Without the transfer of recovery skills and support into the home, work and school environments, wreckage, triggers and interpersonal conflicts create a high probability of relapse and the loss of the recovery investment.

Outpatient treatment integrates recovery at home in the normal environment. Outpatient treatment provides a path to recovery which is:

• 100% Take-Home;
• Organic, Locally Grown;
• Sustainable;
• Integrated;
• Developed from Practical, Relevant Skills;
• Established by Authentic Relationships;
• Accesses Local, Authentic Sober Supports.

“Treatment on an outpatient basis allows a more valid assessment of environmental, cognitive and emotional antecedents of drinking episodes and drinking urges on the part of the patient, and allows the patient to test new coping strategies while still within a supportive counseling relationship.

These conditions would be expected to foster greater generalization of learning in treatment to the patient’s natural environment” (Annis, 1986, p. 183).

“Previous reviews have concluded that there was no evidence for the superiority of inpatient over outpatient treatment of alcohol abuse, although particular types of patients might be more effectively treated in inpatient settings.” The effectiveness of inpatient and outpatient treatment for alcohol abuse: the need to focus on mediators and moderators of setting effects, JOHN W. FINNEY, ANNETTE C. HAHN, RUDOLF H. MOOS Article first published online: 24 JAN 2006 DOI: 10.1046/j.1360-0443.1996.911217733.x Addiction Volume 91, Issue 12, pages 1773–1796, December 1996

“…(M)ore severe patients experienced better alcohol and drug outcomes following in-patient/residential treatment versus out-patient treatment; on the other hand, patients with lower baseline ASI drug severity had better drug outcomes following out-patient treatment than in-patient treatment. Treatment setting was unrelated to alcohol outcomes in patients with less severe ASI alcohol scores.” Day Hospital and Residential Addiction Treatment: Randomized and Nonrandomized Managed Care Clients; Jane Witbrodt, Jason Bond, and Lee Ann Kaskutas Alcohol Research Group, Constance Weisner, University of California, San Francisco, Gary Jaeger; Kaiser Foundation Hospital, David Pating, Kaiser San Francisco Medical Center, Charles Moore Sacramento Kaiser Permanente, Journal of Consulting and Clinical Psychology Copyright 2007 by the American Psychological Association, 2007, Vol. 75, No. 6, 947–95

If a loved one shows up, ruining family events and holidays under the influence of alcohol or drugs, what should I do?

1. Distinguish the love you have for the person from the frustration you feel about their behavior. Talk openly about the two with your loved one and your family.
2. Talk openly with your family and the person with the substance use problem about the problem. Don’t keep secrets.
3. “Invite them to get help”- pushing/ controlling usually makes things worse. Take care of yourself and your family by setting limits.
4. Set limits with your loved one and let them know that you will drive them to a treatment center to get help.
5. Set limits with your loved one and let them know that you will drive them back home if they show up or become drunken or drugged.
6. Set limits with your loved one and tell them that family time is off-limits for drunken or drugged behavior.
7. Make it clear to your loved one and your family that they are “sick”, not “bad”.
8. Communicate “stern love”: you care so much that you want to help them get well, rather than supporting them to destroy themselves.

How can I prepare my family for another holiday with someone’s alcohol or drug abuse problem?

1. Before holidays and family events, communicate openly with the family and the loved one with the alcohol or drug problem and set a plan.
2. Decide upon responses to and limit setting about drunk or drugged behavior and follow-though!
3. Let the person with the alcohol or drug use problem know that the family loves them and only wants to help them get better.
4. Communicate to the family and loved one the meaning of “enabling”: supporting continued alcohol or drug abuse by avoiding, ignoring, or enabling drunk or drugged behavior.
5. Offer to meet with the substance abusing loved one before the event or holiday to discuss how their problem affects you, and to help find them treatment for the problem.
6. Call a professional or treatment program before you meet with the loved one so as to prepare for an opportunity to help them get better.

What do I do if my loved one with the alcohol or drug use problem denies their problem or gets angry?

1. Communicate “stern love”: you care so much that you want to help them get well, rather than continue to destroy themselves.
2. Use the “broken record” technique”: repeat what you are saying if it isn’t being heard or considered.
3. Express your caring, compassionate feelings before expressing your frustration.
4. Recall and discuss incidents where drunk or drugged behavior ruined family events or holidays. Describe your past excuses for their behavior.
5. Attempt to get the help of a professional or a friend who has experience with recovery.
6. Step away from the conversation if you find yourself becoming angry or controlling.

What do I do if a family member or members don’t want to deal with or talk about the problem?

1. Let them know that secrets and silence enables alcohol and drug abuse to grow into deeper, more dangerous conditions.
2. Remind them of past occasions where family events or holidays were ruined by drunk or drugged behavior.
3. Discuss possible consequences of your loved one’s continued alcohol or drug abuse.
4. Discuss possible outcomes of talking openly with your loved one about their problem.
5. Suggest reading material related to alcohol and drug abuse/ addiction.
6. Set a plan.

Treatment working as well or better than residential treatment for alcohol and drug abuse and addiction:

“Treatment on an outpatient basis allows a more valid assessment of environmental, cognitive and emotional antecedents of drinking episodes and drinking urges on the part of the patient, and allows the patient to test new coping strategies while still within a supportive counseling relationship. These conditions would be expected to foster greater generalization of learning in treatment to the patient’s natural environment” (Annis, 1986, p. 183).

 

What are some of the different features of outpatient treatment which create better outcomes than in residential treatment setting?

• Therapeutic and supportive relationships are not disrupted in outpatient treatment.
• Therapeutic rapport with therapists, psychiatrists, prior sobriety supports and physicians are maintained.
• Strengths and assets at work, home, recreation can be built upon during the course of outpatient treatment.

 

Isn’t learning new skills and avoiding drug and alcohol use at home more difficult than in a clean and supervised environment?

• Rather than learning in a nice clean laboratory, apply the new skills directly into your life now. Outpatient treatment provides a much greater “take-home” advantage.

 

The benefits of getting sober at home actually enable newly sober people to

• Practice new skills immediately in real-life situations;
• Apply new discoveries, ideas and behavioral changes- practice improves retention;
• As clients and families learn more effective coping, communication and relationship skills, they can “practice” these skills both in treatment and at home
• Clients and families receive support and validation from each other while expanding their lasting sober supports in outpatient settings. Relationships can be maintained and won’t be disrupted at discharge as in residential treatment.

 

While you participate in an intensive outpatient or day treatment program for alcohol and drug abuse and addiction, what sober resources are found at home different from those in a residential program?

• Outpatient treatment mobilizes available supports (family, therapist, psychiatrist, family doctor, and/or mutual support organizations) rather than creating temporary and artificial supports that will be removed once a residential experience ends.
• Indigenous recovery supports are identified and activated during the course of outpatient treatment.
• The transition from active outpatient treatment into social support and recovery maintenance is much less abrupt than with residential treatment. Social support gains are generalized into real life.
• Clinical changes, recovery supportive resources, therapeutic and professional relationships are likely to be maintained.

 

Addiction creates casualties and long-lasting problems. How is this wreckage handled differently in an outpatient setting treating substance use disorders?

• People coming to terms with an addiction often face mounting financial, vocational and domestic problems- “wreckage”.
• Treatment should not add to those mounting bills, unnecessary absence from work and home.
• Rehab should instead help move you into the solution- toward resolving the “wreckage” of your addiction.

 

Why is residential treatment so widely recognized as the way to get sober?

• Residential treatment will produce better profit/ development margins for the business owner/ provider of care if critical business volumes can be achieved.
• The higher operating costs, administrative time, and professional oversight of residential components draw decision-makers to focus on their residential treatment at the expense of their less complex and less lucrative outpatient services.
• It is clear to the margin-oriented administrator that short-term financial gains will be best made from a residential model if only the beds can be filled.

 

Working people and their families are often covered by affordable health care coverage offered through managed healthcare plans such as HMO’s (heath management organizations), EPO’s (exclusive provider organizations) and PPO’s (preferred provider organizations). The Affordable Care Act has resulted in healthcare exchanges such as “Covered California” where people can purchase affordable healthcare insurance which is priced according to their income.

HMO, EPO, and PPO insurance plans usually relegate behavioral healthcare coverage and management to behavioral healthcare departments or organizations. The reason that services provided by alcohol and drug rehabilitation and treatment centers are managed separately by behavioral health departments is that diagnoses, prognoses and progress cannot be measured through conventional biological markers or measurement tools. A specialist in behavioral health is required to determine the level and type of care needed for complex diseases such as alcoholism and drug addiction now referred to as “substance use disorders”.

Costs and personal restrictions are better contained when a professional who is financially independent from the provider oversees care and monitors costs. Treatment can become exorbitantly expensive when there exists no such oversight. For some people with wealth, rehab can be combined with an extended luxury vacation. Not everyone can or should afford luxury or lengthy treatment.

When you seek a provider contracted with your insurance healthcare plan, the coverage is much better and the services are closely monitored for quality and cost. Ethical business practices can also be enforced such as providing you and your family about the best estimate of cost before a contract is signed.

Providers who are “out-of-network” will often state that they accept insurance. Before signing contracts, take the following steps to protect yourself:

• Ask the out of network provider if they will give you a written estimate of what the out-of-pocket cost will be after the insurance stops authorizing payment for treatment
• Ask if they will provide you an itemized bill which they send to your insurance company, including the charges for urinalysis
• Ask if the provider gets approved for all services rendered and ask how long the insurance company is likely to approve payment
• Ask if they bill you the balance after the insurance company ceases to cover treatment and how much that total is likely to run.

To protect you and your family from unethical business practices or to avoid unnecessary costs and services, ask you insurance representative or therapist for their expert opinion.