Outpatient vs Residential

Callers, as well as clients, find themselves being accused of “taking the easy way out” if they work with me instead of going off to “rehab” which, “everyone knows,” is the only thing that “works.”

A lot of “…” in that sentence. And for good reason. But…

First, I am not the easy way out – quite the opposite. While AA and traditional rehab say you’re powerless and therefore not responsible for your “disease” (there’s those “…” again, damn) and you are off the hook for your drinking past, present and future.

I, on the other hand, say that while your drinking is understandable, you are not powerless, and, yes, you are responsible for your choices and capable of change.

Yes, you have the power to change, I will help – no, I can’t do it to you, or for you, but I will do it with you.

My version of outpatient is also individual, confidential, research & outcome based, may be medically assisted, takes only as much time as you actually need, and incorporates the approaches that actually work:

  • Individual;
  • Assertiveness Training;
  • Motivational Enhancement;
  • CBT;
  • Naltrexone;
  • Brief (4-12 weeks);
  • Family dynamic considerations.
  • As well as other components that your particular circumstances suggest.


Whether 30, 60, or 90 days, $30,000 or $130,000 or more, the “program” is the same, after all, they have a lot of hours to fill as well as a vested interest in your failure:

  • Breakfast;
  • Housekeeping;
  • Group meeting;
  • Walk;
  • 12 Step meeting;
  • Lunch;
  • 12 Step meeting;
  • Walk on the beach;
  • Art/Wolf-Dog/Equine/Ropes Therapy;
  • Dinner;
  • 12 Step Meeting;
  • Movie:
  • Bedtime;
  • Repeat.

Once a week you might get a 50 minute “therapy” session with a former client who has become certified as counselor – which requires a GED, a few Mickey Mouse courses and a test on, you guessed it, AA.

Notice that nothing has anything to do with what led you to self-medicating in the first place, usually: loneliness, boredom, anxiety, unbalanced personal, familial, professional relationships, unbalanced lives, and so on.

Finally, there is a big advantage to going to AA or rehab – you can pretend you are doing something thereby placating whomever might be suggesting that addressing the problem was overdue. In neither case will you have to fix anything, and both AA and rehab will supply you with a whole new set of tools with which to manipulate spouses, family and employers.

This really is the time when you decide whether your goal is to fix or placate – and I don’t do placate.

The Phone Rang:

I answered with my usual, “This is Dr. Wilson. How may I help you?”

“You can’t,” he said, “but I have an interesting story for you.”

“Always happy to listen,” I said.

“Well, you’ll appreciate this one. A year ago a headhunter called me and asked if I would consider a CFO position with a Minnesota residential treatment center. I said I didn’t know anything about treatment.

“He replied that they didn’t need a clinical director, they needed a financial officer.”

“Hmmmm,” I said.

“After some negotiations I accepted the offer and my wife and I moved to rural Minnesota which was a nice change from Chicago.

“As I went through my first year I did get a little interested in what the company did so I started reading up on rehab.”

“Oops,” I said.

“Along came my first annual board meeting, everyone gave their reports, and as the meeting concluded the Chairperson asked if there were any questions. I raised my hand and said, ‘why, when we’re a treatment facility with a national reputation, aren’t we doing any of the things that actually work?’”

“Let me guess,” I said.

“No need,” he said, “I was terminated on the spot.”

We laughed since we both knew how that was going to turn out. Same thing had happened to me at a Minneapolis program in the 1980s. And I’d gotten nearly identical calls from a Medical Director of a facility on Vancouver Island, a counselor in Calgary, Alberta, and others in Malibu, Phoenix, Tampa, etc.

95% of programs, whether residential or outpatient, simply sell AA and do so because it doesn’t work for 90% of their clients. The revolving door is the reality.

If you actually want to address the causes of your self-medicating and fix it, permanently, be very careful about whose services you choose.