Nearly any type of treatment that can be administered on an inpatient basis can also be administered on an outpatient basis with only a few exceptions.
The major therapy modalities often on an outpatient basis include:
- Pharmacotherapy: Pharmacotherapy involves the administration of drugs for medicinal purposes. The majority of individuals receiving medications for substance use disorders, other psychiatric conditions, and medical conditions receive them on an outpatient basis. Very few medications are administered on an inpatient-only basis. Pharmacotherapy may also include the notion of medically assisted treatment where medicines and other medical techniques are used in the treatment of substance use disorders and other psychological/psychiatric conditions. For example, a tapering strategy used in medical detox where a physician slowly tapers down the dosage of the drug on a fixed schedule to assist the individual in negotiating the withdraw process is a medically assisted treatment.
- Psychosocial interventions: Psychosocial interventions refer to interactions with one or more other people that are primarily verbal in nature (but can include other sensory modalities) to assist the person in changing their behavior. This group of interventions includes what most people think of when they hear the word therapy. Formal individual and group therapy or counseling are included in this broad category as are other familiar types of treatments such as support groups.
- Intensive outpatient treatment: A number of individuals entering substance use disorder treatment will have serious issues, such as severe substance abuse problems, co-occurring disorders such as depression or other psychiatric/psychological disorders, and/or come from toxic environmental situations such as abusive homes, family strife, being homeless, etc. These individuals may not be able to enlist in inpatient treatment programs or may have been released from an inpatient treatment program and need further intensive treatment. Intensive outpatient treatment provides intense, focused therapy that is administered at least nine hours a week. Individuals will meet three or more times a week for two or more hours at a time. This provides them the intensive treatment that they need.
- Psychoeducation services: Psychoeducation is a term used to describe classes or seminars that can be used in the therapy process. While these are a form of a psychosocial intervention, they merit special consideration because most individuals do not think of these as therapy or therapeutic; however, learning is often quite therapeutic. Psychoeducation services provide an expert teacher or mentor to explain specific types of information to others who can use this information to better themselves.
Psychosocial Interventions Used in Outpatient Therapy
The term therapy describes a professional relationship where a trained therapist or counselor works with one or more individuals in assisting them to change something about themselves. By definition, groups like Alcoholics Anonymous are not forms of “therapy,” even if individuals find them to be therapeutic. Formal therapy can only occur when there is a trained licensed therapist involved. Any type of interaction or learning situation can be therapeutic, meaning that an individual gets insight about change from it, even if there is no trained therapist involved. Some of the more popular outpatient interventions that are not types of formal therapy will be briefly listed at the end of this article.
A number of different psychosocial interventions or psychosocial therapies are used in outpatient therapy programs. Several of the major paradigms of therapy used in the treatment of substance use disorders are:
- Group and individual therapy: When one client works with a therapist, the sessions are described as individual therapy. When more than one client works with one or more therapists in a session, the intervention is described as a form of group therapy. Individual therapy has the advantage of being focused toward the individual, offering more privacy, and offering more flexibility regarding the client’s schedule. Group therapy offers the advantage of learning and socializing with peers who have similar problems, realizing that one is not alone in their struggles, and the development of important social networks that can last a lifetime. In addition, group therapy has the advantage of working with couples, family members, etc., when the specific issue affects all of these people together.
Both types of therapy are effective and can be used together (an individual attends individual sessions and also group sessions). Types of group therapies include focused therapy in groups (e.g., substance use disorder groups), marital therapy, and family counseling/therapy. Group therapy or individual therapy can consist of therapy from any type of paradigm in psychology, such as Cognitive Behavioral Therapy, Motivational Interviewing, etc.
- Cognitive Behavioral Therapy (CBT): The various forms of CBT are still among the most popular types of therapy used in substance use treatment on an inpatient or outpatient basis. CBT has a large body of empirical evidence to support its use in the treatment of many different conditions. It is important to understand that the term CBT no longer refers to a singular form of therapy, but now applies to a number of different types of therapy based on the principles of CBT.
CBT is a combination of cognitive therapy and behavioral therapy. Cognitive therapy addresses how individuals think about themselves, the world around them, and the future. The crux of cognitive therapy is to understand certain types of irrational and dysfunctional patterns of thinking and believing that individuals develop, and then to challenge those and help clients change them. Behavioral therapy is simply what its title describes: a formal approach to changing certain behaviors in individuals. These are most often accomplished by using different types of reinforcement strategies to increase desired or positive behaviors in individuals. Combining behavioral therapy principles with cognitive therapy has been demonstrated to be an effective approach in helping individuals change. Some types of Cognitive Behavioral Therapy include Dialectic Behavior Therapy, various types of exposure therapies such as systematic desensitization for trauma, and stress inoculation therapy.
- Motivation Enhancement Therapy (MET): Very often, individuals who are in dire need of treatment are either not ready to accept that they have a problem or not motivated into investing the time and energy it takes to induce change. MET is a program that can be used early in the treatment process to assist individuals who have substance use disorders or other types of disorders in realizing that they need to invest energy into a treatment program, developing motivation to change, and making a commitment regarding specific types of strategies they will need to adopt in order to change.
- Motivational Interviewing: Motivational interviewing refers to a specific approach to initially help individuals realize their problem and become motivated to change. Motivational Interviewing has grown into to a specific type of Motivational Enhancement Therapy that can be used throughout the treatment process.
- Contingency Management therapy: This is a program that uses CBT principles to provide incentives for the individual to engage in a program of recovery from a substance use disorder. Typically, certain types of reinforcements are put in place for the individual to remain abstinent.
- Relapse prevention: Relapse prevention programs are specifically targeted to help individuals with substance use disorders avoid relapse on a long-term basis. These programs draw from a number of different psychological paradigms, including cognitive therapy, behavioral therapy, psychodynamic therapy, and others, to help individuals learn to recognize vulnerable situations (e.g., triggers), reduce stress, and develop positive coping skills to remain focused on their program of recovery.
- Mindfulness therapy: Mindfulness has become a very popular concept in both therapy and in everyday life. The term mindfulness is becoming a kind of catchphrase for a number of different interventions. Mindfulness has its origins in Eastern philosophy, such as Buddhism, and it has been adopted for a number of different uses. Mindfulness refers to the notion of being aware of the moment. A number of different mindfulness techniques can help people become aware of what they are thinking, feeling, and doing, and these techniques can be applied in therapy and to real-life situations to cope with substance use disorders and other psychological/psychiatric disorders.
- 12-Step facilitation therapy: This program of therapy is designed to enhance one’s participation in 12-Step groups, such as Narcotics Anonymous, Alcoholics Anonymous, etc.
- An eclectic approach: There are a number of other types of therapeutic approaches that can be used in outpatient treatment. Trained therapists often attempt to combine some of the best features of these different types of therapeutic paradigms or approaches in order to make the treatment individualized and most effective for the specifics of the case. While there is a valid form of logic to the approach of combining certain aspects of different types of therapy that are shown to be particularly effective for specific problems, there is also a potential downside of this approach. Many types of therapeutic approaches require supervised training before an individual can competently deliver them. Therapists who purport to use an eclectic approach may not have gotten this targeted supervised training, and some therapists may simply haphazardly combine techniques without substantial justification for, or experience in, applying them. It is important to make sure that one inquires about the approaches that the therapist plans to use, and the training and qualifications they have to justify the use of those approaches.
Other Outpatient Interventions
There are a number of other outpatient interventions that are popularly seen in substance use treatment programs. Although these are not formal therapies by the strict definition of therapy, it is important to mention a few of them briefly because many individuals find them to be therapeutic. These include:
- Peer support groups, 12-Step groups, or other focused support groups consist of a group of individuals who meet regularly but are not supervised by a professional therapist. Instead, individuals who have successfully been in recovery for whatever type of substance use disorder, or other issue that the group addresses, will supervise the organization and structure of the group. Many of these groups are tied to national organizations, such as Alcoholics Anonymous. An advantage of these groups is that they meet often, are ongoing, and support themselves through donations, making them far less expensive (often even free) than formal therapy.
- Recovery support services are nontherapeutic services that are in place to support individuals who are in recovery. These services are also often provided by peers. They can include things like transportation services, education or employment assistance, specialized living situations, and mentoring or coaching services.
- Case management services provide individuals in recovery with support and assistance in finding resources to assist with their special needs. These are most often headed by social workers, part of a comprehensive addiction treatment program, or come in the form of peer support.