To maintain your recovery momentum, there are several different types of outpatient programs that you can incorporate into your aftercare.
The Importance of Aftercare
Stopping your substance use and completing rehab is really only the first step of your journey. This is why developing an aftercare plan (a structured plan for continuing your recovery efforts) is an incredibly important step in preventing relapse.
Many treatment professionals will talk about a “continuum of care,” which refers to different levels of treatment and support you can receive on your path from active addiction to sobriety. You may have heard the terms “step-up” or “step-down” in reference to addiction treatment, for example your treatment team may have discussed transitioning you to “a step-down level of care.” These terms highlight that recovery is a long-term process that might begin with more intensive treatment and move progressively toward more autonomy or might involve stepping up to a more intensive form of treatment when needed.
Your level of aftercare treatment should match your current needs and then allow you the freedom to access more or less intensive care as needed.
Your inpatient program likely started preparing you for what you might encounter after treatment and hopefully gave you some insight and techniques into how to effectively deal with different high-risk situations. Though the somewhat isolated or self-contained nature of an inpatient or residential program may be the perfect recovery setting for someone needing to place some distance between themselves and life back at home, it isn’t necessarily representative of what you’ll face when initial treatment concludes. Some of the techniques you picked up in rehab may prove more difficult to put into practice at home, in a less structured, more drug and alcohol-accessible, and likely more stressful environment.
Essentially, you will have to learn a whole new way of being in the real world, and the more support you get during this transition, the more you reduce your chances of experiencing a relapse. Rehab helps you set the foundation, and your aftercare efforts let you continue building on your successes.
Planning for Aftercare While in Rehab
A good inpatient program will have a treatment team that focuses not only on your care during your stay but also your recovery once you leave. Prior to the completion of your treatment stay, they will help you work out an aftercare plan. Your plan should be made clear for you to understand and follow and might include ongoing recovery elements such as attending 12-step meetings a set number of times per week, regular family therapy sessions, and/or enrolling in an outpatient treatment program. Your plan will be unique to you and will take into account the progress you’ve made and the areas where you continue to struggle.
Good relapse prevention planning means that you and your care providers have given thought to what physical, emotional, social, and environmental triggers you might encounter upon leaving rehab and have identified several ways that you can successfully manage them. It also means you have identified and connected with sources of ongoing treatment and support so that you won’t face a jarring transition from around-the-clock care to complete autonomy.
Many treatment centers have established relationships with outpatient community providers, and making these connections is often a part of the aftercare plan you establish with your treatment team. Helping patients connect with outpatient care can improve client engagement, increase treatment retention, and improve substance use and psychosocial outcomes.1,2,3
Entering an Outpatient Program
When planning for your aftercare, it is important that you find a good fit both in terms of the level of care and how well you can work the steps into your daily life. Questions to Ask Some questions you might want to ask before making a decision include the following:
- Are there other treatment programs or sources of support within the same organization? There is some evidence that it may be in your best interest to stay in the same place, as that could help make your transition more seamless and decrease your chances of dropping out.4
- How many hours and days per week is the time commitment?
- What activities are involved in the program? For example, will there be individual, group, and/or family counseling, and are there any recreational activities?
- Is there a minimum length of time you need to commit to the program? Better outcomes are associated with longer durations of treatment,5 so this is something you may want to consider. Certainly, we know that the more you practice any skill, the better.
- Do they take your insurance? What are the financial obligations of participating in the program?
Knowing what to expect when you start an outpatient program may help lessen any anxiety you have about entering another type of program. You should expect an initial intake assessment to identify your needs and treatment goals.4 There will likely then be a period of getting to know the place and treatment staff, as well as spending some time with any potential care team developing a treatment plan. This way you can collaboratively come up with some attainable goals, monitor your progress, and be held accountable by your treatment staff.
What Happens in an Outpatient Program?
What happens next will be determined by your particular level of care. Your goals for your time in the program will vary in emphasis during each stage. For example, early recovery might focus more on abstinence, establishing substance-free activities, and relapse prevention, whereas the community support stage will focus more on maintaining an overall healthy lifestyle and staying connected to the community.4
There are several levels of outpatient care, but the one thing they all have in common is that they afford you the ability to live at home and have opportunities to continue your normal activities such as attending work or school.
One of the main differences between levels of care is the time commitment:
- The most intensive step down from an inpatient treatment program would be a Partial Hospitalization Program (PHP) in which you would spend 4-8 hours per day participating in treatment activities.6
- An Intensive Outpatient Program (IOP) could require anywhere from a minimum of 9 hours per week, up to about 20.1,4,6 Typically these programs would last for a minimum of 90 days.4 This way, you can feel more confident in your ability to step down to a less intensive program where you will manage more on your own.
- Standard outpatient care meets even less often, sometimes as few as 1-2 hours per week.4 It could also be on the evenings or weekends to further help you maintain your professional or academic schedule.
The Substance Abuse and Mental Health Services Administration (SAMHSA) delineates core services that you can generally expect outpatient programs to provide.
Here are a few examples:4
- Group and individual counseling
- Psychoeducational programming on substance abuse and life skills
- Family counseling
- Monitoring of any alcohol and drug use
- Medication management
- Help getting started with community support groups such as AA
As you progress in your recovery, you will gain an increased sense of self-efficacy and confidence in managing your addiction. Other programs might also help you address concerns associated with your living situation such as housing or employment, educational services, or recreational activities.
A life spent in active addiction is also often very chaotic and enveloped with people, places, and things related to alcohol or drug use. An outpatient treatment program provides a little more structure as you transition away from inpatient treatment, and teaches you how to live in a new world that doesn’t revolve around substance use. You will be learning how to have fun and cope with emotional stressors in healthier ways. You’ll also discover ways to communicate and establish and maintain healthy relationships. Learning this new way of life is crucial to your long-term sobriety.
What Happens Next?
Once you complete an outpatient program there will likely be an evaluation of whether or not you met your treatment goals. This will determine where to go from here. In other words, if you felt your outpatient treatment wasn’t enough, you can consider stepping back up to a higher level of care. If that doesn’t feel quite right but you know that you aren’t ready to be completely on your own, you may consider other options such as a sober living house where you can be sure you are in an alcohol- and drug-free environment with other people living in recovery. It will also likely be recommended that you continue attending recovery meetings or other self-help groups to maintain your progress.
Whatever your individual recovery path may be, just know that even though the transition from inpatient treatment back home can be a difficult one, it doesn’t have to be lonely. There are numerous resources out there to support you, and following a continuum of care will only increase your chances of long-term success. If you aren’t quite sure what the best decision is for you, most outpatient treatment programs will offer confidential assessments to help you determine what is the right next step so that you can make sure you are getting what you need.
- McCarty, D., Braude, L., Lyman, D. R., Dougherty, R. H., Daniels, A. S., Ghose, S., & Delphin-Rittmon, M. E. (2014). Substance Abuse Intensive Outpatient Programs: Assessing the Evidence. Psychiatric Services (Washington, D.C.), 65(6), 718–726.
- Ouimette, P. C., Moos, R. H., & Finney, J. W. (1998). Influence of outpatient treatment and 12-step group involvement on one-year substance abuse treatment outcomes. Journal of Studies on Alcohol, 59(5), 513-522.
- Trowbridge, P., Weinstein, Z. M., Kerensky, T., Roy, P., Regan, D., Samet, J. H., & Walley, A. Y. (2017). Addiction consultation services – Linking hospitalized patients to outpatient addiction treatment. Journal of Substance Abuse Treatment, 79, 1-5.
- Center for Substance Abuse Treatment. Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2006. (Treatment Improvement Protocol (TIP) Series, No. 47.)
- National Institute on Drug Abuse. (2013). Seeking Drug Abuse Treatment: Know What To Ask.
- Center for Substance Abuse Treatment. What Is Substance Abuse Treatment? A Booklet for Families. DHHS Publication No. (SMA) 08-4126. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2004, reprinted 2005, 2006, 2007, and 2008.