Residential or Outpatient Treatment: How to Choose What's Right for You

By Suzanne Kane

Treatment for alcohol or drug addiction is available in two basic forms: on an outpatient basis or as a resident at a treatment center that specializes in addiction. The decision to seek treatment is the most important criterion for either option. But once the commitment has been made—or once an intervention has been staged and agreement by the addict has been reached—how do you know which option is best?

Each person’s addiction is unique. Therefore, each individual seeking help for addiction—whether inpatient or outpatient—needs a personalized treatment plan. The first step is to understand how each type of treatment works.

Outpatient Treatment
If you or someone you know has a drug or alcohol problem and cannot be away for long periods of time, outpatient treatment may be the best option. Outpatient treatment was developed as an alternative to the standard residential treatment program. Included in outpatient therapy is treatment for the addiction, as well as counseling and help with daily living.
While outpatient treatment facilities all are designed to help the individual trying to quit alcohol or drugs, they may differ in the types of treatment they offer. Many include some or all of the following:

• Treatment for the addiction
• Incorporation of 12-step programs
• Sober living facilities
• Relapse prevention

The purpose of treatment for addiction is to get the person to stop the addictive behavior, understand and address the underlying causes for the behavior, and gradually learn how to change old patterns and habits that helped fuel the addiction.

In order to be accepted into an outpatient treatment program, there are certain requirements that generally must be met. The individual must agree to:

• Accept responsibility for their drug and/or alcohol problem and all actions associated with it
• Express a genuine willingness to attend counseling several times a week
• Completely abstain from drugs or alcohol at least 72 hours prior to entering the outpatient treatment program
• Have not previously been a participant in an outpatient treatment program

If the individual does not meet these criteria, they are probably better suited for inpatient or residential care treatment.

Inpatient or Residential Treatment
As the name implies, inpatient or residential treatment for addiction involves a client living at a specialized facility for a period of time, usually 30, 60, or 90 days. Staff members are all professional, certified counselors and case managers who use the latest assessment tools and advanced treatment protocols. Lengths of stay in residential treatment facilities vary and are flexible, depending on the needs of each client. In other words, how long you stay in treatment depends on the length and severity of your drug addiction.

It’s important to recognize that inpatient services are typically provided by a licensed hospital or addiction recovery center. Residential treatment facilities, on the other hand, may not have the same stringent requirements.

Course of treatment is intensive and involves a multi-faceted approach. Each treatment facility has its own treatment array, but all include one-on-one counseling, group therapy, educational discussions and lectures, relapse prevention, and sessions or counseling based on an individual’s needs on a case-by-case basis. Many include some or all of the following:

• Initial assessment or evaluation
• Treatment plan developed for the individual
• Individual counseling
• Group therapy
• Educational groups for drug and alcohol use
• Process groups
• Groups that are gender-specific
• Planning for transition and aftercare
• Short- and long-term aftercare planning
• Weekly family events
• Court liaison and/or early release for drug and alcohol offenders

Assessment
Both residential and outpatient treatment for addiction involve an initial assessment process. This is designed to assist the treatment facility’s staff and counselors to understand the client’s specific problems, issues, and needs. Any additional relevant information that can help in the client’s recovery is also covered.

During the assessment interview, questions are asked about the client’s family history, background, history of all drug and/or alcohol use, and patterns of behavior. The information obtained is kept confidential and is never released to anyone without the client’s permission. During the course of treatment, the addict is encouraged to share deeper and more personal information, but it is always at the discretion of the client and is never forced.

Assessment also allows the individual to express any feelings or concerns about treatment, including feelings of homesickness or abandonment, and to identify specific drugs they have been taking as well as their goals for treatment.

Following the initial assessment, a comprehensive and individualized treatment plan is developed for each client.

Counseling
Both types of treatment options have trained staff—therapists and social workers—to counsel patients. Individual counseling occurs between the therapist and the client only, meeting 1 to 3 times per week for the duration of the treatment program. Group counseling occurs more frequently, about 4 to 5 times per week, and involves the patient and other patients also in the treatment program. There may be one counselor or several with each group, and the counselors may rotate, depending on their expertise in a particular topic being addressed at that day’s session.
Topics discussed during group and individual counseling vary from day to day and week to week. Some may cover transition skills, or relapse prevention, or how the 12-step process works. Other times, the subject may be family issues or personal relationships, or the group may seek to address the problems or issues of a particular individual or those that the group as a whole experiences.

Relapse Prevention
Treatment also includes a thorough and intensive discussion and preparation of a relapse prevention plan—whether the treatment is residential or outpatient. The client learns how to identify triggers or stressors that prompt a return to using, and develops a plan to counter those triggers. These include actions on how to deal with problems and situations that are bound to occur once the person leaves treatment and is in recovery. Lifestyle changes and abstinence are the focus of these plans.

Relapse prevention also encourages the client to participate in 12-step recovery groups as an immediate and ongoing part of their own recovery. The individual in recovery needs the support of friends and allies, often those met during treatment who have a lasting and permanent bond, to help them get through the tough times ahead, times when they need someone who understands what they’re going through and can help them over the hurdles.

How to Pay for Treatment
Whether inpatient or outpatient, addiction treatment can be very costly. However, it is often covered by major health insurance plans. Many facilities will work with special needs cases on the basis of availability. First, inquire whether the drug treatment facility accepts your insurance, and how much of the cost your insurance will cover. Some treatment centers have information on their websites as to what kinds of insurance they cover and assistance in covering costs: Medicaid, Medicare, county referrals, and whether or not they’re a preferred addiction treatment provider for most major private medical insurance companies such as Blue Cross Blue Shield, Aetna, Cigna, and many others.

Treatment facilities may also offer financing options. Be sure to find out what the total cost of the treatment will be upfront, including finance charges, so that there are no hidden costs. Know exactly what will be included in the cost, and what is considered a fee-for-service program. All reputable treatment centers will first assess the needs of the individual and recommend treatment based on those needs, not on the client’s ability to pay. Don’t make cost the primary consideration of whether or not to get treatment.

Decide What’s Right For You
Weigh and balance the type of treatment available at both residential and outpatient centers. Consider the intensive, 24-hour, 7-days-a-week treatment at a residential facility versus going to an outpatient center several times a week. How much supervision do you need? If your insurance plan covers residential treatment and you feel you would best benefit from the structured, supervised, professional care, then by all means go that route. Statistics are on your side with residential treatment, which have a 70 percent success rate.

Check out the facility’s accreditation, staff, credentials, treatment programs offered, cost, and effectiveness rate. Some treatment facilities offer both residential and outpatient addiction treatment.

Residential treatment facilities vary in other ways beyond treatment. Among the many facilities are a wide range of accommodations—from residential dorms to luxury rooms in secluded locations.

Ask enough questions to satisfy your need for information. Then make an appointment and go for the initial assessment. If you are not convinced that the first facility is the right one for you, check out another—until you find one that feels right. Remember, the most important decision is one you have already made: you want to quit using. Now take the next step and improve your life through recovery.
 

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