Basic outpatient treatment is often overlooked in favor of either more intensive options like residential treatment or even day-long treatment. However, often, the most effective treatment is rather simple; attending weekly therapy and continuing to live life as it is. This is not a second-rate option when the other options lead to little success. For many individuals, it is the ideal treatment, providing enough support in the beginning to begin to make changes while still being able to maintain their normal life and pre-existing relationships.
It is determining when someone requires this level of treatment which is a challenge. The challenges we face emerge in an individual’s thought processes once they enter treatment, often contradictory to their original thought processes of what a treatment should “look like”.
Who would weekly treatment fit best?
Individuals who catch their substance use problem early do extremely well with regular outpatient treatment. Their addiction has not yet taken over their life and they are still working, responsible with relationships and family. They just need a little accountability or professional help but they are managing life well.
Working professionals in demanding professions are able to manage work much better with a weekly treatment schedule versus an intensive treatment option. They can plan around their work schedule to avoid having to explain to their employer why they will be absent or interrupt their work and possibly lose their job as they go through treatment. Custodial parents in treatment benefit from not having their children further displaced for long stretches of time. Weekly options allow the parent to do both, while they are working on themselves and engaging in their commitment to treatment. In most situations, this parental situation provides the motivation to get better faster. Many families find that more substantial drug abuse outpatient treatment works best for individuals transitioning from intensive treatment to maintenance care or for patients whose addictive issues haven’t completely interfered with their daily capacity to function.
The Value of Consistency Over Intensity
There is also the utility of taking part in the steady cadence of weekly sessions. The process of being discharged from a residential treatment program is usually followed by an abrupt interruption of the intensity and focus followed by an abrupt return to their real lives. In an outpatient treatment environment, they leave treatment, and have the ongoing, consistent source of support, and expect to incorporate back into the patients weekly routine.
The consistency of care leads to the opportunity to build sustainable coping skills to treat their addiction issues. The patient is dealing with real life stresses, triggers and challenges in between their outpatient sessions, and then are able to process with a professional that understands their history the following week at the same time.
The focus on incremental behavior change, instead of in-out, all-or-nothing, immediate change in someone’s life is unique to outpatient treatment paradigms. One week a person may work on coping with work stress without substances, the next week practice new social and engagement skills. The week after the patient may begin to refer to issues in family relationships. Treatment is delivered at a comfortable pace, for the most part, that does not feel overwhelming.
Practicing Recovery in Real Time
Another benefit of weekly outpatient treatment is that the person is actually learning and practicing recovery skills in real-time in their own environment from day one.
They are not learning coping skills in an artificial treatment environment and then attempting to use the skills weeks later—they are figuring out and using recovery as it is taught in the places and situations where they will actually need the skills.
If someone is having a tough time at work or has conflict with their partner, they can bring that interaction to their next session while it is still fresh and talk it through. In the case of process, the therapist can help facilitate a discussion about what happened, what worked, what didn’t work, and what they might consider doing differently in the next similar interaction.
Using skills in real-time practice feels much more normal and relevant than discussing something theoretical like managing stress while working through real life situation related to stress in the previous week.
When Weekly Sessions Offer Sufficient Structure
Some people may need supervision around the clock and completely controlled environments to get stabilized. Other people may prefer “structure” in sufficient amounts in which accountability to the structure fosters good progress and change, without being all-encompassing, and the center of their universe.
In the typical weekly outpatient structure, there are individual therapy sessions scheduled, sometimes group therapy, and sometimes family therapy. Regular drug testing, homework, or community support involvement may also be in place. There’s a structure, but it’s not intrusive into all areas of daily living. This level of structure is sometimes a good fit for individuals that have the internal motivation for change, and families, or friends, that are supportive, and stable home lives. They also need professional supervision and accountability; however, they don’t need someone to arrange every hour or activity throughout the day.
The Financial Reality Factor
Weekly outpatient treatment costs significantly less than intensive options, and, most insurances will pay to access outpatient treatment with a reasonable copay. This can make treatment accessible to people that wouldn’t consider treatment otherwise, even with insurance, if they were going to have to pay for a more intensive level of treatment. In addition, being able to work while in treatment means that participants are not dealing with lost wages on top of treatment. This is a distinction that makes the difference for people and families, as a lot of time, this is the difference between getting treatment versus waiting for things to decline, and treatment becoming more complicated and costly.
This is not a choice between low-quality treatment versus high-quality treatment, this is a choice between sustainable treatment that people can actually access and complete.
Building a Foundation for Long-term Recovery
Weekly outpatient treatment typically is for months and often years. This permits fairly thorough exploration of underlying aspects contributing to the addiction. Instead of simply doing short term intense treatment, the person has the opportunity to work through trauma, ongoing mental health issues, issues in their interpersonal relationships and many other factors of relapse if not properly address chronic stress and mental health.
Longer lengths of time also allows opportunity to work on life skills which support recovery. For instance, someone may work for many weeks learning how to be responsible with debt, communicating with family members, managing job stressors or a healthy social relationship.
This slower time frame fosters more sustainable change resulting over time because the person, instead of holding on to disruptive behavior once leaving the confines of a more intense program, had a whole period to change in patterns and habits.
When Weekly Sessions Are Not Enough
Standard outpatient treatment is not appropriate for everyone. There are many individuals who may need to be monitored medically during detoxing, live in unstable places of housing or relationships or are experiencing ongoing discharge still needing a level of intensity.
For a person who has entered and lacked success with outpatient multiple times, this may be a point to step up a level of care. Other times individuals need the complete change of environment and 24 support of residential treatment.
So, the key point is for someone to accurately ascertain what step of care is appropriate and not to assume higher levels of care is better. For many people who need standard outpatient treatment weekly sessions are usually a perfect sweet spot of both support and independence working towards developing a sustainable recovery.
Making Weekly Sessions Work
Families engaging in treatment as a family system. Individuals who wish to benefit from outpatient treatment need to be actively involved in the treatment process. Thus means participating and engaging in the process, being consistent with attending weekly with effort outside of outpatient. Participating openly and honestly about treatment with the therapist and in the process to adjust behaviors outside of meeting.
Supportive environment. It is also very helpful to have some type of supportive environment. To overgeneralize this, having a family who is supportive there is a general knowledge of addiction and recovery, having friends who support sobriety, work environment with options to within a range of flexible hours to attend therapeutic support.
The most wonderful part of outpatient and the weekly sessions, are that they meet them where they are with right number of sessions rather than forcing them to fit the provided treatment. I have found when the characteristics of outpatient treatment fit the need of attending consistently at least once per week, the engagement and participation was sometimes equally effective if not equally long-term to developments cures and recovery as a higher level of care.
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