In Part One of this blog, I discussed the more intensive levels of care, namely inpatient detoxification services and residential treatment services. In Part Two, I will review outpatient levels of care. Moving from the most intensive to least intensive, the first outpatient level of care (LOC) to consider is ambulatory detoxification services. This LOC is considered for the person who is using a substance or substances daily and is physically addicted. Physical addiction was explained in Part One as having developed tolerance for a substance and experiencing withdrawal symptoms when discontinuing that substance. Ambulatory detoxification typically involves going to a treatment center daily for a number of days to obtain medication, monitor vital signs, and assess the person’s comfort level during the detoxification process. A professional addictions specialist would determine whether a person appears to be a good candidate for ambulatory detoxification or would need monitoring in an inpatient detoxification.
Intensive outpatient (IOP) involves non-residential services that typically meet a minimum of 3 hours per day and typically 9 to 12 hours per week. The services often consist of daily educationally focused workshops, group counseling, individual counseling, and urine drug screens. This level of care usually lasts about 4 to 8 weeks, with the average being about 6 weeks. It is similar in its treatment approach to a 28-day inpatient treatment model, but the participant does not have to live away from home or even take a leave from his or her job.
The person who would benefit from IOP services is the individual who is using substances quite regularly, although is not physically addicted, and cannot seem to abstain from his or her substance use for any extended period of time. This LOC is also suggested for the individual who lacks education about substance use disorders and the recovery process.
Outpatient treatment is the next less intensive LOC to consider. Outpatient treatment includes any non-residential treatment services involving less than 9 hours per week or less than 3 hours in any day. It includes structured outpatient programs or treatment in the office of a private practitioner. An example of a structured outpatient program may include two 90-minute group sessions weekly, combined with a weekly individual counseling session. The treatment can last for weeks or months, depending on the provider’s treatment philosophy. The types of groups offered at this LOC also depend on the provider’s treatment philosophy, and can be oriented to a more traditional 12-step disease-model approach or geared toward more of a harm-reduction approach. You should ask about a provider’s orientation towards treatment prior to enrolling. In New York State, all licensed treatment programs are now rated by the Office of Alcoholism and Substance Abuse Services (OASAS) on a star system for their quality of treatment. This system in New York is known as Scorecards and can be accessed at http://www.oasas.ny.gov/providerDirectory/index.cfm.
The newest developing LOC for treatment of substance use disorders is online addiction treatment, such as the Inter-Care program, Chat2Recovery. For those individuals who are either reluctant to enter face-to-face treatment (for whatever reason), cannot commit to being at a specific location on a set schedule due to work or travel commitments, or cannot find accessible quality outpatient services, this may be an alternative for treatment. Chat2Recovery (C2R) has a 6-week program consisting of twice-weekly videoconferenced groups and bi-weekly videoconferenced individual sessions with a licensed clinician. The program is geared toward providing support and education about the recovery process. You can access it at www.chat2recovery.com.
If the level of care that you enter is not working for you, you can always go to a higher or lower level. If you are using your health insurance benefits to pay for treatment, your insurance provider will clearly have a say in which level of care you choose.
Nicholas Lessa is the Clinical Director of Chat2Recovery, an online substance abuse treatment program, and Inter-Care, a leading substance abuse treatment program in New York City. He has been in the field of substance abuse treatment for over 30 years. He is the lead author of two books, Wiley’s Concise Guide to Mental Health: Substance Use Disorders and Living with Alcoholism and Drug Addiction.