In discussions of strategies for addressing the opioid epidemic, improving follow-up treatment does not get the attention as do calls for “More Treatment Beds.” A focus on the importance of better follow-up would, however, have a bigger impact on the problem, which continues to kill an increasing number of people.
Effective treatment exists for opioid and other substance use disorders, but one of the most frequent reasons for treatment not actually working is that patients are inclined to stop it prematurely. An ideal treatment model is designed to take this problem into account. One of the advantages of initiating treatment on an outpatient basis, including outpatient detoxification and intensive outpatient rehabilitation, is that bridges between treatment phases are more likely to be used.
Follow up treatment after initial stabilization is essential to the effective treatment of any chronic disease. Substance use disorders are classic examples of how inadequate attention paid to this basic medical principle leads to a “revolving door syndrome” of relapses addressed by repeated short-term interventions. Transitions between inpatient treatment centers and outpatient follow-up, however, provide unfortunate opportunities to activate a patient’s inclination to drop out. The result is repeated treatment of the acute aspects of the disease.
A second advantage of outpatient addiction treatment is a financial one – 5 people can be treated on an outpatient basis for every 1 person treated as an inpatient. Legislation is bogged down in Congress, where bipartisan collaboration is in particularly short supply. As the U.S. Congress struggles with the reality that the financial resources available for this effort are limited, perhaps more attention will be paid to using the money more efficiently.
Many years ago, when inpatient addiction treatment was the only effective level of care available, having it serve as the primary option made sense. Now that equally effective outpatient detoxification and rehabilitation have become so available, the time has come for outpatient treatment to be offered as the primary intervention. Inpatient treatment – despite its flaws of complicating transitions and high cost – remains a critically needed level of care as a backup to outpatient treatment.