What Experts Are Saying About Outpatient Rehab
by Thaddeus Camlin, Psy.D.
Outpatient Rehab: What the Experts Say
Anyone who encounters the US addiction treatment industry is likely to experience a ‘hard sell’ on inpatient. The idea that addiction problems are resolved by ‘going away for 30 days’ is as pervasive as it is uninformed. Lasting change may be initiated in four weeks, but it takes much longer to become engrained. While the cultural mythos of addiction treatment continues to promote the notion that most people need to go away for 30 days, experts have been saying that outpatient rehab is actually the best fit for most people for quite some time.
William Miller and Reid Hester (two leading experts in the field of addiction treatment) looked at who benefits from inpatient alcohol treatment and found no overall advantage to inpatient vs. outpatient. The cost for 30 days of inpatient treatment easily totals $30k, $40k, $50k, even $100,000. Miller & Hester acknowledge that promoting outpatient treatment over inpatient runs “directly counter to the current practices and financial interests of many for-profit providers,” a diplomatic way of saying that greed fuels the unwarranted emphasis on inpatient care in the addiction treatment industry.
The evidence points in a direction quite different than the cultural zeitgeist of US addiction treatment that pushes the ’30 day cure.’ Research shows that outpatient treatment renders comparable outcomes to inpatient care, and outpatient comes at a fraction of the cost of inpatient. Most people who want to change a pattern of substance use behavior benefit from less intensive treatment over a longer period of time. The DSM-5 points out that prognosis is far superior for people who stay involved in treatment for at least a year. Involvement in treatment for at least a year could mean regular attendance at free meetings, bi-monthly psychotherapy sessions, medication management with a psychiatrist, etc. The cost of entire year of weekly individual therapy sessions would be a fraction of the cost of one month of inpatient care.
In general, a shift needs to occur in the mentality of addiction treatment. People who develop substance use problems usually benefit greatly from shifting from short-term to long-term gratifications. The idea that a problem that developed gradually over a long period of time (as addiction usually does) can then be solved in a month perpetuates a problem at the core of addiction – the problem of instant gratification. Changing behavior patterns is by nature a long-term endeavor. Thinking of addiction treatment as a one to two year project is far more realistic than thinking of it as something that can be “fixed” in 30 days.
For the small percentage of people who need medically supervised withdrawal, inpatient treatment is an important first step in safe and responsible addiction treatment. For most, however, no such drastic measures need be taken. It is widely accepted as best practice for nearly all other treatments to ‘start low and go slow.’ With medications, one starts with the lowest possible therapeutic dose and then gradually increases until desired effects are observed. However, the practice of sending almost everyone who seeks help for substance use to the highest level of care is essentially the equivalent of using surgery as the first line of treatment for lower back pain.
Despite the bigoted attitude that “all addicts are the same,” the widely accepted credo that ‘everyone is different’ also applies to people who encounter substance related problems. The Surgeon General’s report in 2016 advocated for individualized protocols rather than standardized programs, and for group counseling to only be used in conjunction with individual therapy. The time to shift away from shuffling groups of people around through six hours a day of educational lectures is long overdue. Experts familiar with the research know the science is clear – outpatient, individualized care should be the standard in addiction treatment. The only question that remains is how long consumers will be duped by the snake oil salesmen selling 30-day cures.
If you or a loved one are in need of outpatient rehab, give us a call. We are here to help.