Outpatient Addiction Therapy or Rehab? Levels of Care

When someone starts to worry about their drinking or drug use, one of the first questions is often, "Do I need to go to rehab?" It's an understandable question. It's also a bit like asking whether you need surgery before anyone has looked at the problem.

Addiction treatment isn't one thing. It's a range of settings, from a weekly therapy session to round-the-clock medical care, and the right fit depends on the person. This post explains the main options in plain language and how professionals help people choose between them.

It's general information, not a diagnosis or a treatment recommendation for you. A licensed professional can help you figure out what fits your situation.

Why "rehab or not" is the wrong first question

"Rehab" usually brings to mind a residential program where you live on site for weeks. That's one option, and for some people it's the right one. But many people get help while living at home, working, and keeping up with family life.

A better first question is: What level of support do I need right now to be safe and make progress? The answer can change over time. Someone might start with more intensive care and step down to weekly therapy, or start with weekly therapy and step up if things get harder.

The main treatment settings

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) describes these evidence-based treatment settings for alcohol use disorder. The same general continuum is used for other substances too.

Outpatient

Regular office, virtual, or telehealth visits for counseling, medication support, or both. You live at home and keep your usual routine. This is where most individual therapy happens.

Intensive outpatient or partial hospitalization

Coordinated outpatient care for more complex needs. These programs meet several times a week, often for several hours at a time, while you still live at home.

Residential

A program in a 24-hour treatment setting, at lower or higher intensity. You live on site for a period of time.

Intensive inpatient

Medically directed 24-hour services, which may include managing withdrawal.

How professionals decide: the ASAM Criteria

Many clinicians, treatment programs and insurers use The ASAM Criteria, published by the American Society of Addiction Medicine, to match people with a level of care. ASAM describes it as the most widely used and comprehensive set of standards for placement, continued service, and transfer of patients with addiction and co-occurring conditions. The current Fourth Edition was released in 2023.

In plain terms, the ASAM approach:

• Looks at the whole person, including physical health, mental health, and social needs, not just how much someone uses.

• Considers strengths and supports, such as stable housing, a supportive partner or a steady job, as well as risks.

• Uses that assessment to recommend a level of care, and reassesses as treatment goes on so care can become more or less intensive.

The takeaway: the decision is made through an assessment and a conversation, not a quiz. And it isn't permanent.

Safety first: talk to a doctor about withdrawal

This is the most important point in this post. NIAAA notes that when someone who has been drinking heavily for a long time suddenly stops, their body can go into a painful or even potentially life-threatening withdrawal. Withdrawal from some other substances can also be dangerous.

If you've been drinking or using heavily, talk with a medical provider before you stop or cut down sharply. Medically supervised withdrawal is one reason higher levels of care exist. A therapist can help you plan, but a therapist can't manage withdrawal medically.

Questions that help clarify what you need

These questions don't replace an assessment, but they can help you prepare for one:

• Safety: Have I had withdrawal symptoms before, or do I feel unwell when I don't use?

• Health: Do I have medical or mental health concerns that make things more complicated?

• Daily life: Am I still able to work, look after family and keep commitments?

• Environment: Is home a place where I can make changes, or is alcohol or drug use all around me?

• History: Have I tried to cut back before? What helped, and what didn't?

• Support: Who in my life knows, and who could help?

Some people who look "fine" from the outside are struggling more than anyone realizes. If that sounds familiar, our post on high-functioning addiction may resonate.

Where outpatient therapy fits

Outpatient therapy can be a starting point, a step down after a more intensive program, or ongoing support alongside other services like support groups or medication treatment from a medical provider.

Stephen Rought, LCSW, provides outpatient therapy for addiction, with in-person sessions in Chino Hills, California, and telehealth for clients located in California or Florida (Florida sessions are online only). Work includes individual therapy, cognitive behavioral therapy (CBT), family therapy, and referrals to group therapy.

Therapy often focuses on understanding what drives use, building coping skills, repairing relationships and planning for setbacks. Our practical relapse prevention plan covers that last piece in more detail.

Frequently asked questions

Do I have to go to rehab to get better?

Not necessarily. Many people get help through outpatient care. Others need more intensive or medically supervised care, at least for a while. An assessment is the best way to find out.

Can I start therapy before I've stopped drinking or using?

Many people start therapy while they're still figuring out what they want to change. If you've been using heavily, talk with a medical provider about withdrawal safety first.

Can family members be involved?

Often, yes. Stephen's addiction page lists family therapy as one of his services. Family therapy for addiction is offered.

Will insurance cover it?

Coverage depends on your plan and the level of care. Stephen's site says he accepts Aetna. The Getting Started page has current details on booking and payment.

Not sure where to start?

You don't have to figure out the right level of care on your own. Learn more about therapy for addiction with Stephen Rought, LCSW, or call (408) 357-0265

Stephen Rought, LCSW (California #118018). Florida out-of-state telehealth registration TPSW5524 (telehealth only). Chino Hills, CA.