When a person realizes they need help overcoming addiction or substance abuse, access to treatment that suits their desired recovery process is extremely important. The National Institute on Drug Abuse (NIDA) states in their Principles of Effective Treatment that no single form of rehabilitation will work for everyone, as life circumstances, substance of abuse, and psychological needs are radically different.
While there are overall principles of evidence-based detox, rehabilitation, and recovery support that work, in general, the details are very different for most treatment plans. For example, the differences between inpatient and outpatient treatment are many. In addition, there are different types of outpatient treatment that work for unique needs.
What Is Outpatient Treatment?
- Medically managed intensive inpatient treatment
- Residential treatment
- Intensive outpatient treatment
- Standard outpatient treatment
- Early intervention/prevention programs
The American Society of Addiction Medicine (ASAM) recognizes five levels of addiction care:
In general, outpatient rehabilitation provides counseling sessions and medication-assisted treatment (MAT) as needed, but without requiring the individual to reside in the same facility that provides treatment. Instead, people attending outpatient rehabilitation programs live at home or in a safe residence nearby. This gives a person attending outpatient treatment more freedom to spend specific days of the week or evenings with their family; however, it does mean that the person must voluntarily abstain from alcohol or drugs when they are not attending therapy sessions or doctors’ appointments.
Outpatient treatment can be provided at many different locations, and this flexibility may benefit those who need help. Rather than moving into a facility, which may be far away from the people and places one cares about, the individual can remain in their community and get help at a nearby clinic. Mental and behavioral health counselors’ offices, hospitals, health department offices, and physicians’ clinics may all provide a form of outpatient treatment or be able to refer a patient seeking detox and rehabilitation to an appropriate outpatient program.
For the most part, outpatient treatment provides a large social network to support recovery. The process focuses more on group counseling than individual counseling, and several programs make it easy for family members to access counseling, too.
- Must remain employed or do not want to leave their jobs
- Wish to remain close to supportive family and friends
- Have the support necessary to stay away from intoxicating substances
- Have home, work, and other environments that are not emotionally triggering
- Are adolescents or young adults still living at home
- Cannot afford residential treatment
Generally, people who respond well to outpatient treatment:
Types of Outpatient Treatment
There are two basic forms of outpatient addiction treatment: standard and intensive.
- Standard outpatient treatment: This form of outpatient treatment allows a person much greater flexibility with their time. The individual must attend between one and three group counseling sessions per week and may be required to attend individual therapy once per week. Medications like buprenorphine, a partial opioid agonist used to taper those struggling with opioid addiction off the substance, can be prescribed for home use, with regular physician checkups. Therapy and counseling sessions may be ongoing for a long time, often for about one year. There are many times available for counseling sessions, so one can attend a session at night or on the weekends while spending days at work or in school, or focusing on family commitments.
- Intensive outpatient treatment (IOT): This form of outpatient treatment allows the individual to remain at home in the evenings, but requires at least 10 hours – sometimes 20-30 – per week of counseling sessions. This may be spread over three or four days of the week, and the total treatment may last for between one and three months. Day hospitalization involves spending five days per week in treatment. This form of substance abuse treatment takes up less time overall, but it may still require the person to take a leave of absence from work or school, and they may not be able to focus on family priorities. The time commitment and support services provided by IOTs more closely resemble inpatient rehabilitation, but IOT still provides some time at home or in the community.
Working with a doctor or therapist will help one assess which form of treatment will work best, including whether standard or intensive outpatient treatment will be more effective.
Adolescents and Outpatient Rehabilitation
One population that benefits greatly from outpatient drug treatment are adolescents. Typically between the ages of 12 and 17, teenagers usually still live with parents or guardians who can provide emotional and financial support, as well as the accountability to remain sober. While this is not true for every adolescent, those who do not have severe chemical dependencies, few co-occurring mental health conditions, and a supportive living environment do well with counselors trained in this age group’s needs.
Outpatient treatment for adolescents may involve as little as one treatment session per week, or it may involve multiple sessions per week. Part of the importance of outpatient treatment, however, is keeping the adolescent enrolled in school or another educational program. Treatment programs often include prevention training to deter future substance abuse.
When Outpatient Treatment Is Best, but the Home Is Not Safe
Some people who attend outpatient rehabilitation choose this form of care because they want to, or need to, remain at home. For others, though, they simply cannot afford a residential program, which would remove them from triggers in their daily environment. Stress from work or school, difficult relationships with family members, or friends who abuse substances make it emotionally difficult for a person to stay at home, but for too many people, this is the arrangement they must live with. Finding an alternative environment that supports sobriety and recovery can be a huge benefit for those who must attend outpatient rehabilitation.
As the popularity of sober living homes increases, more individuals are turning to these living arrangements while they attend outpatient treatment. Some sober living homes require residents to have completed both detox and at least 30 days of rehabilitation, but more are allowing residents who can pay their own rent and also need to attend outpatient treatment.
A survey following one sober living home in California, which had 46 residents participate in a six-month follow-up study, found that there were improvements across the board for those who stayed in the sober living home. Of those who lived in the special outpatient program sober living home, 76 percent remained in the home for at least five months, and 39 percent reported being employed for at least part of the 30 days prior to the survey.
Detox and Medication during Outpatient Treatment
As better MAT is developed, more medications are being prescribed to help people struggling with chemical dependency taper off drugs. This is very needed for opioids and alcohol because these drugs have some of the highest rates of relapse, especially when the individual does not receive adequate medication management and counseling.
For example, alcohol withdrawal syndrome (AWS), which may develop into a dangerous condition called delirium tremens, is not merely uncomfortable, but it can include life-threatening symptoms like hallucinations and seizures. It is important for physicians to closely monitor their patients while they detox from alcohol, and to use medications to manage withdrawal symptoms when they appear to increase in severity. The physician may, initially, monitor their patient every day to manage symptoms.
Some of the more common medications used to ease alcohol withdrawal are long-acting benzodiazepines, like Valium or Librium. While benzodiazepines can pose risks when not monitored, a physician who meets regularly with their patient to assess symptoms, and adjusts the medication to taper withdrawal symptoms, can help a person overcome alcohol dependence safely while allowing them the ability to live at home, go to work, and take care of their family.
Anticonvulsants can also be prescribed if the individual develops delirium tremens, to reduce the risk of seizures. Some beta blockers, originally developed to manage cardiac arrhythmias, can manage cardiovascular symptoms associated with delirium tremens. In addition, clonidine, a blood pressure medication, can alleviate some of the physical symptoms of anxiety associated with alcohol withdrawal, and it is often prescribed off label for this use.
Insurance Coverage and Financial Assistance for Outpatient Rehabilitation
As of 2014, the Affordable Care Act (ACA) required most insurance programs to provide coverage for substance abuse, behavioral health, and mental health services. While this does not mean that a long-term residential program will be completely covered by every insurance plan, it does mean that every plan bought on the insurance marketplace must provide some financial assistance for treatment. Many insurance companies opted to assist with outpatient treatment programs, as these are often less expensive and less time-consuming. Some inpatient treatment, like day hospitalization or emergency detox services, may also be covered: however, this depends greatly on the individual plan.
Several hospitals and government health departments will work with patients financially to manage several kinds of treatment, including detox and rehabilitation. This may include grant-based financial aid, Medicaid, sliding scale clinics, or payment plans to cover the cost in installments. Veterans who have served in the military are eligible for veterans’ benefits, which includes health coverage for substance abuse treatment, mental health services, and behavioral health programs.
Support groups using the 12-Step format are typically free of charge. While these programs do not cover detox and they don’t provide actual mental health treatment, they do provide emotional and social support. This support helps members to maintain sobriety and remain strong in their newfound recovery.
Outpatient Treatment Options in Las Vegas
Finding outpatient treatment in Las Vegas, Nevada, may feel complicated at first, but there are many options available to help as many people as possible. These options range from free, to nonprofit and government-funded, to private treatment.
Treatment options can be found on the Nevada treatment page on Psychology Today’s website or via the Substance Abuse and Mental Health Services Administration’s (SAMHSA) treatment locator.
Veterans living in Nevada can contact the Nevada Veterans Administration (VA) for help applying to their Substance Use Disorder (SUD) Program.
Community Counseling Center of Southern Nevada (CCC) offers outpatient detox and rehabilitation services for both substance abuse and co-occurring disorders. They work with a wide range of clients in many financial, personal, and behavioral circumstances.
The Nevada Division of Public and Behavioral Health (DPBH) oversees the Substance Abuse Prevention & Treatment Agency (SAPTA), which provides community-based treatment services, including outpatient counseling and treatment. DPBH also manages a crisis hotline, which can help those struggling with addiction find immediate resources to detox safely, get support to transition into outpatient rehabilitation, and find nearby support groups.
Evidence-based treatment in Las Vegas is available for those who struggle with addiction and want help. Many people benefit from outpatient treatment and support groups, so finding a physician or therapist who can assess the benefits of outpatient versus inpatient treatment for the individual is a solid start.