substance abuse

Inpatient vs. Outpatient Treatment: Two Different Approaches

Bryan Vasquez, CATC III, Certified Addiction CounselorLeave a comment

Inpatient rehab and outpatient rehab are two different approaches to treating substance abuse or addiction. The main difference between the two lies in the level of care and the setting in which the treatment takes place. Here’s a breakdown of each:

Inpatient Rehab:

  • Inpatient rehab, also known as residential rehab, involves staying at a treatment facility for a specified period, typically ranging from a few weeks to several months.
  • It provides a highly structured and immersive environment where individuals receive 24/7 care and support from a team of healthcare professionals.
  • Inpatient rehab is recommended for individuals with severe addiction, those with co-occurring mental health disorders, or those who have tried outpatient treatment and continue to experience repeated relapses.
  • The program includes a combination of individual therapy, group counseling, support groups, medical detoxification (if needed), medication management, and various holistic activities.
  • Inpatient rehab offers a safe and controlled environment, removing individuals from triggers and enabling them to focus solely on their recovery. Engagement with others who are going through a similar situation has also been found to be encouraging. The collective group consciousness and connecting with others who understand the challenges and difficulties of recovery, can be highly motivating.
  • In-patient treatment requires a significant time commitment and can be more expensive than outpatient treatment.

Outpatient Rehab:

  • Outpatient treatment allows individuals to live at home and continue their daily routines while attending scheduled treatment sessions at a facility.
  • It provides flexibility and is suitable for individuals with a supportive home environment, strong motivation, and a mild to moderate addiction.
  • Outpatient programs vary in intensity, with options ranging from a few hours of therapy per week to several sessions per day, depending on the individual’s needs.
  • Treatment typically involves individual counseling, group therapy, educational sessions, and relapse prevention techniques.
  • Outpatient treatment allows individuals to practice applying the skills they learn in treatment to real-life situations immediately.
  • It is generally more affordable than inpatient programs and can be an effective option for those with responsibilities such as work, school, or caregiving.
  • Exposure to daily life stressors and triggers may pose challenges for some individuals, potentially increasing the risk of relapse.

The choice between inpatient rehab and outpatient rehab depends on various factors, including the severity of the addiction, the presence of co-occurring disorders, personal circumstances, support system, financial variables, and individual preferences. It is essential to consult with healthcare professionals or addiction specialists to determine the most appropriate treatment approach for your specific situation.

Realize Behavioral Health is an outpatient level of care and has treatment options for dual-diagnosis, co-occurring disorders, harm reduction, moderation support, family support, and general mental health options. If you or a loved one are encountering challenges with alcohol, substance use, relationship problems, or mental health, call today for a free consultation. If we are not the right fit for your situation, we will assist you in finding appropriate care. 

How the Abstinence Violation Effect Affects Recovery

Bryan Vasquez, CATC III, Certified Addiction CounselorLeave a comment

Have you ever made a determination to start a new habit and have you been able to stay 100% dedicated to it through the remainder of your life? (insert cricket sound…) Of course, if you are reading this then you are still living and cannot confirm nor deny the attainment of this goal. If you are like most people, you set a goal to establish some new behavior which can be performed consistently and probably have sometimes where you fall short of your idealized expectations. Perhaps you said you would start waking up an hour earlier so you can exercise, or you’ve sworn off some specific type of food, only to find yourself having periodic success.

This is all a normal part of the change process. Setting a goal, taking steps to achieve it, and at times falling short. For those struggling with some form of addiction, this is a very relatable topic. Making a commitment to stop drinking only to find yourself days, weeks, months or years down the road ingesting alcohol. If you can relate with this, I’d like you to think of a time when you deviated from your goal to abstain and what your mind told you the moment you veered off that path. Did it say something to the effect of “Well, you’ve had one so you might as well drink the rest of the 6 pack…” or “I knew I couldn’t do this, afterall I am an alcoholic and I always screw things up and get drunk”, or even “I slipped yesterday so I am only at day one so I might as well keep going and I can start again tomorrow”. This type of thinking is a prime example of the Abstinence Violation Effect, or AVE.

The Abstinence Violation Effect is when there is any deviation from a desired behavior goal and this deviation is viewed as a total failure. This viewpoint that the deviation is a total failure is then used as a further justification to continue using or doing the addictive behavior. I have had clients that expressed after having one sip of a drink, they felt so badly and shameful for failing that this was the permission giving thought that getting drunk wouldn’t be any worse. After 5 years of sobriety, someone had a glass of champagne at a wedding and then felt that they had wasted their 5 years of sobriety and would have to start over anyway, so they ended up going on a binge for the next 18 months for fear of having to “start over”.

While this phenomenon is common with all types of people, it is often seen the most in those who put a strong emphasis on total consecutive days sober, as opposed to cumulative days sober. If you’ve struggled with an addiction, imagine the most acute period when you were struggling, and then imagine if someone told you that you would have 5 years sober, with only a glass of champagne, or one use of your addiction over the course of those 5 years.  Would you see that as a victory, or would you focus on the fact that you had one day out of 1,825 days where you engaged in your addiction and therefore failed?

It is suggested to work on staying in the moment and not beating yourself up for deviating from the path of your desired goal. Just like your phone navigation system will autocorrect when you drive off the assigned path, so too can you make a course correction if you fall back into an old behavior pattern, however short or long in duration. One sip is better than one beer, one beer is better than dusting off the whole 12 pack and so on. We need not use one slip to justify continued slips. An old quote I enjoy: Start where you are, use what you have, and do what you can!

Being Comfortable Feeling Uncomfortable

Bryan Vasquez, CATC III, Certified Addiction CounselorLeave a comment

Getting comfortable feeling uncomfortable, is one of my favorite recovery sayings because I feel it really sums up what is necessary to live a life free from problematic substance use.  Those who use chemicals to change their emotional state may have begun using, as a means of making a fun time even better, but once the consequences of use outweigh the benefits. The addictive behavior or chemical becomes the primary coping mechanism to avoid temporary discomfort.  At this point it may not even be about fun, but an attempt to feel normal and function in day-to-day activities.  

Choosing to reduce ones use, or to be abstinent, will inevitably push the individual to experience varying levels of discomfort since the body and mind have been conditioned to turn to the addiction as an attempt to relieve the discomfort.  For those who have been through this, we know this relief is fleeting at best.  The choice to stop this pattern is not an easy one and requires one to learn new ways of acting and thinking that will assist in developing tolerance of discomfort.  While the minds initial response will want to be to run away from the discomfort and use whatever is quick and easy, following through with this method will only keep us in the throes of the addictive lifestyle we so hope to escape. 

Understanding and accepting that discomfort is a natural part of life, and really any behavioral change, can be uncomforting during this process.  Dietary changes, deciding to wake up earlier, exercise, communicating better with a spouse, are all examples of changes that will be uncomfortable at first and stopping or reducing a chemical addiction is no different.  Remind yourself that change is uncomfortable at first, and over time this change will become more normalized which will therefore gradually reduce the discomfort as it becomes part of your new lifestyle.  

Avoidance is a common feature of addiction and is the antithesis of engaging in the behaviors that will bring you long-term, sustainable happiness.  We start using substances for a conduit to happiness, and paradoxically people choose to stop using substances to regain their happiness.  Learning to cope with discomfort is mandatory to maintain positive changes because discomfort is what we seek to avoid by having a drink, taking a pill, or smoking something.  

There are many ways to deal with discomfort in healthy ways and when done consistently become easier and easier over time.  I have found acceptance, mindfulness, and engagement in distractions to be some of the most powerful tools to get through temporary discomfort.  The mind will want to think about the future and how the discomfort will always be there, but how can you know what the future brings and how you will feel one day, one month or one year from now?  

Almost everyone I know who has been living a sober lifestyle states the urges and cravings diminish over time and many have gotten to the point where their addictive substance no longer holds any sway over their life.  By focusing on the moment at hand, and not projecting our current discomfort to how we will always feel in the future lessens its power and allows us to experience the transitory nature of all feelings.  Here one moment and shifting the next.  By learning to get comfortable feeling uncomfortable, we no longer make demands that “bad” feelings must be avoided and should not be tolerated.  Instead, we accept life has ups and downs and are able to push through these moments without having to turn to a substance to give us short term relief, while incurring long-term consequences as a result of their use.  

Reducing Harms Associated with Substance Abuse

Bryan Vasquez, CATC III, Certified Addiction CounselorLeave a comment

For many who have been using alcohol or drugs problematically, the advice given from loved ones and many mental health professionals is they must remain abstinent from all mind-altering substances and any deviation from complete abstinence is a cause for major concern. This approach to substance abuse follows an all-or-nothing model that does not consider all the gray areas between severe problematic addiction and complete abstinence, and can often have devastating consequences when a slip, or a lapse, occurs.

Harm reduction is about reducing the harms associated with substance abuse. It can be applied to any circumstance where there is less harm, or the potential occurrence of harm, due to specific interventions or actions to reduce, substitute, or replace the use of a harmful substance. In the case of alcohol, if someone were drinking a fifth of vodka a day, and is now drinking a bottle of wine, the harm would be reduced because a bottle of wine has much less alcohol content.  If someone has been using heroin and now strictly uses cannabis, they will have reduced the harm of a potential lethal overdose. 

Harm reduction can come in many forms and will be greatly needed during a time when addiction is expected to climb 100% over the next two years (CCAPP, 2020). For opioid use disorder, there are two main medications, Naltrexone and Buprenorphine, both of which can come in oral or subcutaneous once-monthly injections. Naltrexone can also be used for those who are wishing to stop drinking or reduce their alcohol intake as it helps with cravings and reduces the euphoric effects of alcohol. Often times, people may not want to use medications to help them cut back, taper or assist them in maintaining their abstinence, but harm reduction approaches have been shown to be highly effective when compared with total days sober, and not just total days abstinent (Peele, 2020).  

When working with clients, my goal is to always help them find ways to reduce the harm, or the potential for harm, caused by their problematic use.  Expecting or demanding complete abstinence, when that is not the goal or desire for someone only sets them up for guilt, shame, and a potential self-fulling prophecy if a slip occurs, giving them the opportunity to tell themselves, “See, I knew I would fail at this.” Following a harm reduction model for those who are seeking it or require it based on medical necessity helps individuals build the self-efficacy and belief that they have power to change their behaviors and live a balanced life, free from the grasp of addiction.  

If you or a loved one have been told abstinence is the ONLY WAY, give Realize Recovery a call today and we can discuss options and provide education on the evidenced based treatments that have been proven to work. 

Peele, S. (2020, March 19). So Alcoholics Anonymous Is “Proven” to Work After All? Not So Fast. Retrieved October 12, 2020, from https://filtermag.org/alcoholics-anonymous-cochrane/

The Disease of Addiction Thrives on Isolation (Rep.). (2020, May 12). Retrieved https://www.ccapp.us/application/files/9715/8932/2072/Addiction_Thrives_on_Isolation.pdf