Outpatient Detox Centers

Published: 08/17/2012 | Author:

Alcohol, prescription pain pills, illicit drugs, and other substances alter the brain’s functioning and structure. Long-term drug and alcohol misuse can lead to physiological dependence, which means your body relies on the presence of the substance to function normally. If you are dependent on drugs or alcohol and you suddenly quit, you’ll experience unpleasant or even life-threatening withdrawal symptoms. If your symptoms are mild or you developed a dependence when taking a prescription medication, an outpatient detox center may be a beneficial option for you.1

What are Outpatient Detox Centers?

Quitting drug or alcohol misuse can cause withdrawal symptoms to emerge, but you don’t have to detox on your own or at home. Professional outpatient detox programs can provide you with detox services that work with your schedule. Unlike inpatient detox, you attend treatment during the day and then return home during non-treatment hours (typically, the evening).

Outpatient treatment can occur in a physician’s office, a hospital, or a free-standing detox center. Because you don’t receive around-the-clock care, outpatient should not be considered for anyone with a risk of severe withdrawal symptoms, such as delirium tremens (DTs), which can occur in cases of severe alcohol or sedative withdrawal and can lead to seizures, extreme agitation, and hallucinations.2

Severe withdrawal symptoms from other substances, including opioids, can include muscle spasms and cramping, nausea, vomiting, dehydration, psychosis, and obsessive thoughts about the substance. Another risk of severe opioid withdrawal is electrolyte imbalances and breathing in stomach contents into the lungs when vomiting.3

However, not everyone experiences dangerous withdrawal symptoms. Many people, especially those with a mild to moderate addiction or those who became dependent on a drug they were taking for medical purposes, are likely to have symptoms that can be managed on an outpatient basis. If you decide on outpatient detox, you must agree to attend detox on a regular schedule and take a withdrawal medication, if applicable.4

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Types of Outpatient Detox Centers

Outpatient detox can occur on several levels of intensity, from several hours of care per day to just a few per week. No matter the setting, it’s important that you have access to medical care, whether through a nurse or physician, as well as therapy and support groups that enhance abstinence.

Examples of outpatient detox types include:5

  • Partial hospitalization programs (PHPs) provide 20 or more hours each week of services.
  • Intensive outpatient detox programs (IOPs) offer at least 9 hours each week of recovery services.
  • Outpatient have weekly therapy and monthly physician check-ins.
  • A doctor’s office is the least intensive outpatient detox option.

Who is Recommended for Outpatient Detox Centers?

Medical, psychiatric, and social factors determine if you can benefit from outpatient detox or inpatient detox. The following are examples of factors that support going the outpatient detox route:6

  • Lack of acute physical and psychiatric illnesses
  • Low risk for delirium tremens, seizures, or convulsions
  • No history of severe withdrawal symptoms
  • No evidence of multiple substance misuse
  • Strong support system
  • Transportation to get to and from treatment daily or several times a week
  • Stable living environment

Also considered is the date of last use and the length of time you have had an alcohol or drug addiction.

Conversely, patients should be admitted to the hospital for inpatient detox if they have:1

  • Abnormal laboratory results
  • History or risk of delirium tremens
  • History of withdrawal seizures
  • A co-occurring mental health disorder, such as depression, anxiety, or bipolar disorder
  • A lack of a sober support system or stable housing
  • Suicidal ideation

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Length of Outpatient Detox Centers Programs

Outpatient detox program lengths vary, depending on the substance and medical interventions, but typically outpatient detox may range from a few days to several weeks. For instance, if you receive a withdrawal medication, such as methadone for opioids or benzodiazepines for alcohol, your outpatient detox program may last longer since you will need to be gradually weaned off your medication.

When detox is complete, maintaining abstinence becomes the focus, which could mean receiving medication-assisted treatment (MAT) for opioids or alcohol, attending inpatient addiction treatment, or transitioning to outpatient substance abuse treatment. If you are struggling with staying sober, you may need a more structured recovery environment. It is a sign of strength and self-care to move to a higher level of care when needed.

Protocols in Outpatient Detox Centers

Most outpatient detox centers follow a specific protocol for treatment planning. The services assigned to you may differ from those assigned to someone else. The treatment team of physicians, nurses, psychologists, and other staff understand there is no one-size-fits-all method and will provide you with individualized care.

Assessment and Diagnosis

Outpatient detox programs begin with an extensive assessment of your physical, psychological, and social health. The assessment helps determine a diagnosis and which level of detox you will benefit from the most. Your doctor may request laboratory tests depending on the substance or substances you’re addicted to.

For example, if you have diabetes, physicians may want to monitor your glucose levels closely. If you have high blood pressure, you may need to avoid some medications during detox. Or, if you are pregnant, your physician may only want to use methadone or Suboxone versus a multi-layered protocol.8

The assessment can also tell your treatment team if certain plans have worked in the past and why or why not. They must consider your family’s history of physical and psychological illnesses, as well as substance misuse. Your social history will inform them of the types of support you have during and after outpatient detox. Below is a brief list of items used to create a treatment plan:8

  • Substance misuse
  • Physical ailments, past or present
  • Mental health disorders, past or present
  • Past traumas
  • Family history of substance misuse
  • Employment history
  • Living environment
  • Social supports
  • History of withdrawal symptoms

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Withdrawal Medications

Your treatment team will determine if medications can help you in outpatient detox. Typically, withdrawal medications are used during alcohol and opioid detox since FDA-approved drugs are available for these withdrawal syndromes. Alcohol withdrawal is typically treated with benzodiazepines since they have a similar mechanism of action to alcohol and can relieve symptoms and cravings. Opioid withdrawal can be managed with the opioid agonists, methadone and buprenorphine, which alleviate detox symptoms.9

Opioid and alcohol withdrawal medications can provide the following benefits:9

  • Easing withdrawal symptoms
  • Reducing cravings
  • Preventing seizures and delirium
  • Enhancing comfort during withdrawal

Behavioral Therapies

Behavioral therapies are beneficial to everyone trying to achieve long-term sobriety. They are counseling techniques used to teach you to change thought patterns that often lead to negative behavior patterns. By learning how to substitute negative thoughts with positive ones, you will notice improved reactions to events that generally may be a trigger for relapse. There are many types of therapies that may be used in outpatient detox centers to promote change and encourage people to enter addiction treatment, including:10

  • Cognitive-behavioral therapy
  • Dialectical behavior therapy
  • Trauma-focused cognitive behavioral therapy
  • Motivational enhancement therapy and motivational interviewing

Recent research on the brain shows it has neuroplasticity, meaning you can train it to change. One of the best ways to do this is through behavioral and psychotherapies.11

Research Shows Outpatient Detox Centers Work

The success of outpatient detox is due to many factors that bridge outpatient detox treatment and recovery. When surveyed, participants explained the reasons for choosing treatment following outpatient detox. Most of the reasons were actions the facility takes to make it successful, including:15

  • Rapport building
  • Education on the disease of addiction
  • Using evidence-based therapies
  • Individualized treatment plans
  • Special topics
  • groups (LGBTQ, women’s, men’s, adolescents, etc.)
  • Flexible hours and services (telehealth, evening programs, etc.)

One study shows withdrawal management is highly effective in reducing potential harm during outpatient detox treatment. Also, detox combined with treatment is much more effective than detox alone. Results of the study showed 27% of those who only receive alcohol outpatient detox readmit to the program within a year.13

In a review of studies on outpatient detox centers versus inpatient and residential programs, researchers report outpatient detox services are just as effective and, in some cases, more effective programs. For example, 50% to 70% of the participants were still abstinent at 18-month follow-ups.5

It seems the key to overcoming alcohol or substance use disorders on an outpatient detox basis involves thorough assessment, proper diagnosis, the use of medication during withdrawal, and for some, continued medication-assisted treatment to maintain abstinence. Behavioral therapies geared toward your personal needs should also be included, and programs meeting these requirements do exist.

If you are looking for outpatient detox centers, call us at 800-483-2193(Who Answers?). We will connect you with the right program.

Resources

  1. Newman RK, Stobart Gallagher MA, Gomez AE. (2021). Alcohol Withdrawal.
  2. US National Library of Medicine. (2021). Alcohol Withdrawal.
  3. US National Library of Medicine. (2020). Opiate and Opioid Withdrawal.
  4. Substance Abuse and Mental Health Services Administration. (2019). Findtreatment.gov.
  5. McCarty, D., Braude, L., Lyman, D. R., Dougherty, R. H., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014). Substance Abuse Intensive Outpatient Programs: Assessing the Evidence. Psychiatric Services (Washington, DC), 65(6), 718-726.
  6. Muncie HL Jr, Yasinian Y, Oge’ L. (2013). Outpatient Management of Alcohol Withdrawal Syndrome. American Family Physician, 88(9): 589-595.
  7. Blevins, C. E., Abrantes, A. M., Kurth, M. E., Gordon, A. L., & Stein, M. D. (2018). Quality of Life and Well-Being Following Inpatient and Partial Hospitalization Treatment for Opioid Use Disorder. Archives of Psychiatric Nursing, 32(3), 505-509.
  8. Schindler, B.A. & Parran, T. (2012). The Clinical Assessment of Substance Use Disorders. National Institute of Drug Abuse. Drexel University College of Medicine.
  9. Substance Abuse and Mental Health Services Administration. (2022). Medication-Assisted Treatment.
  10. National Institute on Drug Abuse. (2020). Behavioral Therapies.
  11. Costa, K. G., Cabral, D. A., Hohl, R., & Fontes, E. B. (2019). Rewiring the Addicted Brain Through a Psychobiological Model of Physical Exercise. Frontiers in Psychiatry, 10, 600.
  12. National Institute on Drug Abuse. (2020). Family-Based Approaches.
  13. US Department of Health and Human Services. (2016). Chapter 4, Early Intervention, Treatment, and Management of Substance Use disorders. Substance Abuse and Mental Health Services Administration (US). Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health [Internet]. Washington (DC).
  14. Davidson, L., White, W., Sells, D., Schmutte, T., O’Connell, M., Bellamy, C., & Rowe, M. (2010). Enabling or Engaging? The Role of Recovery Support Services in Addiction Recovery. Alcoholism Treatment Quarterly, 28(4), 391-416.
  15. Timko, C., Schultz, N. R., Britt, J., & Cucciare, M. A. (2016). Transitioning From Detoxification to Substance Use Disorder Treatment: Facilitators and Barriers. Journal of Substance Abuse Treatment, 70, 64-72.
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