Drug and Alcohol Rehab while living at home: Intensive Outpatient and Day Treatment

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Many people think that “drug and alcohol rehab” means moving into a treatment center, staying in their bed, eating their food and having a roommate. Moving away from your normal living circumstances might at times seem necessary to make the changes necessary to obtain sobriety or engage in a program of recovery. Research has not found that this level of care is necessary or more effective in most cases. (1)

Residential or inpatient care is usually necessary when medical detox is needed, or if environmental containment and supervision is required due to behavioral or psychiatric disorders. If a person is living with or adjacent to others with similar problems, it is important that another living environment is found. Getting sober around using others is unlikely.

The benefit of undergoing treatment in your normal environment is that you will immediately apply your new discoveries and changes into real world conditions. Rather than hoping that you can take home what is obtained in a protective living environment under the supervision and twenty-four hour care of professionals, at home you will learn how to apply the new skills directly into your life. You will also be able to bring in the early sobriety stresses, problems and “wreckage” to the program and to the group for real-world help.

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.

Most people undergoing treatment today do not have the resources to pay for the higher costs related to a residential level of care. Before committing, it is important to obtain a clear view of the costs involved with residential care and avoid relying upon general statement about the center billing the insurance and putting the rest on a payment plan. The rest could turn out to be the majority of the costs of a very expensive treatment encounter. Make sure that you are aware of what you are committing yourself and family.

  • (1)”Subjects benefited equally from outpatient and residential aftercare, regardless of the severity of their drug/alcohol problem.” Differential effectiveness of residential versus outpatient aftercare for parolees from prison-based therapeutic community treatment programs. William M Burdon1, Jeff Dang2, Michael L Prendergast1, Nena P Messina1 and David Farabee 1, *Corresponding author: William M Burdon wburdon@ucla.edu, 1University of California, Los Angeles, Integrated Substance Abuse Program, Substance Abuse Treatment, Prevention, and Policy 2007, 2:16 doi:10.1186/1747-597X-2-16 
  • “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. We consider the implications of our findings for future research, especially the need to examine the conceptual rationales put forward by proponents of inpatient and outpatient treatment, i.e. mediators and moderators of setting effects.” 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 
  • “Greater service intensity and satisfaction were positively related to either treatment completion or longer treatment retention, which in turn was related to favorable treatment outcomes. Patients with greater problem severity received more services and were more likely to be satisfied with treatment. These patterns were similar for patients regardless of whether they were treated in outpatient drug-free programs or residential programs. The positive association between … greater levels of service intensity, satisfaction, and either treatment completion or retention-and treatment outcome strongly suggests that improvements in these key elements of the treatment process will improve treatment outcomes.” Relationship between drug treatment services, retention, and outcomes. Hser YI, Evans E, Huang D, Anglin DM. Neuropsychiatric Institute, University of California-Los Angeles, 1640 South Sepulveda Boulevard, Los Angeles, CA 90025, USA. yhser@ucla.edu 
  • National studies indicate significant reductions in recidivism following outpatient treatment Pre-treatment Post-treatment, Drug Abuse Reporting Program (DARP), National Treatment Improvement Evaluation Study (NTIES), Treatment Outcome Prospective Study (TOPS) 
  • Outpatient treatment of probationers leads to fewer arrests at 12 and 24-month follow-up (Lattimore et al., 2005) vs. untreated probationers 
  • High-risk probationers receiving outpatient treatment experience 10-20% reductions in recidivism (Petersilia & Turner, 1990, 1993) 
  • Reductions in probationer recidivism durable for 72 months after outpatient treatment (Krebs et al., 2009) 
  • Outpatient treatment more effective than residential treatment for drug-involved probationers (Krebs et al., 2009) and during reentry (Burdon et al., 2004) 
  • Greater benefits for the cost for outpatient treatment in non-offender samples (CALDATA, French et al., 2000, 2002) 
  • Aftercare services among drug-involved offenders can significantly reduce substance use and re-arrest (Butzin et al., 2006) 
  • Outpatient aftercare services can reduce likelihood of re-incarceration by 63% (Burdon et al., 2004) 
  • Aftercare services provide $4.4 – $9 return for every dollar invested (Roman & Chafing, 2006) 
  • “…(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. Conclusions Results provide some support to the matching hypothesis that for patients who have higher levels of substance use severity at intake, treatment in in-patient/residential treatment settings is associated with better outcomes than out-patient treatment.” 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 
  • “Compared to those receiving no treatment, those receiving nonresidential treatment took longer to fail or recidivate. However, those receiving residential treatment did not differ from those who received no treatment in time to failure. In the treatment-only model, nonresidential treatment participants took longer to fail than their matched residential treatment counterparts.” The impact of residential and nonresidential drug treatment on recidivism among drug-involved probationers: A survival analysis. Krebs, C. P., Strom, K. J., Koetse, W. H., & Lattimore, P. K. (2009). Crime & Delinquency, 55, 442-471.