When Outpatient Treatment is Not the Right Option

When outpatient treatment for substance problems is not the right option, rehab typically is. Of course, treatment is a very personal thing because everyone has individual concerns and circumstances. However, you can be well-informed about pertinent factors to consider when choosing the right substance treatment setting for yourself or your loved one.

Confronting the Possibility of Treatment

Confronting the possible need for treatment can be an ordeal. It brings us to painful realizations about ourselves and our lives. None of us like being in pain, and naturally, that is what a substance problem takes us to. However, more often than not, we and our loved ones have been in pain about substance use for a prolonged period of time by the time we consider getting help, whether in outpatient treatment or in rehab. That leaves everyone overwhelmed and depleted, and unfortunately, often confused. It is certainly a less than optimal state in which to make difficult and very important decisions.

Also at this point is the painful reality in which we struggle to accept our own need for help. Many of us have long been conditioned to go it alone as a matter of pride. We mistakenly feel ‘weak’ or ‘less than’ when needing help and have to work through the difficult emotions of that before moving forward and reaching out. Others of us have also had traumatic histories in which asking for help was met with rejection, or even at times, was not a viable option. Perhaps, for example, there was no one really available to help us, or asking for help led to some form of abuse. Particularly, those of us who have had childhood abuse, neglect or abandonment issues, can believe that asking is useless and that even when others agree to help, they have a hidden agenda or don’t mean it at all.

Another difficult issue that arises as we approach substance treatment is the fear of losing our ‘best friend(s)’. And, our substances of abuse can seem to be the best options (friends) we have for coping with life overall. We turn to them and they comfort and ‘support’ us. It is an unfortunate and tragic corner to have painted ourselves into, but it is a common reality in the world of substance abuse and addiction. As our substance use progresses, we typically let go of more coping strategies and more pieces of life, the world, and our relationships, in order to grab on more tightly to our substances. We can eventually put all our proverbial eggs in the same basket. The prospect of letting go can be frightening.

Still another dilemma we face as we consider outpatient treatment or rehab is the stigma, shame, and guilt often associated with a substance problem in our culture. Substance Use Disorders are still considered non-medical issues by many, even though the American Medical Association began to accept substance problems as illnesses over 50 years now. Instead of considering them as only medical conditions, there is still a mistaken and widespread belief that abuse and addiction are morality issues, signified by inferior character traits and lack of morals. Many postpone treatment for fear of being ‘exposed’ as a shameful person.

Getting Past the Barriers to Treatment

Whether you or a loved one go to outpatient treatment or rehab to address problematic substance use, the initial barriers, such as those cited above, have to be overcome in some fashion at the beginning of your recovery process. There are many ways to move forward, and depending on your inclinations and resources, you will find your own individual strategies. However, outpatient treatment is a commonly used option to help get through the many barriers.

When one is addicted, thoughts about treatment are usually a long-term, episodically recurring consideration. However, the resolve to get help can easily fade in between one painfully ‘sobering’ moment and the next intoxication. Before you know it, you may have been living with the problem for a long period of time, sometimes years, after the first thought of getting help. It is the nature of illness that causes this. Intoxication along is a confounding thing, and a series of intoxications just layer upon one another until we are out of touch with our own realities. Also, denial is a core symptom of substance problems, and it can be a rigid blind spot or one that flashes off and on.

If you or your loved one is struggling with getting help for a substance problem, outpatient treatment can be a good first step. It seems less drastic to many than entering a rehab program right away. Also, for people still in a good bit of denial, outpatient treatment can help work through those issues. People sensitive to how others perceive their need for help and/or their substance use, often feel less exposed and less vulnerable when starting out in outpatient treatment.

However You Get to Treatment, You Can Benefit

It’s often said that no matter why or how you go to treatment, you can benefit. This is true even in the extreme

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the situation of being involuntarily sent to substance treatment by the courts. And, everyone’s motivations for seeking substance treatment are not the same. Some may go to save a job, a marriage, or self-respect, for example. Others may go to prevent more bad things from happening, already stinging from a host of severe negative consequences.

Whatever your personal journey to treatment, there are issues that you and any treatment provider have to address to find the right treatment setting, best ensure your safety and well-being and give you a viable option you can not only work into your current life somehow but can afford as well. Some of these important issues include:

  • How physically ill from your substance use are you?
  • Have you overdosed, or are at risk of overdosing?
  • How heavy has your substance use been?
  • How long have you been abusing substances?
  • What particular substance(s) are you addicted to?
  • Do you require a medically supervised detox for medical safety and/or successful completion of detox?
  • Are you isolated in your home environment and daily life? Do you need the support of others more intensively than staying at home while in treatment could provide?
  • Even with outpatient medical guidance for a gradual withdrawal, is your home life or daily routine conducive to abstinence?

The ‘Perfect Rehab Storm’

Many people have several factors converging for the ‘perfect rehab storm’. That is, they need to skip outpatient treatment and go to rehab, or they need to leave outpatient treatment and step up the intensity of their treatment for a time. A substance illness is a progressive condition. Things change. Effective treatment often means treatment must change as well to keep up with the changing illness.

Such a perfect storm occurs when people may not be able to resist substance use while living at home or may use a substance that absolutely requires a closely supervised medical detox only a rehab setting can provide. One’s use may have escalated and now has reached dangerous levels, for example, or one may have begun to incur severe, substance-related consequences. These issues are best clarified in medical consultations with your healthcare providers and/or someone in the addiction treatment field. We can help you with a free consultation as well.

There are no sweeping generalities, or one-size-fits-all treatment recommendations, for all people with a substance use problem. Individuals have complex and unique life circumstances. For example, a single parent has to consider childcare when going to treatment of any type. Everyone must consider how to afford treatment. There may be work or school-related issues that complicate a treatment schedule. There may be active and difficult family opposition to treatment, or denial among your supports that you even have a problem. The list can go on and on.

However, when it becomes clear that going to rehab is an urgent need, it is always wise to follow the advice of care providers, or your own instincts. Trusted loved ones can also provide helpful feedback. They are able to observe what is happening to you more objectively than you can when you are in trouble. However, do not confuse rehab with only a dire need situation. It is not. Effective rehabs are equipped to deal with all degrees of addiction severity—from mild and moderate to severe.

A Substance Use Disorder

Looking at the medical criteria for a Substance Use Disorder can help you clarify your situation or the situation of an addicted loved one. Substance Use Disorders cover a wide spectrum of problems related to substance abuse. There are eleven symptoms possible in diagnosing such a disorder. The severity of the disorder can be mild (2-3 symptoms), moderate (4-5 symptoms), or severe (6 or more symptoms). Keep in mind that a Substance Use Disorder progresses, so the symptoms had at any one time can change. There is no amount of symptoms that indicate outpatient treatment is more or less appropriate than rehab. However, reviewing these symptoms with your healthcare provider, an addiction specialist, and loved ones can help you determine the best treatment option now. Other factors will have to be taken into consideration, too, but this is a good start.

Symptoms of a Substance Use Disorder are:

  1. Taking the substance in larger amounts or for longer than you’re meant to.
  2. Wanting to cut down or stop using the substance but not managing to.
  3. Spending a lot of time getting, using, or recovering from use of the substance.
  4. Cravings and urges to use the substance.
  5. Not managing to do what you should at work, home, or school because of substance use.
  6. Continuing to use, even when it causes problems in relationships.
  7. Giving up important social, occupational, or recreational activities because of substance use.
  8. Using substances again and again, even when it puts you in danger.
  9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.
  10. Needing more of the substance to get the effect you want (tolerance).
  11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.