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Outpatient Opioid Addiction Treatment: When to Seek Rehab

Opioid use disorder (OUD) is the inability to stop using opioids even though you experience negative consequences. You likely experience withdrawal symptoms and cravings when you try to quit, which indicates you have developed a dependence on the substance. Outpatient opioid addiction treatment programs include intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs). Both offer highly effective services, including medication assistance for detox, counseling, and peer or family support.1

In this article:

What is Outpatient Opioid Addiction Treatment?

Not everyone with an OUD needs inpatient, 24-hour medical supervision during detox. Instead, they can benefit from outpatient opioid addiction treatment. Outpatient treatment plans can vary for each person, but there are common variables.2 All outpatient programs incorporate some level of therapy and counseling on-site, which means you must travel to the facility to receive these services. However, unlike inpatient programs, you do not need to stay at the facility overnight for round-the-clock supervision. Outpatient programs can range in intensiveness, from a few hours of visitation per week to several hours daily.

Methadone Maintenance Treatment (MMT)

Methadone is a long-acting opioid that doctors prescribe to treat opioid addiction. This is often done on an inpatient basis, though one can step down to outpatient care depending on doctor recommendations. Methadone maintenance treatment is effective, especially in treating heroin use disorders and withdrawal. It can be safe and effective for months or years.

Medication-Assisted Treatment (MAT): Suboxone and Naltrexone

Methadone is not the only medication for treating opioid withdrawal. Buprenorphine and Suboxone (a buprenorphine-naloxone formulation) are common treatments for opioid use disorder. They are synthetic opioids that act on opioid receptors much differently than heroin or prescription opioids.

Naloxone and buprenorphine attach to opioid receptors in the brain and change its reward circuit away from dependence. Buprenorphine relieves withdrawal symptoms but avoids giving you any euphoric effects. The given prescription is just enough to reduce cravings. Naloxone is a drug that reverses opioid overdoses when given alone. When paired with buprenorphine, it serves as a deterrent. If someone decides to misuse Suboxone by crushing or injecting it, the naloxone reverses the effects and causes withdrawal symptoms.

Behavioral Therapies

Medication-assisted treatment (MAT) is highly effective when you also participate in behavioral therapies. The types of behavioral therapies for outpatient opioid addiction treatment include:11

  • Contingency management (CM) interventions or motivational incentives
  • Community reinforcement approach (CRA) plus vouchers
  • 12-Step facilitation therapy
  • Individual therapy
  • Group counseling and education
  • Family therapy
  • Couples counseling

Behavioral therapy goals include changing negative thought processes that lead to unhealthy behaviors. You learn to replace negative thoughts with positive ones to support healthy actions and reactions.

Peer Support Treatments

Peer support is a vital part of recovery. In outpatient opioid addiction treatment, you will have access to 12-Step facilitation groups connected to Narcotics Anonymous (NA). You may also engage in the SMART Recovery tools and co-occurring disorders support groups.

Holistic Therapies

Outpatient opioid addiction treatment centers understand they must treat the whole person to achieve long-term recovery success. Alternative treatments can complement medication and behavioral therapies based on your unique recovery needs. Examples include equine, art, music, meditation, yoga, and nutrition therapies.

Levels of Outpatient Rehab

Outpatient rehabilitation consists of treatment programs offered for a specific number of hours each week. When not in treatment, you can work, live at home, and fulfill your personal, professional, and social responsibilities.

Being recommended for outpatient rehab means you likely have a supportive living environment and are surrounded by friends and family who can be there for you during outpatient detox and treatment.

Outpatient rehab consists of three primary programs:3

  • Partial hospitalization program (PHP): Participants meet for approximately 20 hours each week, Monday through Friday. Some PHPs occur at the hospital, where detox and inpatient rehab occurs. However, PHP is part-time, and you return to your home every night.
  • Intensive outpatient programs (IOP): IOPs are like PHPs but with fewer hours each week. IOPs offer around 10 hours of services each week. Meeting times of individual and group therapies are more flexible, and many treatment centers offer evening and weekend options.
  • Individual counseling sessions: These vary in number, length, and content for each participant. Some meet once a week, and others may meet once a month. Some sessions include family members, while others are one-on-one meetings. Individual counseling gives you a chance to focus only on your progress without including your peers.

Medication assistance for withdrawal, peer support groups, and family therapies are crucial parts of outpatient rehab.3

Where can Outpatient Opioid Addiction Treatment Take Place?

Methadone maintenance treatment must occur in a methadone facility approved by the Substance Abuse and Mental Health Services Administration (SAMHSA). Each day, you must travel to the facility, receive your dose from a clinical staff member, and meet with doctors and counselors as scheduled. Hours of operation are usually Monday through Friday. On the weekends, you may be given a 2-day supply to cover the days the facility is closed.4

Facilities for Partial Hospitalization and Outpatient Treatment

Partial hospitalization and intensive outpatient opioid addiction treatment programs can occur in the same facility as inpatient rehab. Some PHPs occur in stand-alone facilities but not as often as IOPs. The most common locations include community hospitals, residential programs, and stand-alone community or private treatment centers.1

Medication management can occur at each PHP and IOP location if a medical doctor or psychiatrist is on staff. Usually, nurses and licensed or certified mental health and substance misuse treatment professionals lead therapy activities.3

Counseling Clinics

Individual counseling may take place with a licensed therapist working in a larger treatment facility or one who has their own office in the community. Peer support groups can take place at any treatment facility and churches, libraries, and other community locations. Outpatient counseling may also occur in schools and school-based clinics, primary care clinics, or mental health clinics.3

Signs You May Need Outpatient Opioid Addiction Treatment

To determine whether you need outpatient opioid addiction treatment, clinicians use the 11 criteria for substance use disorder in the Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM5):5

  1. Tolerance, when you need more opioids to achieve the effects you desire
  2. Withdrawal symptoms that appear when you go without opioids
  3. Using more opioids than you intend and for longer periods
  4. Trying to quit or cut back but can’t
  5. Spending much of your time seeking opioids, misusing and recovering from them
  6. Giving up activities you once enjoyed to misuse opioids
  7. Continuing to use despite physical and psychological problems worsening
  8. Recurring use despite being unable to fulfill personal, professional, and social duties
  9. Continuing to use even though doing so causes broken relationships
  10. Misusing opioids and putting yourself in dangerous situations
  11. Intense cravings for opioids

The severity of these criteria helps determine if a person needs inpatient or outpatient opioid addiction treatment. The higher the number of criteria you meet, the more intensive the level of care you need.5

Clinicians also use the six dimensions of the American Society of Addiction Medicine (ASAM) levels of care guidelines for treatment, including:6

  • Level of intoxication and potential for withdrawal
  • Past and current physical health and conditions
  • Past and present mental health and conditions
  • Readiness for change or the level of interest in changing
  • Potential for relapse or factors that may lead to continued use
  • Current living environment and whether it will be a support or hindrance for recovery

ASAM Guidelines for Outpatient Opioid Addiction Treatment

Level one for outpatient opioid addiction treatment is the least intensive outpatient program. For successful outcomes, this level is advised for persons who:6

  • Are in the early stages of change
  • Step down from a more intensive level of care
  • Have emotional and physical stability
  • Need less than nine hours of services

ASAM Guidelines for Intensive Outpatient Opioid Addiction Treatment

Level 2.1 is intensive outpatient opioid addiction treatment offered to those who meet the following:6

  • Needing 9 or more hours of treatment services a week
  • Having supportive living environments, including transport to and from treatment
  • Benefitting from attending evening or weekend therapy
  • Requiring medication assistance to ease withdrawal symptoms but do not require 24-hour supervision

Level 2.5 is a partial hospitalization program for opioid addiction treatment, provided you meet the following criteria:6

  • Any unstable physical or mental conditions do not need 24-hour medical supervision
  • You need a structured program with daily monitoring
  • You need at least 20 hours of treatment each week
  • Any benefit from withdrawal medication management on a part-time basis
  • You have a supportive home environment for recovery

ASAM Guidelines for Inpatient Opioid Addiction Treatment

Levels 3 and 4 are recommended for those needed inpatient treatment because they meet the following:6

  • Require 24-hour medical supervision
  • Lack a current stable living environment
  • Possess limited cognitive abilities due to opioid misuse
  • Have severe co-occurring disorders
  • Need daily medication-assisted treatment for detox and withdrawal symptoms

Outpatient Rehab as a Step Down from Inpatient Care

Entering opioid addiction treatment sometimes means starting in intensive inpatient detox or rehab due to a need for medical supervision and care. When you complete an inpatient program, treatment doesn’t stop. The continuum of care involves stepping down from inpatient treatment into an intensive outpatient program.7

Going from an inpatient program back into your home environment can lead to relapse without a plan to continue treatment. Day treatment and intensive outpatient programs help you practice the skills you learn in a higher level of care and get feedback and support as you transition into your sober life.7 Partial hospitalization programs can function as a bridge between intensive inpatient services and intensive outpatient services.

Also, suppose you step down to outpatient opioid addiction treatment and realize you need more time receiving 24-hour care. In that case, you will have a much easier and quicker transition back into inpatient treatment.

When to Seek Inpatient Rehab for Opioid Addiction

If you have experienced a relapse after trying to quit misusing opioids, it may be time to seek inpatient rehab. While relapses are common, they signify that you didn’t learn all you could to prevent the relapse. Other reasons to seek inpatient rehab for opioid addiction include:2

  • Needing medication during detox that eases withdrawal symptoms and cravings
  • Having a polysubstance use disorder
  • Having co-occurring substance use and mental health disorders
  • Learning the results of an evaluation show you qualify for inpatient rehab
  • Having physical or psychological conditions that compound opioid use disorder
  • Surviving one or more opioid overdoses in the past

Therapies for Opioid Addiction Treatment

At every level of care, specific therapies work for treating opioid use disorders.8

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy teaches you to change your thought processes so you can change your behaviors. For example, if you have a bad day, your thoughts become negative. You start thinking about all the things that have gone wrong, and you feel depressed, angry, or frustrated. These feelings lead to misusing opioids to escape the stressful emotions. With CBT, you learn to stop negative thinking and replace it with positive thoughts that lead to you feeling good about yourself and your life even though a stressor appears. Your positive emotions lead to positive, healthy reactions that do not involve opioids.

Contingency Management Therapy (CMT)

Being rewarded for good behavior is something everyone wants and needs. Rewards reinforce good behavior, and, in this case, the good behavior is avoiding the use of opioids. Working with your therapist, you will create rewards, and each time you reach a milestone in recovery, you receive a prize.

Motivational Enhancement Therapy (MET)

It can be hard to maintain motivation during recovery. Some days are tough, making you want to give in and relapse. MET is a way to keep you motivated to avoid a relapse on opioids.

Family Therapy

Your opioid use disorder affects friends and family. Some of those closest to you may be why you continue to use opioids. For you to recover, your friends and family need to recover also. Family therapy can help them set boundaries, stop enabling, quit their addictions, recognize family roles, and heal.

Peer Support Therapies

Peer support groups such as 12-Step facilitation and SMART Recovery are part of successful treatment plans. Some are themed peer support groups based on faith, gender, infectious diseases, culture, sexual orientation, same-sex, trauma, age, etc.

Holistic Care and Interventions

Holistic care involves participating in activities that heal the mind, body, and spirit. Examples of holistic care as part of opioid addiction include acupuncture, massage, meditation, yoga, biofeedback, breathwork, and mindfulness.9

Continuing Your Care and Support After Opioid Treatment

When you complete outpatient rehab for opioid addiction, you must continue to receive care and support. You can attend support group meetings or recovery management check-in sessions with your counselor. Other options include telemedicine and teletherapy, mobile health technology and Apps, participating in recovery activities, and taking advantage of having a case manager and aftercare plan.10

How to Start Outpatient Opioid Addiction Treatment

There is no better time than right now to begin your journey of overcoming an opioid use disorder. Are you ready to find out if an outpatient opioid addiction treatment program that includes medication to ease withdrawal symptoms, behavioral therapies to teach you necessary skills, and peer support is right for you? The first step is to receive an evaluation from a clinical specialist.

Call us at 800-891-9360(Who Answers?) any time to speak with a treatment specialist. They will help direct you to the right clinician.

Resources

  1. National Institute on Drug Abuse. (2020). Treatment Settings.
  2. S. Department of Health and Human Services. (2016). Chapter 4, Early Intervention, Treatment, and Management of Substance Use Disorders. Substance Abuse and Mental Health Services Administration (U.S.); Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health [Internet]. Washington (D.C.).
  3. National Institute on Drug Abuse. (2020). Types of Treatment Programs.
  4. Ali, S., Tahir, B., Jabeen, S., & Malik, M. (2017). Methadone Treatment of Opiate Addiction: A Systematic Review of Comparative Studies. Innovations in Clinical Neuroscience, 14(7-8), 8-19.
  5. Hasin, D. S., O’Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., Compton, W. M., Crowley, T., Ling, W., Petry, N. M., Schuckit, M., & Grant, B. F. (2013). DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale. The American Journal of Psychiatry, 170(8), 834-851.
  6. Medicaid Innovation Accelerator Program. (2017). Overview of Substance Use Disorder (SUD) Care Clinical Guidelines: A Resource for States Developing SUD Delivery System Reforms.
  7. Proctor, S. L., & Herschman, P. L. (2014). The Continuing Care Model of Substance Use Treatment: What Works, and When is “Enough,” “Enough?” Psychiatry Journal, 2014, 692423.
  8. S. National Library of Medicine. (2020). Opioid Misuse and Addiction Treatment. MedlinePlus.
  9. National Center for Complementary and Integrative Health. (2021). Complementary, Alternative, or Integrative Health: What’s in a Name?
  10. McKay J. R. (2021). Impact of Continuing Care on Recovery from Substance Use Disorder. Alcohol Research: Current Reviews, 41(1), 01.
  11. National Institute on Drug Abuse. (2020). Principles of drug addiction treatment: A research-based guide (Third edition).

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