If you read levels of care you know that 90 percent of addiction treatment is delivered in outpatient treatment programs. The three primary options are: Regular (1-8 hours per week), intensive (9-19 hour per week), and day treatment or partial hospitalization (20+ hours per week). Other options that often are delivered on an outpatient basis include: detoxification, medicated-assisted treatment for opioid use disorders, and seeing someone in private practice.
All outpatient care is not created equal, there are incredible variations in the credentials of who delivers treatment, types of interventions offered, and cost. Before heading off to a program you want to do your homework and shop around for a program that will best fit your needs. Here is what you need to know about the two most critical factors in picking the best outpatient program: (1) who delivers care, (2) types of treatment offered.
1. Who Delivers Treatment
By far the most important variable in optimizing your treatment is the clinician who actually delivers care. Think about this: a program does not deliver treatment, people deliver treatment. This is why you should not be shy about asking specifically about the credentials of who you would work with when comparison shopping. Because addiction most often co-occurs with other mental health issues, it’s best to pick programs that employ clinicians that have at minimum a master’s degree in a counseling related field, and are licensed or on track to be licensed by the state in which they practice.
The degree means they have at a least a baseline knowledge of how to diagnosis and treat not only addiction, but mental health problems as well. The license is important because it means their work is regulated by a Board. To maintain their license they must participate in continuing education, and abide by all the laws and ethics that govern their practice, which gives you added protection that they know how to deliver quality care. In sum, those who have graduate degrees and are licensed provide you a degree of confidence that you are working with someone who has invested a considerable amount of time (and money) into becoming a professional treatment provider.
As you shop around, you will find that many outpatient programs will utilize clinicians that have certifications in addiction treatment. There are many different types of certifications that all have different requirements. Some require no college education, while others require a graduate degree. The reason you will find many outpatient programs utilizing clinicians without graduate degrees and licenses is because owners of treatment programs can pay them less money. Keep in mind that addiction treatment is a business, and in most cases a for-profit business. So as a consumer, to a large degree you get what you pay for. Those with better credentials and more experience cost more, which is often why many of the best therapists don’t work in outpatient programs but go into private practice where they can make more money.
As the consumer you need to be vigilant in asking enough questions to really understand the credentials of the staff. In general, ensuring that who you work with has a graduate degree – no matter what their certifications are – is your safest bet.
Also, please know that there is more to being a competent therapist than having a graduate degree and license. Scott Miller is a psychologist who has spent his career pursuing the ingredients of top performing therapists. Check out his blog and this insightful video on the evolution of psychotherapy. While there is a ton of information on these links, know that beyond education and licensure, you will benefit from a therapist who:
- Fits treatment to your needs
- Measures in some way your progress and makes adjustments to treatment accordingly
- Listens empathetically
- Engages emotion and goes beyond just talk therapy when appropriate
- Keeps you motivated to work on your issues outside of therapy
- Is not afraid to refer you to another therapist if treatment is not working
2. Types of Treatment Offered
Beyond selecting a program based on the credentials of the clinician(s), the second factor that you should consider in selecting where to go is the types of treatment offered. This means you need to know what types of treatments have been shown to give you the best outcomes. Here again, not all types of treatment are equal. A ton of research has been done on addiction interventions, and the following links will provide you enough knowledge to know what to ask when you are comparison shopping for a program:
- Investing in addiction treatment: Is it worth the cost?
- Matrix of evidence-based practices and overview of evidence-based practices
- Principles of drug addiction treatment
- American Psychological Association’s guide to evidence-based practices
One of the best ways to get at this issue is to first ask for an overview of what treatment will look like. What can you expect from the first few sessions? How are interventions chosen? If a program administrator tells you that the program uses a combination of individual and group therapy, but does not provide details of what happens in these sessions, then ask! And ask how a program measures whether what they are doing with clients is working. What specific assessment tools do they use session by session to measure progress? If they don’t use any tools, ask why. Programs that have no way of measuring outcomes have no accountability to the interventions they are delivering.
Also, ask whether the program supports the use of addiction medications. For opioid use disorders, I would not select a program that has no experience with buprenorphine or methadone, because both of these medications have been shown to significantly improve outcomes. Sadly, despite all the evidence that addiction medications can help those who struggle with addiction, there are still many programs that know very little about these medicines, and some that actually oppose their use.
How to Locate Outpatient Programs in Your Area
There are a number of ways to get a list of programs to begin comparison shopping. The first is to use the Substance Abuse and Mental Health Services Administration’s Behavioral Health Treatment Services Locater website. If you are seeking help for opioid use disorders, SAMHSA offers an Opioid Treatment Program Directory. Use these sites as a starting point, and then fill in the gaps by doing your own web search in your community. Also ask those you trust who may know of good programs, including: your doctor, pastor, friends, or others who may be knowledgeable about addiction treatment in your community.
The challenge comes when you get your list, do your homework by calling and interviewing the programs in your area, and none offer clinicians with solid credentials delivering evidence-based practices. Or worse, you live in a community where there are no treatment programs at all. In such cases, your best bet is to seek out someone in private practice, or consider starting with an online program.