What Is Outpatient Rehab? Is It Really Effective?

Alcohol can sneak up on us. What starts as an innocent glass of wine with friends over tapas on Saturday night turns into an additional mimosa or two on Saturday morning (hey, it’s the weekend, right?), and then a few more beers while watching reruns of Law and Order with your roommates on Thursdays, and so on. Before you know it, it’s easy to find yourself drinking multiple days a week, and maybe every night.

It’s notoriously difficult to spot just when the problem starts, but that’s beside the point. We all have our individual “triggers,” but once alcohol has enough of a hold of us, the main trigger for drinking is really our last drink. It’s a vicious cycle: no matter why we originally turned to booze, our desire for the next drink is now fueled by the aftereffects of the previous one.

So what do you do? Do you have to go to a detox? Alcoholics Anonymous meetings for the rest of your life? Rehab? Eek! It all sounds overwhelming. Then someone suggests outpatient rehab as a more “user-friendly” option. But what is outpatient rehab? And is it really worth it? Let’s explore outpatient alcohol treatment in more detail to help you decide.

Why Go Away for Treatment?

There are a few reasons when going to a specialized facility for treatment makes sense.

• Getting medical care. If we’ve been drinking for a long time, suddenly stopping can bring on unpleasant withdrawal symptoms caused by a shift in neurotransmitters (primarily GABA and glutamate) in our brain. While these symptoms can simply be uncomfortable for many people, they can be medically dangerous, especially if we’re talking about seizures or delirium tremens (DTs).
• Disrupting our routine. While leaving home for a month (or even a week) can be difficult, it’s often exactly what we need to make a clean break with our habits. Getting out of our usual surroundings gives the brain much-needed space to form new patterns and associations.
• Getting on the fast track to recovery. The information and resources we get in a treatment program can often set us up for long-term success. We usually have access to a care team that includes medical professionals, therapists, and sometimes nutritionists. Immersing ourselves in recovery-related discussions, workshops, and one-on-one sessions is certainly a major time commitment, but in the long run it’s often time well spent.

How Does “Rehab” Work?

As physical therapist Joerg Teichmann writes, “In rehabilitation there is no elevator. You have to take every step, meaning one step at a time.” And while this might be true for many types of recovery, including treatment for alcohol misuse, those “steps” can look and feel quite different depending on the option we choose. 

Treatment facilities — or “rehab” centers, as they’re often called — come in all shapes and sizes. Let’s take a look at what’s out there.

• Inpatient (and detox). This type of facility is the most intense, and it’s appropriate for the most severe cases of alcohol use disorder (AUD). (To learn more about the difference between AUD, which is characterized by a physical dependence on alcohol, and alcohol misuse, check out our blog Alcohol Misuse vs. Dependence.)


  
  Inpatient treatment usually involves a daily schedule of therapeutic activities and support groups to keep us engaged and focused on recovery. There’s round-the-clock medical care available for those who need it, especially if we’re dealing with withdrawal.
• Partial hospitalization. Partial hospitalization, or “partial” as it’s sometimes called, is the next level down. It usually takes place in a hospital setting and provides similar services as inpatient hospitalization with one key difference: participants live at home and travel to the program daily, usually staying for the full 8-hour period.
• Outpatient (or “Intensive Outpatient”). Finally, there’s “intensive outpatient” treatment, or IOP. While it’s a significantly lower time commitment per week, it can last for multiple weeks, or even months. IOP is often housed at the same facilities that provide inpatient treatment but could have a separate location. Either way, participants are usually required to travel there for a few hours at a time but have the rest of their days to themselves to go on with their normal routines.

What Is Outpatient Alcohol Treatment All About?

For those who don’t need 24-hour supervision, IOP programs can be great alternatives. Their main goals? Setting up an effective psychological and social support system, helping prevent relapse, and teaching clients coping strategies. The idea is to put us back in the driver's seat of our own recovery and leave us feeling like we have the tools to keep going and steer ourselves back on course if things get rough.

Now, let’s take a closer look at what goes on inside on a day-to-day basis.

• Logistics: the typical day. Unlike Partial Hospitalization, IOP programs usually don’t meet every day. We might be looking at three or four days a week, usually for about three or four hours at a time. Sessions are typically held either in the morning (for example 9 until noon) or evening (5 until 8). 


  
  The time block is broken up into individual sessions, which focus on different aspects of recovery, with breaks in between (we’ll touch on the details of what might be covered below). At least one is usually a “process” session for clients to talk about any general issues going on, and to assess their overall progress. 
• Addressing withdrawal. While withdrawal sometimes requires medical supervision to get through safely, that’s not always the case. If our symptoms are mild — no seizures or delirium tremens — we might be able to handle them on an outpatient basis, with access to medical professionals, or the option to move up to a higher level of care if we need to.
• Therapeutic activities. Some sessions might be centered on therapeutic activities, such as art therapy, journaling, or meditation. Alcohol misuse recovery can feel like a daunting process, and tackling it is a highly personalized matter. What works for some folks might not work for others, so it’s good to give different types of therapeutic approaches a fair try, even if it seems a bit cheesy at first glance. (We know, coloring emotion wheels is not for everyone, but let’s not rule it out right off the bat!)
• Learning coping skills. Many of the sessions might be focused on developing coping strategies, such as techniques based on cognitive behavioral therapy (CBT), which teaches us to uncover any cognitive distortions they might have around alcohol or other issues and reframe them in more productive ways. The idea behind CBT is that certain thoughts (for example, “I need alcohol to have fun”) lead to emotions (feeling left out or awkward without a drink at a party), which then lead to behaviors (drinking). When we recognize that the original thought is a distortion (in this case, “fortune-telling,” or assuming something is true about the future without concrete evidence), the emotion tends to fade, opening the way for new behaviors.
• Relapse prevention. One of the major goals of IOP is usually relapse prevention. In an effort to reduce the chances of going back to old behaviors, clients are encouraged to learn to spot triggering situations and make plans for them ahead of time. For example, if after-work happy hours are a trigger, having an “exit plan” or sharing concerns with a close friend who can be on call could be helpful. 


  
  In the end, though, preventing relapse is all about learning to see alcohol differently. After all, if drinking no longer seems like something that’s even worth doing, we are less likely to fall back into the trap.

Pros of Outpatient Rehab

IOP has some definite advantages, especially when compared to more demanding forms of rehab:

• Outpatient rehab is more flexible and accessible. IOP allows participants to maintain their daily routines, which can be a dealbreaker for many, especially those with families or jobs that don’t allow for an extended leave of absence. Balancing treatment with work, school, or family responsibilities is a lot easier than it is with inpatient treatment. Plus, nothing beats being able to come home and sleep in your own bed at the end of a long day!
• Studies show that IOP works. According to a review article titled “Substance Abuse Intensive Outpatient Programs: Assessing the Evidence,” many studies have found outpatient rehab to be just as effective as its more intense counterparts. As the authors report, “Taken together, randomized trials and quasi-experimental studies consistently reported equivalent reductions in problem severity and increases in days abstinent at follow-up for participants who received intensive outpatient or day treatment services compared with those in inpatient or residential care.”
• IOP tends to be more affordable. Financial advantages of outpatient rehab over inpatient options are another plus. They are generally more affordable and often covered by health insurance policies.
• We can still have access to our support team. IOP allows us to stay connected with our support network, such as families and friends. We’re living at home, so as far as access to our home-based support network, it’s business as usual.
• It’s a bit more private, especially if we want to stay under the radar. First things first: there’s absolutely no shame in seeking treatment of any sort. That said, it can be easier said than done, and many of us don’t want to reveal the details to everyone in our lives. IOP is easier to integrate into our lives “discreetly” — for example, if we

Outpatient Rehab Drawbacks

At the same time, IOP does have its potential drawbacks. Here are the main ones: 

• It requires self-motivation and commitment. Staying motivated might be a bit harder. Going to treatment can feel like having an extra part-time (or even full-time) job, so if we already have one on top of that, things can get hectic. 
• We have to balance our priorities, and time management can get tricky. Living at home is great, but it also means we still have all of our usual responsibilities. Including IOP in our schedule can call for some intricate reshuffling of priorities and delegation of tasks. We can’t be in two places at once, as much as we might like to be!
• Avoiding relapse triggers could be a challenge. Once again, being at home base is great, but it also means that we are faced with the same environment — and the same triggers — that we had to face before. The brain loves patterns, and facing the same “people, places, and things” (to borrow a 12-step term) can land us in rough waters if we’re not careful.

Is Outpatient Rehab Right for You?

Here are some things to keep in mind when deciding if IOP is right for you or if an alternative might be a better fit:

• Is it intensive enough? Be honest with yourself (and your care team) about the level of care you need. Sometimes, more intensive treatment is needed, especially if you’ve gone through withdrawal before and know that you might be at risk of more serious symptoms.
• Is it too intense? On the other hand, if IOP seems too intense for your situation, that’s okay, too! Perhaps you’re at the stage of your alcohol journey when you’re trying out a sober-curious lifestyle, or maybe you just need help staying on track. In that case, consider an app such as Reframe to be your sidekick! 
• Is it comprehensive enough? Another thing to consider is if a particular IOP program covers everything that you are seeking help for. For example, are you struggling with multiple substances? Or, perhaps, you’re also dealing with an eating disorder or depression? If so, make sure that the program you choose includes a dual-diagnosis track that will be able to address all of your needs. Dealing with multiple challenges at once can be a tricky puzzle to solve, but it’s completely doable!

Tips for the Journey 

Finally, here are some words of wisdom from others who have been where you are and found hope.

• Give yourself a break. Falling into the alcohol trap is never your fault — alcohol’s addictive, and many have faced the same troubles. In the words of mindfulness expert Thich Nhat Hanh, “Sometimes we say, ‘I didn’t want to do it, but it’s stronger than me, it pushed me.’ So that is a seed, a habit energy, that may have come from many generations in the past. We can smile at our shortcomings, at our habit energy. With awareness, we have a choice; we can act another way. We can end the cycle of suffering right now.”
• Count your wins. Once you’re on the journey toward changing your relationship with alcohol, there’s no such thing as going back to “square one.” So even if you have a slip-up, you’re always moving forward, simply because you have embarked on this new chapter of your life and are in the process of change. As much as we’d like to avoid them, of course, every detour teaches us something valuable. As Rian Mileti writes in The Decision To Have World Peace, “Life is the slow change from who we used to be into who we are now.”
• Have hope. As many who have faced the same challenges will tell you, it can be done! And as Benjamin Alire Sáenz writes in Last Night I Sang to the Monster, “If you can quit for a day, you can quit for a lifetime.”
• Stay curious. In the words of Gabor Maté, author of In the Realm of Hungry Ghosts: Close Encounters with Addiction, “Compassionate curiosity directed toward the self leads to the truth of things.” Exploring life beyond alcohol is an adventure. Embrace the unknown and remember all the benefits that are waiting for you!

A New Chapter

In the end, whichever path you choose — and whether IOP or another form of treatment ends up being a part of your story — congratulations on being on this path. You are writing a new chapter in your own story, and even if it’s a challenging one, keep going. It’s most certainly worth the effort!