The primary difference between outpatient treatment for an alcohol use disorder and inpatient treatment is that outpatient treatment programs require attendance only during treatment sessions. Once the treatment sessions have been completed, the client returns home and carries on with normal activities. Inpatient treatment programs require individuals to remain on site and stay in the facility even after they have completed treatment. Thus, outpatient programs allow individuals to live at home, go to work, and engage in other activities whereas inpatient treatment centers also provide living facilities, meals, strict supervision around the clock, and recreational activities for the individual.
Most people who seek treatment for an alcohol use disorder will engage in some form of outpatient treatment program at some point. Even individuals who initially are enrolled in intensive inpatient treatment programs or residential treatment programs will eventually complete these programs and transition to outpatient care. Inpatient treatment programs are most often designed to deliver very intense and/or specialized treatment services for a limited period of time whereas outpatient treatment is designed to continue to deliver treatment while the individual carries on with their daily activities.
Advantages of Outpatient Alcohol Treatment Programs
Except under very strict circumstances, inpatient treatment programs are not necessarily more effective than outpatient programs. Outpatient treatment for alcohol use disorders is generally preferable for a number of reasons.
- Clients can engage in their normal activities. People in outpatient treatment program can continue to work, go to school, and fulfill their normal commitments. There is far less disruption to the person’s daily life.
- Clients have increased flexibility. Individuals in outpatient treatment programs have more flexibility and freedom than people who are in inpatient units.
- There may be increased confidentiality. People involved in outpatient treatment often have more confidentiality regarding their participation in treatment. Whenever a person is admitted to an inpatient treatment facility, they usually must inform their employers, friends, family members, etc., as to why they will be unavailable for the period of treatment. Individuals in outpatient treatment programs need not divulge the fact that they are in treatment for a substance use disorder.
- Clients can more immediately apply the lessons learned to life in the “real world.” People involved in outpatient treatment programs are often able to immediately apply the principles and techniques learned in therapy, social support groups, etc., in their life, allowing the person to get feedback and adjust the principles they have learned for their specific needs.
- There is an equivalent treatment quality. The types of treatments available as an outpatient are basically equivalent in quality to treatments that are applied in an inpatient unit. Nearly any treatment used in an inpatient unit can be used for outpatients.
- Care is often more affordable. Outpatient treatment is far less expensive than inpatient treatment as individuals do not have to pay extra for housing, meals, etc.
The Basic Types of Services Available for Outpatients
According to Kaplan and Sadock’s Synopsis of Psychiatry and Treating Addiction: A Guide for Professionals, there are a few specific types of procedures that are only available for inpatients who are being treated for alcohol use disorders. Outpatient treatment programs can provide the majority of resources that are used in the treatment of alcohol use disorders, including:
- Medically assisted treatments: Medically assisted treatments include various medical procedures and the use of medications. The majority of these can be prescribed on an outpatient basis.
- Behavioral or psychosocial interventions: Behavioral interventions include substance use disorder therapy, other forms of psychotherapy, participation in social support groups like 12-Step groups (e.g., Alcoholics Anonymous), and all forms of complementary and alternative treatments (e.g., music therapy, art therapy, yoga, meditation, etc.). All of these are commonly provided in outpatient clinics and rehabilitation centers.
- Educational services: Often, a crucial component of treatment for an alcohol use disorder is psychoeducation – simply teaching the individual about alcohol abuse. Psychoeducational services can be provided in the form of lectures, workshops, skills-building forums, and other avenues that are not defined as formal therapy groups. These can all be provided on an outpatient basis.
- Case management: Services to help people who have special needs can be provided on an outpatient basis. Case management services are not usually provided by therapists, counselors, medical professionals, etc. These can consist of several different services, such as finding the person housing, getting them involved in vocational rehabilitation, getting direct job training, tutoring, finding a specific specialist for a rare condition the individual may have, etc.
- Other support services: Other services that may be required for a specific individual, such as getting the individual transportation, assigning a mentor, getting the person a caregiver, etc., can also be provided on an outpatient basis.
Outpatient therapy provides other benefits that are similar to those experienced by those in inpatient treatment, such as extending one’s network of friends, having a feeling of purpose instilled in oneself despite issues with alcohol, working on motivation, etc.
One of the goals of inpatient treatment is to provide intensive treatment that is not normally provided to those in outpatient treatment programs. However, there are several different types of outpatient treatment programs that can provide the similar intensive type of treatment that inpatients receive. Some of these programs are outlined below.
- Intensive outpatient programs (IOP): IOPs are outpatient treatment programs that are structured to provide the type of intensive treatment that occurs on an inpatient unit. The major difference is that individuals return home after treatment has been completed for the day. The American Society of Addiction Medicine (ASAM) defines the minimum amount of treatment time that qualifies for an IOP as nine hours of intensive treatment per week. Many IOPs exceed this amount. Individuals meet between three to five days a week for anywhere from three to six hours of intensive treatment and then return home in the majority of these programs.
- Partial hospitalization programs (PHP): Partial hospitalization programs for alcohol abuse are often used for individuals who have severe medical issues or very complicated psychological presentations. These individuals can be treated without being placed in an inpatient unit or hospitalized if they do not require 24-hour supervision. These programs will meet three to five days a week for four hours or more of treatment a day in a hospital or clinic; then, the person returns home.
- Other models: There are several other models of outpatient treatment that provide the type of intensive treatment that individuals get in inpatient units but do not require individuals to live in the unit where they are treated. One of these is the Florida Model, which combines outpatient and inpatient treatment. In this model, the individuals live in a housing center that is connected to the treatment facility, but is not part of the treatment facility. They attend treatment in a clinic or hospital and then return to their housing center after treatment is completed.
When Is Outpatient Treatment Not Appropriate?
There are situations when it is not appropriate for individuals to engage in outpatient treatment for an alcohol use disorder. According to ASAM and the American Psychological Association, situations where outpatient treatment is not preferred include:
- Complicated withdrawal syndrome: Individuals who chronically abuse alcohol can develop complicated withdrawal syndromes once they discontinue use of alcohol. These withdrawal syndromes can include issues with confusion, psychosis, and even potentially fatal seizures. There is no way to predict whether an individual who has a chronic alcohol use disorder will develop a complicated withdrawal syndrome once they abstain from alcohol; however, a past history of complicated withdrawal would be a significant risk factor. Anyone with a history of moderate to severe alcohol abuse could develop a complicated alcohol withdrawal syndrome. These individuals need inpatient treatment initially until the situation is stabilized.
- Co-occurring disorders: Many individuals who are recovering from even moderate alcohol use disorders will have co-occurring mental health conditions or chronic medical issues that require significant around-the-clock monitoring (e.g., suicidality, alcohol poisoning, significant cardiovascular disease, etc.). These individuals are best placed in a residential treatment center or inpatient treatment unit initially.
- History of unsuccessful recovery: It is not unusual for someone in recovery from an alcohol use disorder to have a history of several unsuccessful attempts at recovery. Such a situation can be the result of complicated issues, and these individuals will fare best if they are placed on an inpatient unit or in a residential treatment center initially.
- Toxic environments: Many individuals with alcohol use disorders also have other environmental conditions that are often referred to as “toxic environments.” A toxic environment is any situation in the person’s environment that will result in significant interference in their ability to engage in recovery or that is potentially dangerous (e.g., spousal abuse). Individuals who have extremely stressful living conditions or who live in areas with high levels of drug abuse may meet the qualifications of what many treatment providers referred to as “toxic environments.” These individuals will benefit from being placed in an inpatient unit or residential treatment program initially until they can develop a foundation for recovery or until their environment can be changed to a safer one.
- Referral requests: Often, the referring therapist or physician may want to place an individual into an inpatient treatment initially for reasons other than those listed above.
Making Outpatient Treatment Work
There is no magical formula to success in recovery from an alcohol use disorder. An individual in an outpatient treatment program should maximize their potential for success by taking the following steps:
- Learn to listen. Listen to treatment providers, and maintain an open mind.
- Be truthful. Be honest with treatment providers and peers in recovery.
- Participate. Participating in group therapy and social support groups will augment overall recovery efforts.
- Inquire. Ask questions if unsure about something.
- Practice. Practicing the principles learned in treatment outside of the treatment situation will result in a stronger and more efficient recovery effort.
- Adhere to medication schedules. Use any prescribed medications according to the instructions on the medication. Check in with supervising doctors if any side effects occur.
- Get support. It’s important to have a strong support group of individuals to contact if relapse seems imminent. This includes sponsors, peers in recovery, and treatment providers, such as therapists and physicians.
- Balance stress. Being in an outpatient treatment program can be stressful. Set aside some time to relax and engage in recreational activities that do not involve the use of drugs or alcohol.
- Stay positive. Try not to get discouraged when experiencing difficulty in recovery, cravings, or triggers for relapse. Instead, use the situation to learn and move forward.
- Engage in aftercare. Simply going through withdrawal management (medical detox) is not the same thing as recovering from an alcohol use disorder. Getting through the withdrawal process is simply the first step in recovery. Comprehensive therapy and aftercare should follow detox.
- Be patient. Recovery from an alcohol use disorder takes time. The longer one remains in therapy, the better the chances are for long-term success.