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Does Outpatient Detox Work?

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How Do I Get Clean and Sober?

Often the first step of recovery from drugs or alcohol is entering a detox facility. The two main settings in which detox takes place are inpatient and outpatient. Outpatient provides patients with the freedom to continue their daily lives while detoxing. Although outpatient provides less structure than inpatient detox, it can still be effective in managing withdrawal.

How Many People Have an Addiction?

People struggling with addiction.Substance addiction represents both a complex personal health issue and an alarming epidemic in modern society. The Substance Abuse and Mental Health Services Administration (SAMHSA) notes that in 2014, 20.2 million American adults or 8.4% of the population struggled with a substance addiction.1

As we know, it can be challenging for someone to overcome drug use on their own. Uncomfortable withdrawal symptoms, medical complications, and intensified cravings can cause even the best-intentioned people to relapse and fall back into the cycle of addiction. For this reason, many people find that a formal outpatient detox program represents the first step towards recovery.

What does this Process Entail?

Detox refers to a group of interventions intended to assist someone either acutely intoxicated or in the midst of drug and alcohol withdrawal.2 Detox aims to enhance a person’s comfort and safety throughout withdrawal by providing medical and psychiatric support, monitoring, and stabilization. Furthermore, detox also helps facilitate a patient’s admission into comprehensive treatment for addiction. After all, for many people, detox is only the first step towards achieving recovery.

There are different detox settings, and the right setting will depend on the drug of choice, the severity of addiction, and mental and physical health.

Outpatient detox can occur as part of an intensive outpatient program (IOP) or a partial hospitalization program (PHP). It is often recommended for patients with mild to moderate withdrawal symptoms.2

Outpatient detox programs provide a structured setting in which patients are required to attend onsite meetings and services for several hours each day ranging from 3 to 14 days.3 A multidisciplinary team of physicians, nurses, therapists, addiction counselors, and technicians provide support in evaluating the patient and providing care.

Difference between inpatient detox vs. outpatient detox.Outpatient detoxification services occur in scheduled sessions, which can range from a few hours per week to several hours per day, depending on a patient’s needs.2 Patients often commute to and from the detox facility while living at home, continuing to work or attend school, and maintaining social relationships.3

Outpatient detox is different from an inpatient setting in the sense that it does not provide 24/7 monitoring and management. When a patient undergoes inpatient detox, they live on-site and receive continuous care. There is complete separation from the substance-using environment.3 Potential downsides to inpatient detox include the fact that it generally costs more than outpatient services and that it may enable a temporary avoidance of personal responsibilities by facilitating patient over-dependence on treatment staff.

Services Provided

When patients first enter detox, they will likely undergo urine toxicology screening and receive an initial biopsychosocial assessment to evaluate their general health history, mental status, vitals, patterns of substance abuse.2

This information helps treatment staff develop an appropriate, integrative treatment plan for care. Outpatient detox may employ a variety of services to engage and retain patients in their care, including the following:2,4

  • Support Systems: Detox centers may integrate 12-step meetings, group therapy meetings, and client advocates to intervene with patients who wish to leave detox prematurely.
  • Case Management: Case management minimizes barriers to treatment and aftercare and can assist with wraparound services that include issues related to housing, health care, and employment. Case managers can help detoxing patients mentally transition to and from detox into addiction treatment.2
  • Behavioral Therapy: Individual, family, and group therapies can improve a patient’s level of motivation, provide incentives for sobriety, and build appropriate coping skills to manage drug cravings. Many detox and treatment centers offer a combination of different forms of psychotherapy to provide support to their patients.4
  • Medications: As part of a medical detox protocol, many patients benefit from medications, such as methadone, Suboxone, to manage withdrawal or craving symptoms associated with opioid abuse. 4 Furthermore, patients struggling with co-occurring disorders, such as depression or anxiety, may receive psychiatric medications that help alleviate or reduce the negative symptoms associated with detox.

Is Outpatient Detox Effective?

Needing treatment tailored to your needs.

Though outpatient detox can be effective for those with relatively mild substance addictions who are not at risk of severe withdrawal, there has been limited research to document the respective success rates and other differences between outpatient and inpatient detox centers. One study examining 164 patients found that significantly more patients completed inpatient detox compared to outpatient detox.2 As the addiction epidemic continues to unfold, more research will likely emerge comparing different detox outcomes. Like with any treatment, everyone’s detox experience will vary. This means that every patient will respond differently to interventions and suggestions.

With that said, outpatient detox is not typically recommended for the following populations:2,3

  • Patients with high-risk medical conditions, like pancreatitis, gastrointestinal bleeding, or cirrhosis
  • Patients withdrawing from substances, such as alcohol or benzodiazepines, that present with potentially life-threatening withdrawal symptoms
  • Patients withdrawing from opioids, which can cause distressing and painful withdrawal symptoms.
  • Patients struggling with homicidal or suicidal ideation, as mental health symptoms may worsen during the withdrawal process
  • Patients in negative or disruptive family or employment situations, where living at home would be counterproductive to successful detox treatment
  • Patients who cannot travel daily to the outpatient detox facility
  • Patients with a history of chronic relapse, as they will likely need a higher level of care

Outpatient detox is less structured than inpatient detox, as patients are not medically and psychiatrically supervised at all times.2 As patients do not live on-site as they do during inpatient or residential treatment, there may be easier access to drugs and alcohol. In some instances, factors such as these can lead to premature drop-out and increased relapse risk.

However, outpatient detox can provide tremendous support for patients struggling with substance addiction issues. It is a cheaper and less-invasive option to inpatient detox treatment and can represent a person’s first point of contact with substance abuse treatment.

Sources

  1. Substance Abuse and Mental Health Services Administration. (2017). Mental and Substance Use Disorders.
  2. Substance Abuse and Mental Health Services Administration. (2008). Detoxification and Substance Abuse Treatment.
  3. Hayashida, M. (1998). An Overview of Outpatient and Inpatient Detoxification. Alcohol Health & Research World. V. 22 N. 1.
  4. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).

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