrawal symptoms may want to opt for inpatient treatment.
- Going to treatment once to a few times a week leaves much more time open for work, childcare, and all the other activities of life.
Intensive Outpatient Program
Intensive Outpatient Program (IOP) Treatment Centers
These treatment centers provide Intensive Outpatient Programs in Massachusetts and involve intensive outpatient treatment.
The intensive outpatient treatment program Massachusetts aids those in the early phases of sobriety and recovery from substance abuse. It is a program designed to help individuals develop the insight and skills necessary to be abstinent from drugs and/or alcohol.
Intensive Outpatient Treatment (also known as IOP for “Intensive Outpatient Program”) is a primary treatment program recommended in some circumstances by a clinical and medical assessment. IOP may be recommended for those who do not need medically-supervised detox. IOP can also enable people in recovery to continue their recovery therapies following successful detox, on a part-time yet intensive schedule, designed to accommodate work and family life.
Start rebuilding your personal life and mending your important family ties right away, when you live at home and participate in intensive outpatient treatment in Massachusetts. With the Intensive Outpatient Treatment program you are able to establish a foundation for long term recovery support in your local community right from the start of your treatment, instead of waiting until you return from living away in a rehab center.
In the Intensive Outpatient Program, you continue your life with support from the local clinical, emotional and peer support systems provided by the IOP.
Outpatient Rehab in New Hampshire
Our outpatient treatment team consists of exceptionally qualified, mostly doctoral level clinicians who have worked together for over a decade. We collaborate with you to provide individualized treatment that fits your particular resources and situation as described below:
Individual Outpatient Therapy for addictions is simply one-on-one sessions. Many individuals prefer the privacy and focus of individual therapy. You can choose the most suitable therapist and schedule for your goals.
Individual Intensive Outpatient (IIOP)This approach is for those who prefer or need the intensity of rehab without the restrictions. The therapists of your choice work together as a treatment team. In addition to the individual sessions, an optional variety of holistic therapies, couples and family support can be added if preferred.
Group Intensive Outpatient (Group IOP) Working with you, we develop a customized, structured treatment plan through primarily group therapy. Individual therapy sessions, optional holistic therapies, couples therapy and family support can be included.
Outpatient rehab is highly effective for early-stage addicts because these programs tend to focus on techniques for overcoming addiction. The first signs of addiction can be subtle and easy to overlook, but for those who are fortunate enough to recognize these signs, outpatient rehab is an effective option. Typically, those who are suitable for outpatient drug rehab are cognizant of the fact that they have a drug problem and are motivated to learn how to correct it.
IS IOP EFFECTIVE?
Clinical research and practice have established that IOP is an effective and viable way for individuals with a range of substance use disorders to begin their recovery. In the 1980s, it commonly was believed that only clients who were relatively high functioning, employed, and free of significant co-occurring psychiatric disorders could benefit from IOP and that IOP was not effective with clients who were compromised by significant psychosocial stressors such as homelessness or co-occurring disorders. Today substantial research and clinical experience indicate that IOP can be effective for clients with a range of biopsychosocial problems, particularly when appropriate psychiatric, medical, case management, housing, and other support services are provided.
Recognizing that substance abuse is a chronic disorder similar to diabetes, hypertension, and asthma has led researchers to question the acute care model of service delivery that has characterized substance abuse treatment for the past 50 years (McLellan et al. 2000). Increasingly, IOP programs are involved in substance abuse treatment beyond the initial 8-12 weeks.
Several studies comparing intensive outpatient treatment with residential treatment have found no significant differences in outcomes (Guydish et al. 1998, 1999; Schneider et al. 1996). Finney and colleagues (1996), however, in a review of 14 studies, found that the available evidence tended to favor inpatient slightly over outpatient treatment. The consensus panel has concluded that clients benefit from both levels of care and that comparing inpatient with outpatient treatment is potentially counterproductive because the important question is not which level of care is better but, rather, which level of care is more appropriate at a given time for each client. Matching clients with enhanced services also improves client outcomes. McLellan and colleagues (1998) found that compared with control subjects, clients with access to case managers who coordinated medical, housing, parenting, and employment services had less substance use, fewer physical and mental health problems, and better social function after 6 months. It is in the best interest of clients to have a broad continuum of treatment options available. Some clients entering IOP may be able to engage in treatment immediately, whereas others may need referral to a long-term residential program or a therapeutic community. Some clients can be detoxified successfully in an ambulatory setting, whereas others need residential services to complete detoxification successfully.
The distinction between substance abuse treatment programs and mutual-help groups, such as 12-Step support groups, often is misunderstood by managed care organizations and the public. The American Medical Association (1998) has adopted a policy stating that clients with substance use disorders should be treated by qualified professionals and that mutual-help groups should serve as adjuncts to a treatment plan devised within the practice guidelines of the substance abuse treatment field. Likewise, the American Psychiatric Association, American Academy of Addiction Psychiatry, and American Society of Addiction Medicine (ASAM) have issued a joint policy statement that asserts that treatment involves at least the following (American Society of Addiction Medicine 1997):
- A qualified professional is in charge of treatment.
- A thorough evaluation is performed to determine the stage and severity of illness and to screen for medical and mental disorders.
- A treatment plan is developed.
- The treatment professional or program is accountable for the treatment and for referring the client to additional services, if necessary.
- The treatment professional or program maintains contact with the client until recovery is completed.
According to the policy statement adopted by these treatment professionals’ associations, mutual-help groups are an important component of treatment, but they cannot substitute for substance abuse treatment as outlined above.
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.