Outpatient Addiction Treatment

Group therapy

Treatment works

So, what is outpatient addiction treatment? First of all, the lingo is changing in the addiction treatment field. Although most professionals in the field still refer to addiction as addiction, there are some organizations referring to addiction as Substance Use Disorder or Alcohol Use Disorder. These changes in terminology are for diagnostic reasons mostly, and I still prefer to distinguish between alcohol/substance abuse and alcohol or other drug addiction. With temporary alcohol/drug abuse, a person might be mishandling a divorce or a close death by drinking too much or using some other drug to deal with pain and lonliness. This is usually temporary, and the person might need short-term counseling to find better ways to cope — however, if signs and symptoms show that the person is in the early or middle stages of addiction, progressing toward late stage, full blown addiction, then this is a serious medical problem that requires some form of treatment.

When a potential client comes to NewDay Counseling for a free consultation, we gather enough information to determine if the person is temporarily abusing alcohol or some other drug, or whether the person appears to have a more serious problem and could be in the early or middle stages of alcoholism or some other drug addiction. We also determine if the person has insurance or the ability to pay for treatment. For some reason many people tend to think addiction treatment should be free, but we’re a private organization and receive no government funds. There are organizations that receive state and/or federal funds, and we refer to these treatment options if the person can not pay for treatment or doesn’t have insurance. When people receive other medical treatment, they expect to pay for it or have it covered by insurance — addiction treatment is no different. Addiction might be the most under-treated medical condition in the healthcare realm, costing society billions of dollars a year. Addiction also needlessly causes pre-mature death.

When the issue of money becomes a barrier to treatment, even for someone who can easily pay, we always do a calculation of how much the person is now spending/wasting on alcohol and other drugs and the consequences of drinking and doing drugs — like DUI costs or making bad financial decisions or days not working or loss of a job because of a drug screen or failure to get a promotion due to lack of motivation or trips to the emergency room because of an accident while drunk — and when the calculations are finished the cost of treatment looks like a very smart investment. For an amount equal to most payments for furniture, a big screen TV or a nice stereo, a person can make payments on something, treatment, that can turn the individual’s life around and enable the person to become prosperous and happy in the future — yes, it’s a good investment.

Once we’ve determined that a person has an alcohol or other drug problem that is serious enough to warrant treatment, we have to decide if the person needs to go inpatient or is appropriate for outpatient. Outpatient treatment is less expensive and, of course, less restrictive. In outpatient a person can continue to work and be with the family if there is a family. Our Medical Director makes the final decision between inpatient and outpatient. If a person is in danger of going into withdrawals, and it’s too risky to try detox medication on an outpatient basis, we’ll recommend the person go to an inpatient detox, then the inpatient facility will determine how long the person stays inpatient. It could be that the person stays inpatient for a week or so then is transferred back to us at NewDay Counseling to complete addiction treatment in outpatient.

If the person is going to receive addiction treatment with us in an outpatient program, we perform what’s called a Bio/Psycho/Social assessment which asks pertinent questions about the person’s drug use/drinking history, family history, medical history, emotional state, employment situation and history, etc. After gathering all this information, a treatment plan is developed. The treatment plan establishes treatment goals, objectives, and interventions to accomplish the objectives.

The person begins group therapy which is four evenings a week, Monday, Tuesday, Thursday and Friday, from 5:30pm to 8:30p. One hour of group is educational, regarding some topic pertinent to addiction or recovery from addiction, then the other two hours are process group therapy. Very real, powerful and therapeutic relationships are developed in group therapy if the person opens up and allows others to know him/her. When a group of people are working together toward common goals it’s a much more effective than going it alone or simply talking to a therapist once a week for an hour, especially when what you’re dealing with is something as powerful as addiction. The client receives at least one individual session a week, more if necessary, then family involvement as indicated.

The person in addiction treatment and their counselor work on treatment plan goals, and the counselors meet once a week, at least, with the Clinical Director and Medical Director to discuss clients’ progress and what adjustments are necessary. Referral sources, such as physicians, attorneys, employers, EAPs, if they are on the signed release of information form, receive updates regarding the clients’ treatment — the client has to agree to this update information, otherwise, the client’s treatment is confidential. Unless a client gives us permission to tell someone he/she is in treatment, we can’t tell anyone unless there’s a court order signed by a judge legally requesting the information, but even then it has to be a court order signed by the judge, not just a subpoena.

Near the end of treatment, the counselor and the client begin developing a discharge plan. I prefer to call this a Recovery Management Plan. This plan is very important and should address the long term goals of treatment. Addiction is a chronic brain disease and it takes a long time to clear up, gain insight, stabilize and develop the coping skills necessary to make changes. Then treatment becomes maintenance. We recommend that the client find a support group like Alcoholics Anonymous, Narcotics Anonymous, Rational Recovery, a recovery church group, or whatever, just support from others going through the same recovery from addiction and maintenance of recovery. After a period of time in a support group like AA, the person can begin helping newcomers coming into the group, and this is when recovery goes to a higher level.

Once an individual begins feeling good emotionally, mentally, physically and spiritually, making positive changes, developing purpose and meaning in life, and then helping others do the same, recovery becomes not a “staying away” from alcohol or other drugs, but a moving forward to a better life that improves as time goes on. Recovery can seem like something is pulling the person forward — this is recovery, and it has to be managed and maintained.

Getting help for an alcohol problem

alcohol treatment

Removing the stigma surrounding alcohol problems

As I’ve written here, far too many people with an alcohol problem don’t get help for the problem. This is from a study done in Sweden in 2013:

Approximately half of all people with high alcohol consumption in Sweden fulfill criteria for either harmful consumption or dependence. Among the alcohol-dependent, the majority have dependence with low severity. They are also reluctant to seek treatment. This qualitative study, with data from seven focus group discussions and 14 individual interviews, aims to describe and explain how representations of alcohol consumption, dependence, and treatment create barriers to treatment. Thirty-two adults from the general population fulfilling DSM-IV criteria for alcohol dependence participated. Most of the participants agreed that they were heavy drinkers but did not perceive themselves as alcohol dependent. Having alcohol problems, as well as realizing the need for and entering treatment, was associated with shame and stigma, producing a strong barrier to treatment. The participants’ knowledge about treatment was limited and somewhat faulty, as they thought that treatment mainly involves medication with disulfiram, lifelong abstinence, and inpatient care at rehabilitation clinics. As these treatments are socially restrictive and stigmatizing, this understanding created a barrier to treatment. While treatment for alcohol problems in primary care was seen as less stigmatizing, the expertise among general practitioners in this field was questioned. Results indicate that, to lower the threshold for treatment seeking, treatment services need to better match the needs and wishes of the potential service users as well as take stigmatization into account. Primary care practices and general practitioners need to market their ability to treat people with drinking problems. The clinical understanding of alcohol dependence needs to be expanded to include mild to moderate dependence, conditions which can be managed in primary care.

What’s interesting in the above excerpt is that those with an alcohol problem who were questioned about addiction treatment centers thought that treatment is primarily about lifelong abstinence. I’m not sure what was meant by this — I don’t know if the researchers doing this study think that abstinence is not a goal in addiction treatment centers or whether they’re suggesting something more nuanced, but I’ll make the more nuanced point. I would never lead an alcoholic to believe they can drink successfully, because the evidence suggests otherwise. Some people who abuse alcohol temporarily because of a divorce, a death in the family, a job loss, or some other life event that was stressful will likely be able to drink socially once they’ve dealt with the stress and learned better ways to cope with stress, but anyone who shows definite signs and symptoms of alcohol addiction should make abstinence a goal, although lifelong abstinence is not a realistic approach. No one can choose to change forever by simply choosing a long term goal, only one day at a time through a plan of recovery management. Excuse my cliché of one day at a time, but it’s a cliché phrase because it’s true.

A recovering alcoholic remains abstinent one day at a time, and then after a while he/she realizes that their life has changed for the better, so they choose sobriety as a way of life. At first a person getting help for an alcohol problem might use their energy to stay away from the first drink, but after being in recovery for a while and going through positive mental/emotional/physical/spiritual change the person loses the mental obsession to drink and is pulled toward more positive change — sobriety becomes something the recovering person embraces and seeks out.

Yes, there’s much bad information about alcohol and other drug problems, and there’s much misunderstanding about substance abuse and addiction treatment, but hopefully we can all change these perceptions and remove the stigma surrounding substance abuse and addiction through education.