Substance abuse treatment generally begins with detox, overseen by medical professionals, and then transitions to a rehabilitation program. These programs provide therapy to promote individuals changing behaviors around intoxicating and addictive substances, and understanding the root causes of their addiction. Once a person completes a rehabilitation program, support groups, therapists, physicians, and other forms of aftercare can help the individual reduce their risk of relapse and build a sober, healthy life.
The Continuum of Care and Outpatient Treatment
Although the outline of the path to sobriety is basically the same for everyone, individual components of treatment can be radically different. The National Institute on Drug Abuse (NIDA) states, in their Principles of Effective Treatment, that detox and rehabilitation must both be easy to access and varied to help a wide range of individual needs.
As medical professionals better understand the disease of addiction and evidence-based approaches to treating this condition, rehabilitation programs are becoming more varied in their approaches to individual needs. The American Society of Addiction Medicine (ASAM) created a Continuum of Care to help treatment providers understand varying medical needs among those entering drug and alcohol rehabilitation. The levels of this scale are outlined below.
- Level 0.5: This level is about education and prevention. Clinicians and counselors find adolescents or adults who have specific risk factors for substance abuse problems, such as mental illness, family history, or a high-stress environment. Educating these high-risk groups regarding the behavioral signs of substance abuse can reduce their risk of later struggling with addiction.
- Level 1: This is standard outpatient treatment, which involves 1-3 counseling sessions per week. These sessions are typically group therapy, but one may be individual therapy if it is deemed necessary. Therapy requirements involve less than 10 hours per week in session and allow low-risk people to live at home and hold a job, as long as they can stay sober.
- Level 2: Both intensive outpatient treatment and partial hospitalization, these programs help people who can live safely at home part-time while focusing intensely on individual and group therapy for several hours, several days per week. These types of programs also work well for those struggling with co-occurring substance abuse and mental health conditions.
- Level 3: These are low-intensity residential services, which benefit those who need help staying sober by providing living arrangements and consistent behavioral therapy.
- Level 4: This high-intensity form of residential treatment helps to change behaviors, provides medication to ease into sobriety, and offers 24-hour nursing oversight and regular physicians’ visits to manage chronic conditions associated with long-term substance abuse.
Most outpatient treatment falls between Level 1 and 2, although variances between standard and intensive outpatient treatment can make a significant difference in how effective this form of treatment is for a person.
Who Benefits from Outpatient Treatment?
Typically, outpatient programs share some similarities to residential or inpatient treatment, especially the focus on evidence-based therapy and medication-assisted treatment (MAT) when needed.
Like inpatient programs, outpatient programs may include:
- Group and family counseling
- Individual behavioral therapy
- Tapering medications
- Referrals to support groups after rehabilitation is completed
However, the amount of program options provided by outpatient rehabilitation depends on the program’s intensity. Standard outpatient treatment will focus much more on group therapy while a physician not associated with the program may prescribe MAT drugs like buprenorphine. Intensive outpatient treatment may involve MAT providers and requirements for individual or family counseling in addition to regular, longer group sessions. Intensive outpatient treatment is also likely to involve stepping down from more medically intensive services like detox to less frequent support group sessions; standard outpatient will focus more on group support.
Intensive outpatient treatment is a strong option for people who want to focus on their treatment for several weeks, up to a few months, and then return to daily life. It is less expensive than inpatient treatment but provides a similar level of intensity. Those who have mental health issues alongside addiction may benefit from this intense, short-term focus on counseling.
Standard outpatient treatment works well for people who:
- Do not have long-term, high-dose substance dependency
- Can remain sober with support from loved ones
- Want to stay near loved ones
- Are adolescents and live with supportive parents or guardians
- Want to, or need to, remain employed
- Prefer their friends or coworkers not know they were in treatment
- Do not need MAT
- Cannot afford higher levels of treatment
The Effectiveness of Outpatient Treatment
While outpatient treatment is more effective for specific groups, substance abuse recovery is an ongoing process. Addiction is a chronic disease involving structural changes to the brain, especially the reward center and neurotransmitters; these changes lead to intense cravings, compulsive behaviors, and changes to mental health. As a chronic illness, addiction is not considered to be curable, and understanding the risks of relapse back into substance abuse is one aspect of treating this condition.
NIDA states that relapse into new or more intense symptoms is part of many chronic illnesses, not just addiction. While 40-60 percent of people struggling with addiction will relapse into substance abuse again at some point, similar statistics are associated with other chronic illnesses. For example, relapse rates among those with type I diabetes are 30-50 percent; relapse rates among people with hypertension are 50-70 percent.
In the case of other chronic illnesses, relapse is an indication that the individual must return to their physician and develop a new treatment plan. Unfortunately, addiction has not been treated this way until recently. Relapsing into substance abuse is not a failure of the original course of treatment, and it is not a moral failure. Instead, it’s an indication that the individual must return to treatment and potentially enter a new level of treatment. Returning to standard outpatient treatment may work for some, but for others, entering a more intensive level of treatment may be more appropriate. Oftentimes, people enter residential treatment after relapsing.
How to Pay for Outpatient Treatment
Outpatient treatment is typically less expensive than inpatient treatment, as outpatient services do not involve housing, meals, and associated services. Insurance programs are typically more willing to cover outpatient treatment due to this reduced cost, although medically necessary inpatient services may receive coverage.
When the final pieces of the Affordable Care Act (ACA) came into effect in 2014, insurance companies were required to cover substance abuse, mental health, and other forms of behavioral treatment. This means that most people are likely to have some kind of financial assistance from their private insurance or from public insurance programs like Medicare and Medicaid. This does not, however, mean that insurance fully covers these programs. Some people may use a combination of private insurance, public insurance, and private funding. Many treatment facilities offer payment plans, allowing clients to finance the cost of treatment and pay it off over time.
Regardless of the cost, it is important to find a rehabilitation program that works. If finances are a concern, speak with a representative from the addiction treatment center. These individuals are well versed in maximizing insurance benefits and can work with prospective clients on making sure treatment is accessible.