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What to Expect When Starting Outpatient Treatment
April 17, 2017
Starting outpatient treatment can be a little scary, especially if you don’t know what to expect or are worried that treatment won’t work for you. Chances are, it will work, and in the process, you’ll improve your overall quality of life.
Engagement in treatment is a major factor in determining its outcome. Research shows that the more engaged you are with treatment, the better your chances of successful long-term recovery. Knowing what to expect when starting outpatient treatment can help ease your worries and get you excited about the prospect of finding meaning in life outside of drugs and alcohol.
Here, then, are nine things you can expect when starting a high-quality outpatient treatment program.
1. Expect a dynamic, individualized plan based on your assessment.
When starting outpatient treatment, you’ll undergo a comprehensive assessment to determine the extent of your substance use disorder and identify any co-occurring mental illnesses, such as anxiety or depression. Based on this assessment, you’ll work with a team of providers to develop an individualized recovery plan that addresses your unique, complex issues.
This customized approach is essential for the best treatment outcome, according to the National Institute on Drug Abuse, which identified several core principles of effective treatment to help guide treatment programs:1
- No single treatment plan is right for everyone.
- Effective treatment addresses all of an individual’s needs, not just the drug abuse.
- Treatment plans must be reviewed periodically and modified to address new and changing needs.
- Treatment must address any co-occurring mental disorders and treat them in the context of the addiction and vice versa.
The Substance Abuse and Mental Health Services Administration echoes the point that there is no single pathway to recovery and recommends a holistic approach to treatment that addresses issues of body, mind and spirit.2 SAMHSA has outlined four major dimensions that support a life in recovery, and a high-quality treatment program will address all of these issues in depth:
- Health, which includes managing physical and mental health problems and making informed choices that support good health and well-being.
- Home, which ensures you have a safe and stable place to live.
- Purpose, which includes engaging in meaningful daily activities and having the independence, income and resources to participate in the community.
- Community, which includes having relationships and a social network that offers support, love, friendship and hope.
Your individualized treatment plan will address your specific issues and needs in all of these areas, and the various supports and services you receive in treatment will be coordinated and integrated for the best possible outcome.
2. Expect to learn a lot in therapy.
Outpatient treatment will involve engaging in cognitive-behavioral therapy, which is a cornerstone of addiction therapy. It may sound complicated and boring, but it’s anything but. Cognitive-behavioral therapy helps you sort through a variety of issues in several ways.
Identifying Self-Destructive Thought and Behavior Patterns
Self-destructive thought and behavior patterns are at the heart of an addiction. Unhealthy ways of thinking and behaving often lead to substance abuse, and once substance abuse transitions to addiction, physical changes in the structures and function of your brain lead to unhealthy behaviors. Just as it takes time to develop unhealthy ways of thinking and behaving, it takes time to replace these with healthier thoughts and behaviors. Some of the most common harmful patterns of thinking include:
- All-or-nothing thinking, where if any situation falls short of perfect, it’s a total failure.
- Overgeneralization, where a single negative event tarnishes your entire world view and leads you to use the words “always” or “never,” such as “I always mess things up” or “I can never catch a break.”
- Discounting the positive, where you reject positive experiences, saying things like, “Anyone could have done that,” or “I could have done better.”
- Magnification, where you exaggerate the extent and impact of your problems while minimizing the value of your strengths and virtues.
Identifying these and other unhealthy thought patterns and learning to replace them with healthier ways of thinking requires that you examine your ideas and beliefs and learn to look at the world realistically, as it really is. Once you begin doing this, these new patterns of thinking will have a big impact on your behaviors.
Developing Coping Skills
Addiction is often the result of a lack of coping skills. Maybe you’re dealing with chronic stress, a dysfunctional family life or depression and use drugs or alcohol to cope with negative events and emotions. Developing strong coping skills to handle these potent triggers for relapse is essential for staying in recovery. For example:
- If stress is an issue, you’ll learn effective ways of reducing stress and tension through deep breathing, meditation and visualization as well as by removing some of the stressors in your life.
- If family dysfunction is an issue, you’ll learn healthy ways of coping with particular situations and communicating more effectively with family members.
- If you have a mental illness, it will be addressed in therapy and through medication to improve your mental functioning and relieve troublesome symptoms.
You’ll also learn coping skills to deal with cravings and other specific triggers, such as driving by the liquor store on your way to work every day or attending a large family gathering.
Finding Purpose and Meaning in Life
Finding purpose and meaning in life is a major focus when starting outpatient treatment, and it’s an important factor in preventing a relapse. In the course of cognitive-behavioral therapy, you’ll talk about the things that hold meaning for you. You’ll identify your strengths and values and learn to use these every day to help you find purpose in life. You’ll work with your therapist to identify a variety of ways to have fun and enjoy life without using drugs or alcohol.
Supports will be put in place to help you find purpose and meaning. This could involve going back to school, finding a particular type of job or engaging in more creative pastimes.
3. Expect to have a discussion about medication.
A combination of medication and therapy is the best approach to treatment for those who have an opioid or alcohol addiction or a co-occurring mental illness.3 If you’re a candidate for medication, you’ll have a discussion about it when starting outpatient treatment.
Medication-assisted treatment for opioid addiction involves taking a medication like buprenorphine to keep cravings at bay and prevent withdrawal symptoms while you work in therapy to reclaim your life. MAT can help you sustain long-term recovery, and it can either be a short-term, long-term or lifetime treatment strategy.
MAT is also available for alcohol addiction. Disulfiram is a medication that interacts with alcohol to make you sick to your stomach if you drink, while naltrexone can reduce the pleasure you get from drinking. Medications like acamprosate can reduce the intensity of cravings for alcohol so that you can focus on recovery.
Medication for Mental Illness
Mental illness is often caused by an imbalance of brain chemicals like dopamine, which causes feelings of pleasure, and serotonin, which promotes feelings of calm and well-being. When these neurotransmitters are out of whack, symptoms will appear, and these can dramatically reduce your quality of life and lead to substance abuse as a form of self-medication.
The good news is that numerous medications are on the market to help treat mental illnesses of all kinds. Finding the right medication or combination of medications that work for you may take a little time, but once you find the right one, it can transform your life and improve your chances of enjoying ongoing recovery.
4. Expect to learn skills you didn’t know you were missing.
Missing skills can have a detrimental impact on all areas of your life, from your health and relationships to your finances and lifestyle choices.
Some of the most common missing skills include:
- Financial skills, including paying bills, repairing your credit and budgeting your money.
- Anger management skills to help you control angry thoughts and reduce outbursts.
- Nutritional skills, including making healthy food choices, grocery shopping and preparing healthy food.
- Vocational skills, which may range from learning specific job-related skills to understanding workplace culture and expectations.
- Educational skills, such as managing your time, filling out financial aid forms, applying for scholarships and learning good study habits.
- Parenting skills, including communicating effectively with your children and providing a consistent, healthy living environment for them.
- Communication skills to help you communicate more effectively with friends, family members and co-workers.
Therapy will help you identify the essential skills you’re missing, and your treatment plan will include pathways for obtaining those skills.
5. Expect a variety of therapies to be included in your treatment plan.
When starting outpatient treatment, you may be expecting only traditional “talk” therapy sessions, but a high-quality outpatient program will offer a variety of therapies that explore issues from a number of angles. The availability of a combination of traditional and complementary therapies is an important factor in choosing an outpatient treatment program. In addition to cognitive-behavioral therapy, some of the most common therapies you may engage in include:
- Psychoeducational groups. These educational groups help you learn about the science of addiction, its effects on your emotions and behaviors, how relapse occurs and how addiction can be sent into remission for the long-term.
- Group therapy. Working with peers in recovery is a highly effective, research-based mode of treatment. During group therapy, which is facilitated by a trained and licensed therapist, group members share experiences, offer and receive support and work through a variety of issues together.
- Spiritual therapy. Spirituality in a treatment context doesn’t require religion. Rather, it’s a process of gaining a higher level of self-awareness, treating yourself more compassionately, seeing a bigger picture and facilitating the healing of mind and body.
- Biofeedback therapy. Stress is a major trigger for developing an addiction or relapsing once you’re in recovery, and reducing stress is an important focus in treatment. Biofeedback therapy helps you learn to mentally control your body’s involuntary responses to stress, including heart rate, body temperature and blood pressure, to help you relax.
- Adventure therapy. Nature is a powerful healer. Adventure therapy takes treatment into the great outdoors, where recreational activities and nature appreciation help you develop important skills like self-confidence, leadership, communication and trust.
- Trauma therapy. A large number of people in treatment for addiction have a lifetime history of trauma, which is a powerful factor in developing a substance use disorder. Trauma therapy helps you work through difficult experiences and emotions. It also helps you develop essential coping skills for dealing with the aftermath of trauma, including symptoms of post-traumatic stress disorder.
6. Expect to stay in treatment for at least 90 days.
When starting outpatient treatment, it’s impossible to know how long it should last, since people progress through treatment at different rates. However, the National Institute on Drug Abuse stresses that for residential or outpatient treatment, anything less than 90 days is of limited effectiveness.4 Treatment lasting significantly longer is recommended, since the longer you remain in treatment, the more positive the outcome.
As you progress through your program, you’ll “step down” periodically, which means that you’ll need fewer weekly therapy sessions or a certain type of therapy will no longer be needed at all. This step-down model ensures that you move through treatment at your own pace, and you step down only when you’re fundamentally ready.
While 90 days is a typical duration of treatment, some people need more time to work through the complex issues that underlie their addiction.
7. Expect an individualized aftercare plan once treatment is complete.
When you’re first starting outpatient treatment, you may wonder what will become of you once treatment is complete. The good news is that you won’t be left in the cold to fend for yourself. When your treatment program is complete and you’re ready to move forward in recovery on your own, an individualized aftercare plan will be developed and set in place to help guide you through the early months of recovery. This essential support plan will likely include ongoing therapy, and based on your needs, other components may be added, including:
- Time in a sober living facility to assist with the transition to regular life
- Engaging with a 12-step or alternative support group for ongoing peer support
- Vocational assistance to help you find or maintain employment
- Educational assistance to help you get a diploma or degree
- Legal assistance for help with legal problems
- Continued family therapy to help restore a high level of functioning within the family system
- Ongoing mental health care to monitor any mental conditions and the medications used to treat them
- Relapse prevention programming to help you maintain sobriety for the long-term
- Case management to monitor your progress, assess for changing and emerging needs and modify the aftercare plan as needed
8. Expect setbacks, but don’t let them stop you.
It takes time to learn new ways of thinking and behaving, and making better lifestyle choices and developing healthier habits takes practice. Setbacks are very common in early recovery as you learn new strategies and develop new coping skills.
A setback is anything that moves you closer to a physical lapse—an instance of using again—such as putting yourself in a high-risk situation or not setting healthy boundaries. The cardinal rule of recovery is that a setback is not the end of the world, and it shouldn’t stop your recovery in its tracks.
In a paper published in the Yale Journal of Biology and Medicine, addiction expert Dr. Steven Melemis stresses that setbacks are a normal part of progress, and they’re caused by missing skills or poor planning.5
How you approach a setback can either make or break your recovery. Those who view setbacks as entirely negative and see themselves as failures may stop focusing on the progress they’ve made so far and start focusing instead on how difficult recovery can be. They begin to feel frustrated and overwhelmed, and they may give up altogether. On the other hand, those who stay focused on their progress and view a setback as an opportunity to figure out what skills they need to work on are far more likely to get back on track with recovery quickly, better equipped and more motivated than ever.
9. Expect your future to be everything you want it to be.
Hope is the foundation of recovery, according to SAMHSA, which defines hope as a belief that a better future is possible. You’ll talk a lot about the future when starting outpatient treatment. You’ll talk about the things that are important to you, the dreams you have, the ideal life you see for yourself. And then you’ll start building it, slowly at first, piece by piece, until you’re living a healthy, purposeful and authentically happy life.
The foundation for your future will be laid in treatment, where you’ll explore what makes your life meaningful and work to repair damaged relationships. You’ll develop a toolkit of skills and strategies for long-term sobriety and learn to set realistic, actionable goals that challenge you and bring you enjoyment and greater self-confidence in the process of achieving them.
Starting Outpatient Treatment is an Exciting New Chapter in Your Life
When starting outpatient treatment, you may be afraid that it won’t work for you. This is a common fear, and it’s not unfounded. Some people don’t recover from addiction, and others live in a perpetual cycle of relapse and recovery. But the good news is that most people who enter a high-quality treatment program, fully engage in their treatment plan and stay in treatment for an adequate period of time stop using drugs, according to the National Institute on Drug Abuse.6
Starting outpatient treatment is starting a whole new chapter in your life, and it can be an exciting time of self-discovery. Recovery isn’t easy, but then, neither is living with an active addiction. As long as you stay engaged with your treatment plan, you’ll be able to reclaim your life, reinvent yourself, and improve your sense of well-being and quality of life.
You can expect that treatment will be worth it.
- Treatment Approaches for Drug Addiction. (2016, July). Retrieved from https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction
- Recovery and Recovery Support. (2015, October 5). Retrieved from https://www.samhsa.gov/recovery
- Medication Assisted Treatment (MAT). (n.d.). Retrieved from http://www.integration.samhsa.gov/clinical-practice/mat/mat-overview
- Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). (2012, December). Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-long-does-drug-addiction-treatment
- Melemis, S. M. (2015, September). Relapse Prevention and the Five Rules of Recovery. Yale Journal of Biology and Medicine, 88(3), 325-332. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553654/
- Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). (2012, December). Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment