Veteran and VA Outpatient Rehab for Substance Abuse Treatment

Many people hear the term “rehab” and immediately think of inpatient substance abuse rehab. People will think of long stays in residential facilities, and of constant medical support and supervision. However, Outpatient rehab is another common treatment type that seldom receives the same attention. Outpatient drug rehab provides people with daytime treatment, often on a part-time basis. Outpatient programs allow people to continue living at home and possibly attend work or school, while still receiving the services and support they need.¹

Veterans seeking substance abuse treatment programs may choose this level of care if their medical provider decides that they do not require intensive inpatient rehab, or if they need an intermediate level of care but have competing personal responsibilities.² Outpatient treatment means that one can continue to maintain family, work, or community routines while also in treatment. Many veterans who don’t need or have already completed detox or acute medical treatment for substance abuse will opt for outpatient treatment.

What is Outpatient Rehab?

Outpatient rehab is a type of substance abuse treatment that is designed to provide in-depth, evidence-based medical and behavioral health treatment for substance abuse disorders. Patients go to treatment “part-time” and don’t live on the premises. Outpatient rehab may also sometimes be referred to by other terms like partial hospitalization or day treatment. Modern veteran outpatient substance abuse programs have roots in the Veteran Administration alcoholism treatment units that were developed after World War II. Before the post-traumatic stress disorder (PTSD) diagnosis was established, veterans were treated for alcohol addiction and post-traumatic symptoms in these early VA outpatient clinical settings. Today, medical providers may assess and recommend outpatient substance abuse treatment for a variety of reasons. Sometimes providers may even recommend an outpatient setting as a transitional treatment for those who have already completed an inpatient drug rehab program or residential rehab program but still require supportive care.³

There are a variety of types of outpatient rehab treatment. These variations include:⁴

• Intensive outpatient programs (IOP): Sometimes referred to as IOPs, these outpatient rehab programs range in length from several weeks to several months. Common components include both group and individual therapy, psychoeducation to promote behavioral change and use of coping skills, and medication management where applicable. Intensive outpatient programs can provide a safer transition out of inpatient rehab care for some.
• Partial hospitalization programs (PHP) or day programs: Partial hospitalization programs offer intensive outpatient rehab treatment at a higher level of care. Participants do not stay overnight at the treatment center, but attend the program several days a week for full days of treatment. Many PHPs operate on a traditional weekday work schedule. Partial hospitalization programs may be appropriate for people with a level of acute substance dependency that requires intensive care, but who are not struggling severely enough to require around-the-clock inpatient rehab treatment. Like IOT programs, PHPs can also provide a supportive transition for individuals exiting an inpatient rehab program.
• Outpatient detox programs: Detox programs are most often inpatient because, for individuals who are chemically dependent, close medical supervision is needed for safety. Withdrawal symptoms for some substances can even be life-threatening. However, for those who are not struggling with opioid, benzodiazepine, or alcohol dependency, supervised outpatient detox is sometimes possible.

How Does Outpatient Rehab Work?

If you attend an outpatient rehab program you will likely meet in a hospital, mental health clinic, or rehab facility. Support provided will most often include both individual and group therapy. Medication prescribing and management will likely also be offered and closely monitored, with provider appointments embedded in the program schedule. In intensive outpatient settings, additional psychoeducation and life skills training may also be provided. Education on the biology and neurobiology of addiction as well as classes or workshops on developing effective coping skills and managing stressors are commonly included. Life skills training such as career counseling may also be integrated into some treatment programs. Many outpatient programs will also include access to 12-step group meetings, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).

Programs may vary and individual treatment plans may also vary according to patient needs, but some common behavioral health therapies utilized in outpatient rehab include cognitive-behavioral therapy (CBT,) motivational interviewing, family therapy, 12-step supports, and a matrix model of psychoeducation around issues related to substance abuse and recovery.⁵ Each day, a treatment plan including community support or group behavioral therapy and training, as well as one on one individual psychological and medical supports, is employed with the intent to promote sustained change and long-term recovery.

Additionally, treatment for co-occurring mental health disorders is often part of outpatient rehab programs. Veterans struggling with substance use may also be grappling with PTSD, anxiety, or depression symptoms.⁵ It is important for these symptoms to also be addressed as part of a cohesive and effective treatment plan. Developing a treatment plan and coping skills for managing mental health symptoms can help prevent future relapse.

What are the Benefits of Outpatient Treatment for Veterans?

The VA offers care tailored to the unique mental health experiences of veterans. As such, VA services may be a helpful entry point for veterans when initially seeking information about substance abuse or entry-level treatment. Veterans covered under the VA benefits system can discuss outpatient rehab treatment options with their primary care provider to learn more. Outpatient treatment may be appealing to veterans who are reintegrating into civilian life, and may not want to step away from progress they’ve made rekindling community bonds. Prior family or financial responsibilities may be another reason why veterans may prefer outpatient rehab over residential or inpatient.

Regardless, veterans struggling with mild to moderate substance use disorders may benefit from outpatient rehab treatment, whether in a VA rehab program or in another clinical setting. Specific outpatient treatment benefits for veterans include:

• Independence and flexibility of schedule during treatment.
• Ability to maintain a connection to social supports (work, family, school, etc.).
• Ability to sleep at home and maintain a connection to routines, which may be especially important for Veterans who are dually diagnosed with PTSD or TBI.
• More affordable care than inpatient treatment.
• Less difficulty reintegrating into daily civilian life after completion of treatment.
• For veteran-specific rehab programs, the ability to relate to peers in a treatment setting.

How Long Do Outpatient Programs Last?

Outpatient rehab treatment programs can vary from several weeks to several months in length. The length of outpatient programs varies depending on a veteran’s unique needs and insurance coverage.

Does the VA Offer Outpatient Rehab for Substance Abuse?

Even if your local VA hospital has no outpatient VA rehab availability or does not have the specific program that meets your individual needs, the VA may still be able to connect you to a Community Care partner that would provide appropriate outpatient treatment.⁸

The U.S. Department of Veteran’s Affairs does offer outpatient rehab programs for substance use disorders. A variety of services are included in these veteran rehab programs, including:⁷

• Both short-term and intensive outpatient substance abuse counseling.
• Pharmaceutical drug substitution therapy where indicated.
• Nicotine replacement or cessation therapies.
• Marriage and family therapy.
• Self-help/ 12-step groups.
• Ongoing follow-up care for relapse prevention.
• Special programs for Veterans with specific concerns (like women veterans, returning combat veterans, and homeless veterans).
• Treatment for co-occurring mental health diagnoses such as PTSD or depression.

In order to access these services, veterans must first enroll in VA healthcare services. To do this, you can find a VA medical center near you. From there, a primary care provider within the VA system can assess for substance abuse issues and refer to appropriate services.

If your local VA hospital has no outpatient VA rehab availability or does not have the specific program that meets your individual needs, the VA may still be able to connect you to a Community Care partner that would provide appropriate outpatient treatment. In addition, even if you are a veteran and you do not have VA healthcare, the VA Community Resource and Referral Center can assist you in locating care in your community.⁸ Under certain conditions, if the indicated care is not available through the VA, the VA may pay for care with an outside Community Care provider.

How Much Does Outpatient Rehab Cost?

Outpatient rehab costs are a concern for many veterans. The costs of rehab programs can vary greatly depending on a number of factors such as insurance coverage, specific program, and length of treatment. Individual treatment needs are also a determining factor. To determine the cost of outpatient treatment, it is best to reach out to your insurance provider and the relevant outpatient treatment facilities.

Will the VA or Insurance Cover Outpatient Programs?

The VA Alcohol and Drug Dependence Rehabilitation Program provides Outpatient VA rehab to qualified veterans. To utilize outpatient treatment programs located in VA medical centers and clinics, veterans must be enrolled in the Department of Veteran Affairs healthcare system.

Most private insurance companies also offer full or partial coverage of outpatient rehab costs, if medically indicated. Insurance companies may, however, vary in coverage policies. It is best to contact your insurance to determine which outpatient treatment centers may be covered under your plan.

For low-income families, Medicare and Medicaid may cover outpatient rehab treatment in part or full. Be aware that not all outpatient rehab facilities accept these insurance plans. The details of your eligibility and coverage for rehab treatment can vary from state to state, as well. However, under the Affordable Care Act (ACA) addiction treatment accessibility has expanded. Many rehab centers accept plans through the health insurance marketplace.

Outpatient vs Inpatient Rehab: What’s the Difference?

Inpatient and outpatient rehab for substance use disorders are two different options for two levels of need. While those who are severely chemically dependent may require inpatient detox and rehab with around-the-clock medical supervision,⁹ individuals who are in less acute phases of dependency but still need support may be well-suited to outpatient rehab care. Outpatient care may also be an appropriate transition program or step down from inpatient or residential group home settings. Level and type of substance use, medical conditions, and mental health status are all factors in determining whether outpatient care is appropriate. If it is, however, many people can benefit from rehab while still sleeping at home and continuing some regular routines outside of rehab. Effective recovery does not always have to mean an inpatient say.