When you or your loved one is struggling with an alcohol use disorder (AUD), you may be unsure about the various types of treatment options available. You may have heard about inpatient and outpatient treatment programs but aren’t sure which is right for you. Inpatient treatment means 24/7 treatment in a rehab program, whereas, in outpatient treatment, you go home at night after participating in treatment sessions for several hours each week.
While outpatient treatment is a valuable treatment option, it may not always be the most appropriate level of care for certain individuals, such as those with relatively more severe AUD and/or significant acute alcohol withdrawal risks. Undergoing a thorough assessment by a doctor or other substance abuse treatment professional can help you determine if outpatient treatment is right for you.
What is Outpatient Treatment?
Outpatient treatment is a form of treatment for drug and alcohol use disorders in which a person regularly attends treatment at an outpatient center but is able to return to their home or other outside living arrangements outside of program hours.3 Several types of outpatient programs are available, with a varying number of treatment hours per week and intensity of oversight.1 Some programs offer daily sessions and others only meet 1 to 3 times per week.2
Some outpatient programs are relatively time-intensive and structured and are known as either partial hospitalization programs (PHPs) or intensive outpatient programs (IOPs). Both provide a full range of assessment, ongoing support, and linkages to more intensive levels of care if needed.1
PHP, also known as day programming, offers a slightly more flexible environment than residential inpatient treatment but still provides a relatively intensive level of care. This level of care allows patients to attend treatment during the day before heading back home in the evenings. In PHP, you might expect to receive roughly 4 hours of group therapy daily, 5 days a week.
IOPs focus on managing substance use disorders and instances of chemical dependence that do not necessarily require 24-hour supervision or detoxification/withdrawal management efforts. They typically include an average of 9 hours of programming per week, which are usually spread out over 3-5 days per week, though this can vary based on the program and individual needs.3
IOPs are designed to establish support mechanisms, provide coping strategies, and help with relapse management. These types of programs require somewhat fewer hours of daily therapy than their counterpart PHPs, providing patients with additional flexibility in managing their normal lives off-site.
Successful outpatient program participation is contingent upon a person’s home environment being alcohol/drug-free and further benefits from the presence of a safe support system. These types of programs are also sometimes utilized after completion of an inpatient program (i.e., step-down treatment after residential rehab) as a way of easing the transition back to an individual’s everyday life. However, this isn’t always the case, as all types of outpatient programs may serve as a person’s initial point of rehabilitation care, when appropriate.
How Are Outpatient Programs Structured?
While precise treatment offerings may differ, many outpatient programs adhere to a relatively standard schedule. For instance, an intake appointment with a thorough psychosocial assessment will take place prior to the start of outpatient treatment.
In terms of what a day-to-day schedule looks like, typically, an IOP program will meet in the morning or evening for 3 hours, 2 or 3 days per week. For example, each day, the program may start with daily check-in and include group meetings throughout the day on skills to resist drugs or alcohol and psychoeducational group meetings on topics such as stress management.
Many programs also offer a weekly one-to-one session with a counselor, weekly family groups, or family sessions for each IOP participant. Many programs also include a weekly visit with a physician. Some programs include a weekly treatment team meeting, where the person in treatment may be invited to discuss their goals and treatment outcomes with the counselors and doctors who run the IOP.2
For a PHP, groups may meet 5 to 7 days a week, for 5 to 6 hours per day, though programs may include 8 hours of sessions per day. Though more time intensive, the programming structure will resemble that of IOPs, with daily check-ins, psychoeducational groups, and skill groups. Many PHPs also offer weekly physician sessions, individual counseling, family counseling, and treatment-planning sessions.2
Many IOPs and PHPs incorporate and provide an introduction to the 12-step model of self-help programs (e.g., Alcoholics Anonymous) and either host meetings on-site or will have participants travel as a group to off-site meetings.2
What Therapies Are Used?
Many outpatient programs will utilize a combination of medical and behavioral treatment interventions, though these approaches may vary from one program to the next as well as based on the type of substance use disorder being treated. Some of the more commonly used therapeutic interventions include:
- Cognitive-behavioral therapy (CBT): This approach teaches people to identify certain types of maladaptive thoughts so that they can adjust the resultant behaviors associated with them, such as using and/or abusing alcohol. The underlying idea is that thoughts and behaviors are learned, and thus can be unlearned.4 CBT teaches people to cope with triggers that lead to drinking and to learn new ways to cope and avoid relapse.4
- The Matrix Model: This approach was developed to treat people who used stimulants, though variations of the original treatment protocol have been used to help people with substance use issues involving opioids and alcohol. The Matrix Model incorporates numerous approaches and treats the whole person, including relationships, behavior, and emotions. 4 This approach emphasizes the counselor-client relationship and teaches patients how to structure and manage their daily schedules and free time.4
- Contingency management: This approach is based on the idea that individual recovery may be promoted when some of the rewarding aspects of using drugs or alcohol are replaced with other types of rewards to encourage abstinence. Clients are often given vouchers for submitting negative urine drug screens, for example, or attending certain groups. These vouchers can be traded for a variety of items.4
- Motivational interviewing: This approach focuses on meeting a client where they are and not forcing a person to see that he or she has a problem with drugs or alcohol. Instead, the therapist works on “rolling with resistance,” an approach in which the counselor helps the person determine his or her own definition of the problem, as well as the solution, which minimizes power struggles and resistance, as the person isn’t being told what to do. Other techniques are designed to motivate change.5
- 12-step facilitation: Patients are introduced to the concept of 12-step groups for recovery and relapse prevention. The principles of 12-step groups are used as a foundation of the program and attendance at 12-step groups, such as AA is encouraged and promoted as a tool for aftercare.4
- Family therapy: Family therapy incorporates the family into treatment by including them in sessions and encourages members to set up family rules that reinforce abstinence and discourage substance use. This approach includes contracting for positive behaviors and sometimes incorporates elements of contingency management.6
- Medication-assisted treatment (MAT): This type of treatment involves FDA-approved medications, in combination with counseling and behavioral therapies, to treat certain types of substance use disorders.7 Often used in treating opioid use disorders, certain types of MAT can help people control cravings and decrease continued drug use. Some drugs are also used to treat people with an AUD, as discussed in the following section.
Are Medications Used in Outpatient Settings?
Numerous medications may be used in outpatient treatment to aid with withdrawal management and help prevent relapse. These medications are used in conjunction with counseling. The long-term use of drugs such as methadone and buprenorphine is often incorporated into treatment to aid in managing symptoms of withdrawal from opioids and in controlling cravings and preventing relapse.8
The following 3 medications are most commonly used to treat an AUD:8
- Disulfiram is given only after a person has undergone detoxification and is abstinent from alcohol. Disulfiram’s side effects may include nausea, vomiting, chest pains, and headaches if even a small amount of alcohol is ingested.
- Acamprosate does not prevent withdrawal symptoms, but aids in helping a person continue in abstinence from alcohol once they’ve stopped drinking. It is typically started on the 5th day of abstinence from alcohol.
- Naltrexone prevents a person from feeling some of the rewarding euphoria associated with alcohol use, thereby facilitating a decrease in ongoing drinking behavior. Naltrexone can be given by injection, including formulas that work for several weeks at a time. Naltrexone can be administered even if a person is actively drinking. Naltrexone also controls cravings for opioids, which is helpful if a person struggles with opioid misuse in addition to alcohol issues.
Again, it is important to note that medication is only one element of AUD treatment. Comprehensive rehabilitation efforts combine medications with counseling and behavioral therapies.8
Several factors are involved in determining whether a patient is a candidate for MAT. These factors include:10
- The person’s motivation to stop drinking.
- The person’s readiness to change his or her drinking.
- Underlying psychiatric or medical issues.
- Ability to tolerate the medication.
- Potential for relapse.
- Whether or not the person is pregnant.
Who is a Good Candidate for Outpatient Therapy?
Not everyone is a candidate for outpatient therapy. Factors a physician or treatment professional may consider include the following:9
- Severe intoxication at time of presentation.
- Cognitive limitations.
- Psychiatric issues, including psychosis, aggression, or suicidal ideations.
- Underlying medical conditions, which require more intensive medical supervision to prevent serious consequences.
A full assessment by a substance abuse treatment professional can determine whether the person has adequate social supports and is mentally/physically able to undergo outpatient treatment or if they would be better treated in an inpatient setting.
How Effective is Outpatient Treatment?
Outpatient treatment has been demonstrated to be effective for an AUD; however, some people tend to do better overall in this type of setting than others. People who respond less favorably to outpatient treatment include:11
- People with prior treatment attempts.
- Participants who attempted suicide.
- People with co-occurring disorders.
- People who relapsed while in treatment.
- People with more lengthy durations of relapse prior to returning for additional treatment.
- People who have dropped out of treatment.
Although people in these groups may not do as well as others overall, many participants in these groups still benefit from outpatient treatment. A recent study indicated that outpatient treatment may be just as effective as inpatient treatment for treating AUDs.12
Other studies show that 50%-70% of people who attended an IOP were abstinent from alcohol during follow-ups.13 Another review of numerous research studies showed that overall, outpatient treatment was just as effective as inpatient treatment for the majority of participants.13
Get Help Today
If you’re ready to seek treatment for alcoholism but are unsure of your next steps, American Addiction Centers’ (AAC) admissions navigators are available to chat 24/7. Alcohol.org is a subsidiary of AAC which offers addiction treatment facilities across the U.S. Call our hotline today to learn more about your treatment options; all calls are 100% confidential.
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. Substance Abuse and Mental Health Services Administration. (SAMHSA). (2015). Detoxification and substance abuse treatment.
. Substance Abuse and Mental Health Services Administration. (SAMHSA). (2014). 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. Treatment Improvement Protocol (TIP) Series, No. 47. Chapter 3. Intensive Outpatient Treatment and the Continuum of Care.
. Substance Abuse and Mental Health Services Administration. (SAMHSA). (2013). Substance abuse: Clinical issues in intensive outpatient treatment.
. Department of Mental Health. (n.d.). A definition of motivational interviewing.
. National Institute on Drug Abuse. (2020). Family behavior therapy.
. Substance Abuse and Mental Health Services Administration. (SAMHSA). (2020). Medication-Assisted Treatment (MAT).
. Substance Abuse and Mental Health Services Administration. (SAMHSA). (2020). Medication and counseling treatment.
. Substance Abuse and Mental Health Services Administration. (SAMHSA). (2006). Substance abuse. Clinical issues in intensive outpatient treatment. Treatment entry and engagement.
. Substance Abuse and Mental Health Services Administration. (SAMHSA). (2015). Medication for the Treatment of Alcohol Use Disorder: A Brief Guide.
. Soyka, M., & Schmidt, P. (2009). Outpatient alcoholism treatment–24-month outcome and predictors of outcome. Substance Abuse Treatment, Prevention, and Policy, 4(1), 15.
. López-Goñi, J. J., Fernández-Montalvo, J., Arteaga, A., & Esarte, S. (2017). Searching objective criteria for patient assignment in addiction treatment. Journal of Substance Abuse Treatment, 76, 28-35.
. McCarty, D. et al. (2014). Substance abuse intensive outpatient programs: Assessing the evidence. Psychiatric Services, 65(6), 718-726.