One of the main alternatives to inpatient alcoholism treatment is outpatient. But how exactly does outpatient treatment work for substance abuse? Let’s take a closer look at this option and try to determine if it is a good fit for you.
First of all, let’s define inpatient treatment. This is where the alcoholic checks into an inpatient treatment facility, usually for 28 days, and they stay there for the duration. They sleep there at night. They go to groups and meetings each day. At the end of their stay they go back home and follow up with things like AA meetings, counseling, therapy, or possibly even outpatient treatment.
Now the only real difference with this is that you go home each day after attending outpatient alcoholism treatment. Instead of sleeping in the facility each night and eating your meals there, you bring a lunch (typically) and then you go home each night to sleep. In addition to this, most outpatient treatment only runs five days a week instead of every single day.
Does it work? That depends on who you ask. I have seen plenty of government data that is pulled from hundreds of different treatment centers that suggests that outpatient treatment is not as effective as inpatient treatment, but those claims must be taken with a grain of salt. Here’s why:
Part of the problem has to do with your own personal level of willingness. It may be the case that the level of treatment you receive is pretty much irrelevant when it comes to your overall results. In other words, if you are truly at the point of surrender and you are truly willing to change your life, then it doesn’t matter much what kind of treatment you sign up for—you will succeed. Whereas the person who has not fully surrendered is almost certain to relapse.
What does this have to do with outpatient treatment? The major issue is that there are many alcoholics who are at a point of “half surrender,” and they are not quite willing to commit fully to recovery, and so what happens is that they become partially willing.
For example, ask a struggling alcoholic if they are willing to go to prison for 5 years in order to beat their addiction. Most of them will say “no.” Not that this is a real solution, but the point is that the willingness is not there. Ask them if they will live in long term treatment for 2 years. Then ask them if they will do a 90 day inpatient program. Ask them if they will do a 28 day program. Ask them if they will do outpatient therapy 4 days a week. Ask them if they will do a one hour counseling session twice a week. Ask them if they will hit an AA meeting once in a while.
And so on. Read through the preceding paragraph again and look at the progression. Each question to the alcoholic presents a possible treatment solution that is less and less intense. No one wants to sacrifice 5 years of their life if they can help it. Nor do they generally want to live in rehab for several years. People are naturally not going to want to go to the extremes when it comes to treating their addiction. Part of this is denial, we want to minimize the admission that we have a problem at all, so why would we agree to such intense forms of treatment, thus admitting to our problem? We want to minimize the fact that we are alcoholic, so please give us less treatment, thank you!
So back to the issue of outpatient treatment. This is clearly a treatment option that falls in the middle of the spectrum. You have several more intense treatment options such as 28 days of inpatient rehab or even long term treatment. But you also have less intense options than outpatient such as casual AA meeting attendance or counseling sessions once or twice a week.
As such, what the alcoholic has to determine is whether or not outpatient treatment is really an intense or focused enough solution to help them with their problem.
Is outpatient treatment really enough help for your situation?
When I finally surrendered to my addiction, outpatient therapy was not enough to help me. It just wasn’t intense enough. I was struggling with drug and alcohol addiction on a daily basis and my entire life revolved around getting and using more substances. I needed a way to break free and just attending an outpatient program 5 days a week would not have been enough. I needed more than that.
One way to test this is to simply try it. Give outpatient treatment an honest effort and if you find yourself drinking or using drugs again then you know that you need more treatment. You will know that you need a more intense form of treatment, such as inpatient rehab.
You may ask yourself if your environment has any impact on your drug or alcohol use. Keep in mind that your environment includes the relationships in your life. So if you typically drink or use drugs with certain people that you see on a regular basis, ask yourself if you are still going to be running into those people during outpatient treatment. The problem of course is that you are generally at home for roughly 16 hours each day while you are attending outpatient, and probably all of the weekends as well. As such, you will be especially vulnerable during the weekends and you won’t have any specific support during that time. Ask yourself if this might be a problem or not for you and if you typically drank or used drugs on the weekends or not. For example, if you are at an inpatient treatment center, getting through the weekend is not a problem at all. There is no temptation to relapse because there are no drugs or alcohol available when you are at an inpatient treatment center. That’s kind of the whole point—being in a controlled environment is a huge advantage when you are first trying to sober up, because temptation is everywhere.
So you need to figure out if you can handle all of that temptation on your own, because that responsibility will be entirely yours if you choose outpatient treatment. Being able to go home each day allows you the freedom to do what you want, but that freedom comes with great temptation. You may be saying to yourself “But I don’t want to relapse, I don’t want to drink any more,” but your addiction may cause you to change your mind at some point. No matter how strong your conviction may be right now to stay sober, nearly everyone becomes tempted at some point. Do you have support systems in place outside of an outpatient program to help get you through such temptations? Maybe you do. Maybe you are in the habit of attending AA meetings every single day, maybe you live with roommates who are in recovery already and who are stable, maybe you have vast support systems in place that can help you to maintain sobriety around the clock, even when you are at home.
But many alcoholics are starting from scratch when they first sign up for outpatient therapy. They don’t have 24/7 support systems in place, and they may not be used to attending daily AA meetings or anything like that. And if that is the case then you need to seriously consider the fact that outpatient therapy may not be enough to help you in your specific situation.
Therapy and counseling without the accountability
Outpatient therapy is essentially the same as inpatient treatment, but there is less accountability. The problem is that you get to go home each night, and then all bets are off. When you stay at inpatient treatment everyone is in the same controlled environment and there is no temptation present.
In many cases you still get the same therapy as if you were doing inpatient treatment. But there are other intangibles that are important as well. The biggest one are the bonds that you build at an inpatient treatment center while you are going through the process of early recovery.
When you attend outpatient treatment, you are an outsider coming into a group. Then when the counseling is over you go home again and you remain an outsider.
When you are at an inpatient facility you are inside of the group. You eat meals with the group. You wake up with them, go to sleep when they do, you may even smoke cigarettes with them throughout the day. You are an insider in the group because you are all living together during your stay at an inpatient facility. During free time you may bond with the group in unique and social ways that simply won’t happen if you are in outpatient treatment.
This bond that you feel with the people at an inpatient treatment facility is something that most people in recovery feel is an important part of the early recovery process. If you only attend outpatient therapy then you miss out entirely on this special bond with your peers. You will still form a bond with the people you meet at outpatient meetings, but it won’t be nearly as deep as the bond that you form during inpatient rehab.
Inpatient treatment disrupts your disease more completely
It probably sounds like I am advocating for inpatient treatment rather than outpatient. I admit that this is essentially the case—I believe that inpatient treatment is always the better choice for people who are struggling with substance abuse. There is one major reason why this is the case.
That reason has to do with the idea of disruption.
Addiction is a pattern. It is a habit. You are trapped in a cycle of substance abuse. In order to break out of this cycle you need to somehow disrupt the pattern.
How do you disrupt an addiction?
Treatment is an attempt to do this. The intensity and focus of the treatment that you choose is the only real question.
Going to outpatient treatment is one level of focus and intensity. It is a middle option out of many. You are saying “I am making a decision to quit drinking, and I am going to attend meetings and groups 5 days a week for 8 hours in order to learn more about how to do that, and in order to get some social support for it.”
When you go to inpatient treatment, you increase the intensity and the focus. You basically say: “I am going to quit drinking, and to help me with that I am going to check into rehab for 28 days, and thus dedicate my entire life to recovery for the next month. For 28 days I will eat, sleep, and drink recovery in every moment of my life.”
Each option is an attempt to disrupt your pattern of addiction. The more intense option of inpatient treatment just does a more thorough job of this. When you live in rehab for 28 days, you completely disrupt the cycle of addiction. When you stay in a controlled environment for 28 days, there is no question that you will remain sober. When you walk out of such a facility, you know that you will be doing so with a full month sober under your belt. Take a look at the data concerning people who choose outpatient treatment, and how many of them have relapsed before the first 28 days are over. Such a statistic is not very encouraging or inspiring. Inpatient rehab simply disrupts addiction more thoroughly.
If at first you fail, increase the intensity of treatment
So one of the important ideas that you can get from this analysis is that if you fail at treatment the first time, don’t just try again, but also increase the intensity of that effort. They say that insanity is doing the same thing over and over again but expecting different results. Well, apply this principle to your recovery efforts. Don’t just keep going to the same level of treatment over and over again, only to relapse. That doesn’t make sense. If you fail after making an effort, then try again but redouble your efforts. That means you need to try harder, you need to try something different, you need to push yourself to do more somehow. In the world of treatment options, that might mean that you need to try inpatient rather than outpatient treatment. Or it might mean that you need to go to long term rehab rather than a 28 day program. I once met a man who has been to treatment 29 times in his life. He had finally landed in long term treatment with me. I learned that he later relapsed and died of an overdose.
Addiction is not something to play around with. If you fail at treatment then it is time to get more serious in your efforts. Dedicate your life to sobriety. That is the key point that many people in early recovery fail to realize. How hard do you have to try in recovery? How much effort does it take to remain sober? You must dedicate your life to sobriety, period. If you are not making it your number one priority each and every day then you are setting yourself up for failure.
If you continue to fail, increase the duration of treatment as well
One of the ways to increase the intensity of treatment is to simply increase the duration of it. You may go to treatment your first time and they may only have you go through a short detox session, only to follow up on the outside with counseling, meetings, or even outpatient therapy. If this is the case and you find that you can’t make it work, you probably need to go to treatment for a longer period of time.
Treatment works. There is nothing wrong with the concept of treatment, it is not flawed in any way. It is the individual who relapses, who may fail. But the concept of treatment is a good one and it does work. You check into a facility and they keep you there for a certain period of time in a controlled environment. There are no drugs or alcohol there to tempt you. Relapse is impossible while you are at an inpatient facility. The only question is how long you will stay and what you will learn while you are there.
The main challenge of treatment is to say to yourself “OK, I am going to be back out of here and in the real world again at some point, what do I need to learn between now and then so that I don’t fall on my face and relapse the second that I walk out of rehab?”
Therefore treatment is a learning process. But the concept of being in a controlled environment is dead simple. You essentially put yourself out of harm’s way by checking into rehab for a while, you build up a few weeks sober, and you hopefully learn what you need to know in order to maintain your sobriety after you leave rehab.
If at first you fail, try and try again. Try longer treatment, try more intense treatment. Don’t give up and decide that you were meant to drink or use drugs forever. That is an unacceptable outcome and you deserve better than that. Anyone can recover if they are willing to dedicate their life to sobriety. Part of that commitment means that you are willing to go to any length when it comes to the treatment process. Outpatient therapy may be part of your aftercare, but all of us owe it to ourselves to go to inpatient rehab and get that first 28 days of sobriety under our belts first. Don’t talk yourself out of inpatient rehab or make excuses for yourself, only to relapse later because you did not get the help or treatment that you needed.