Closing the Revolving Door—Problems With Intensive Outpatient and Partial Hospitalization Treatment for Addiction

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Drug and alcohol abusers frequently get caught in a revolving door of treatment—a perpetual cycle of treatment and then relapse. Treatment can get a bad name.

Yet, treatment is usually the only real solution for someone struggling with addiction. Though some people can stop using drugs and alcohol without help, for most, intervention is necessary. But what kind of intervention or treatment can stop the revolving door? Where is that one-way door that leads to a sober life? The answer must lie in finding the right treatment to begin with.

Determining the type of treatment usually begins with a quick screening or assessment. Sometimes these assessments are ordered by the courts to determine if an individual fits the parameters of an addict. Assessments are also done to assess for severity of addiction and what level of care is appropriate for the situation. This should be a straightforward and workable process that fits the severity of the problem with the right degree of treatment. Unfortunately, this is not always the case.

Most assessments attempt to place the addict in the least restrictive care possible. As a result, classes or group sessions are often recommended as treatment. There can be a few reasons for these low-level-care placements. Most insurance carriers do not want to pay for what they view as unnecessary residential treatment. Additionally, there can be errors in the assessment based on incorrect or incomplete information about the addict, or misinterpretation of the information presented. And there are reasons, systemic to the current field of addiction.

Addiction Viewed as a Medical Problem

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Addiction is increasingly but incorrectly viewed as a medical problem. A paradigm of medicine is to start with the least intensive solution. This usually makes sense. Why cut off an arm if one can take a pill to cure the infection?

Unfortunately, addiction treatment does not easily fit into this mold. Starting with a “lower,” less intensive treatment to assess workability is not an option for most. While assessing for the outcome of lower-level treatment, there is a possibility of overdose, continued criminal activity, or the increased risk of disease. Also, the abuser may lose hope if classes or group sessions do not work and may be unwilling to give treatment another shot. It is important to get it right the first time.

Though it is not the current standard of care, a better option is to immediately address the situation at a level of care sufficient to ensure a long enough period of abstinence to establish new patterns of behavior.

It is virtually impossible to achieve a desired long period of abstinence through an outpatient program. It is too easy to continue to use drugs, hang out with friends that use, and continue the pattern of behavior that created the problem in the first place.

Medications are commonly used to replace addictive substances in outpatient treatment programs. These medications (akin to medical bandages) range from opioid replacement drugs such as Methadone and Suboxone to anti-anxiety meds, such as Klonopin and Xanax. It is largely because of these meds that outpatient programs appear to have any effect at all. But upon graduation, the client may still be addicted—even if to the replacement drug.

We need better outcomes than this on the first try. Because of the potentially fatal nature of addiction, not everyone gets a second try.

Levels of Care for Addiction Treatment

The concept of “level of care” is important to understand when dealing with an addiction. Each “level of care” represents the intensity of treatment. 

Levels include residential levels and outpatient levels. There are different levels within each category of residential and outpatient.

Outpatient Addiction Treatment

Outpatient visit
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The outpatient level of care is provided several times a week, for 1-2 hours a day. Individuals live at home and continue to engage in daily activities such as work. This level of care is sometimes called “Drug and Alcohol Classes” by the criminal justice system. This level of care may also be required when someone is placed on Methadone maintenance or Suboxone therapy.

A slightly more restrictive level of care, Intensive Outpatient increases the contact to 3 hours a day for 3-6 days a week.

For outpatient to be effective, the individual must have a stable living environment, stable work, little or no criminal justice interaction and the addiction must not be categorized as severe or moderate.

With its lax requirements, outpatient treatment is not likely to help someone with real addiction problems. There is simply not enough time in treatment to identify and change the underlying issues which caused drugs and alcohol abuse in the first place. And there is too much opportunity for mishaps.

Consider these points if you are contemplating outpatient treatment for severe abuse issues:

  • There is no around-the-clock care. This is the most apparent shortcoming of an outpatient program. If a recovering addict is attending an outpatient program for only a couple of hours per day, what is happening for the rest of the day? Who is there to prevent the addict from using drugs or drinking alcohol after drug class? There is no certainty of a safe and substance-free environment.
  • Programs are often too brief. Most people coming off drugs and alcohol need a good several weeks, even several months in some cases, to really kick the habit. If an outpatient program offers only a few sessions delivered over a couple of weeks, that is barely enough to scratch the surface of what it takes to get clean.
  • There is a lack of withdrawal and detoxification services in outpatient programs. Because outpatient programs do not offer residential care, they simply cannot provide effective withdrawal and detoxification services to their participants. Recovering addicts will either need to receive withdrawal and detox elsewhere or try to do it themselves. Going solo with withdrawal and detox is extremely dangerous and never recommended.

Residential Addiction Treatment

Residential treatment centers are locations where addicts live throughout the duration of their treatment program. They vary in length and type of treatment. Most offer several hours of treatment each day.

One of the most obvious benefits to a residential center is the fact that recovering addicts receive around the clock supervision and care. The safety and security of a drug-free environment helps the addict buckle down and focus on their program. A distraction-free effective program facilitates the changes in behavior that are necessary for someone to overcome addiction.

Here are some points of consideration regarding residential treatment:

  • The addict can focus on recovery without the distractions and stresses of day-to-day living. Real recovery from addiction takes time, dedication and work. Residential provides the environment where this can more easily happen.
  • Several hours per day, without distractions and stresses, can be devoted to recovery activities under the supervision of trained staff.
  • Recovering addicts usually have access to effective withdrawal and detox help in a residential setting. This is safer and easier on the addict.

Choosing the Proper Drug Rehab
for Your Loved One

Narconon Graduate

There are so many options to consider when trying to find an effective treatment center. There are hundreds of rehabs with many types of programs. It can be confusing.

There are a few basic facts to understand before getting into the complexities of different treatment options.

Any type of drug treatment is usually better than no type of drug treatment at all. However, getting the right type of treatment the first time goes a long way towards ensuring long term success.

Outpatient programs can help but are not recommended for someone who has been using drugs and alcohol for some time and cannot seem to stop on their own. Long term users usually fare better in long term residential treatment.

For over half a century, Narconon has used proven rehabilitation technology that gets to the root of the drug problem. Narconon creates a path for long-term success for all who seek help at the many Narconon centers across the world. The success of the Narconon program is measured in the thousands of graduates who lead healthy, drug-free lives.

The Narconon program is unique in many ways and effective in each of those ways. Narconon is a drug-free program. Supplemental drugs are not used in the recovery process. The drug-free approach provides a safe, invigorating, enlightening, and, most importantly, an effective pathway to drug-free living.

Narconon begins with a Drug-Free Withdrawal. It focuses on assisting addicts to come off drugs in a comfortable and rapid manner. Withdrawal is followed by the New Life Detoxification, a unique regimen of exercise, sweating in a dry sauna, and nutrition designed to cleanse the body of drug residues. Next, recovering addicts engage in Objectives—practical exercises that help them come out of painful and unpleasant past experiences and arrive in the present. Then, recovering addicts participate in Life Skills courses which teach the skills and the tools necessary to face life without turning to drugs and alcohol.

There is a drug addiction epidemic in the United States. Addiction has ruined the lives of millions of addicts and their families. You and your family do not need to participate in this epidemic of suffering. Call Narconon and begin the process of positive change today.



After graduating from the program in 2008, Matt works to help others find a new way to live life, free from drugs and alcohol. Matt is an Internationally certified drug and alcohol counselor and has written extensively on addiction and evidence-based treatment. You can follow him on Linkedin.