ADDICTION OUTPATIENT TREATMENT
Outpatient treatment of substance use disorders is appropriate for patients whose clinical condition or environmental circumstances do not require a more intensive level of care [I]. As in other treatment settings, a comprehensive approach is optimal, using, where indicated, a variety of psychotherapeutic and pharmacological interventions along with behavioral monitoring [I]. Most treatment for patients with alcohol dependence or abuse can be successfully conducted outside the hospital (e.g., in outpatient or partial hospitalization settings) [II], although patients with alcohol withdrawal must be detoxified in a setting that provides frequent clinical assessment and any necessary treatments [I]. For many patients with a cocaine use disorder, clinical and research experience suggests the effectiveness of intensive outpatient treatment in which a variety of treatment modalities are simultaneously used and in which the focus is the maintenance of abstinence [II]. The treatment of patients with nicotine dependence or a marijuana use disorder.
Outpatient treatment settings include but are not limited to mental health clinics, integrated
dual-diagnosis programs, private practice settings, primary care clinics, and substance abuse treatment centers, including opioid treatment programs. For individuals with primary nicotine dependence or a marijuana use disorder, treatment is always provided in an outpatient setting. For individuals with other substance use disorders, outpatient treatment is appropriate when clinical conditions or environmental and social circumstances do not require a more intensive level of care.
As in other treatment settings, the optimal outpatient approach is a comprehensive one that includes a variety of psychotherapeutic and pharmacological interventions along with behavioral monitoring, where indicated. The evidence base for empirically supported outpatient treatments is larger for alcohol, nicotine, and opioid dependence treatments than for other substance dependence treatments. In addition to medication therapies, outpatient treatments with strong evidence of effectiveness include CBTs (e.g., relapse prevention, social skills training), MET, behavioral therapies (e.g., community reinforcement, contingency management), TSF, psychodynamic therapies/IPT, self-help manuals, behavioral self-control, brief interventions, case management, and group, marital, and family therapies.
Many specific outpatient treatments have been designed to enhance an individual's participation in treatment and sense of self-efficacy regarding the reduction or cessation of problematic substance use. As in the case of residential and partial hospitalization programs, high rates of attrition can be problematic in outpatient settings, particularly in the early phase (i.e., the first 6 months). Because intermediate and long-term outcomes are highly correlated with retention in treatment, individuals should be strongly encouraged to remain in treatment. Clinicians should also encourage and attempt to integrate into treatment a patient's participation in self-help programs where appropriate.
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