Outpatient treatment programs for alcohol use disorders differ from residential or inpatient treatment programs in that clients only come to the facility during treatment times, and then return home or to some other dwelling and continue with their daily routine. The specific structure associated with an alcohol use disorder outpatient treatment program will vary, depending on the individual and the particular treatment program. There is no “one size fits all” approach to outpatient treatment for an alcohol use disorder.
Outpatient Treatment Services
In general, most of the treatment services that are provided to those in residential treatment can be utilized on an outpatient basis. According to the book Substance Abuse: Inpatient and Outpatient Management for Every Clinician, the structure of the program depends on the specific situation. Individuals in outpatient treatment programs have access to:
- Withdrawal management services: Although it may be preferable for individuals who are undergoing withdrawal from alcohol to be treated on an inpatient basis, this may not always be practical. In some cases, the use of a withdrawal management program can be implemented on an outpatient basis.
- Medically assisted treatments: This includes the use of medications, such as benzodiazepines to help with withdrawal symptoms, Antabuse (disulfiram) to assist with abstinence, and medications like ReVia (naltrexone) to manage cravings.
- Therapy: The core component of recovery from an alcohol use disorder or any substance use disorder is involvement in psychotherapy. Individuals have access to individual therapy, group therapy, specialized counseling services, psychoeducational services, etc., as an outpatient.
- Peer support: For most individuals with an alcohol use disorder, this means participation in Alcoholics Anonymous (AA), some other 12-Step group, or a non-12-Step social support group, such as Rational Recovery (RR).
- Complementary treatments: Alternative treatments, such as psychodrama, wilderness therapy, art therapy, etc., can be delivered to outpatients.
- Additional services: Other services, such as case management services, vocational rehabilitation or job training, occupational therapy, speech therapy, etc., can all be delivered on an outpatient basis when they are part of an individual’s recovery program.
Structure of the Program
Outpatient treatment programs are structured to be delivered around the schedule of the individual. This means that individuals who work, go to school, or have family commitments design the structure of their program to work around their responsibilities and other commitments. Clients can schedule their appointments with physicians and therapists, and attendance at support groups meetings, around their daily routine.
Often, individuals attend separate treatment components at different locations. For example, they may get medication refills and physical checkups from an addiction medicine physician or psychiatrist, and then attend peer support group meetings at another location. Some larger treatment centers host all offerings of their programs on site. Typically, the person consults with their psychiatrist or addiction medicine physician on a periodic basis, attends therapy (individual or group therapy) on a weekly basis, and attends social or peer support groups one or more times a week.
The program is typically structured so psychotherapy is the main component. The time it takes individuals to complete their psychotherapy varies, depending on the specific case. Some individuals may attend psychotherapy for a few months, others for a year, and others may be involved in psychotherapy groups for many years. When the course of the psychotherapy has been completed, many individuals focus on participation in 12-Step groups like AA or other peer support groups, and continue to receive medical management from their primary care physician, psychiatrist, or addiction medicine physician.
The way the program is structured and the specific times the individual attends therapy, peer support groups, etc., are often left up to the individual; however, there may be some specific cases where an individual has less control over the structure of their program. Most often, this includes involuntary participation in activities that are mandated by the legal system or an individual’s employer. These mandatory activities can include:
- Attendance at specific treatment groups
- Routine or random drug and alcohol screenings
- Probation or parole meetings
- Educational classes
- Community service work
Many of these specialized activities are not flexible, and individuals must attend them or suffer specific consequences, including potential incarceration or loss of employment. In these instances, there is very little flexibility regarding how these programs are structured, when they are delivered, etc.
There are some specialized situations where individuals may require more intensive treatment as an outpatient. There are several variations of outpatient treatment programs that are designed to deliver very intensive treatment that is on par with the intensive treatment received in a residential unit. When a person is involved in these intensive outpatient treatment programs, they are often considered to require concentrated care, but they do not require 24-hour supervision. These types of programs consist of:
- Intensive outpatient treatment (IOT): While standard outpatient treatment for an alcohol use disorder may consist of 1-3 hours of psychotherapy per week, an IOT is typically structured to deliver a minimum of nine hours a week of intensive treatment. Most often, programs involve therapy 3-5 days per week. Some programs deliver even more therapy.
- Partial hospitalization programs (PHP): These are offered for people who have severe emotional issues or medical conditions that require that they be relatively close to a hospital or clinic, but they may not need 24-hour medical supervision. These programs consist of intensive treatment at a facility, such as a hospital or clinic; the person lives in a residence that is not considered to be part of the hospital or clinic but is connected to the site or on the hospital campus.
The Main Goals of Outpatient Treatment
Outpatient treatment programs for alcohol use disorders are structured in order to provide the person with the following:
- Tools to maintain sobriety from alcohol and avoid relapse
- Skills to increase the quality of the person’s functioning, such as their emotional functioning, ability to deal with stress, quality of the person’s relationships, ability to maintain employment, and ability to grow and learn.
- The opportunity to work or go to school while receiving treatment for their alcohol use disorder
- Continued engagement in personal relationships while receiving treatment for their alcohol use disorder
- The opportunity to immediately use the skills and knowledge they get from treatment in their daily lives
- Confidentiality, such that they do not have to notify relatives or employers that they must be absent for a period of time due to treatment
- Less financial commitment, as outpatient treatment is typically far less expensive than residential or inpatient treatment.
The strengths of an outpatient treatment program for an alcohol use disorder are the flexibility of its structure, its ability to allow the person to continue to function in daily life, and its ability to offer services that are used in inpatient or residential treatment programs.