Outpatient treatment consolidates the gains made in the detoxification and inpatient and
residential treatment levels of care. Typically, clients may still need to think about change or
begin to plan for change on their discharge frominpatient or residential treatment. On entering
outpatient treatment, clients may have actually begun some behavior change, but the novelty of
the change can lead to relapse as the client moves away from the controlled and structured
environment.
Clients in outpatient treatment usually need support from at least one other person who cares
about them. This can be a time when clients are vulnerable because as they change, others
around them may change in response. Friends and significant others may feel threatened,
abandoned, jealous, or angry and may try to sabotage the client's efforts. This puts tremendous
pressure on clients because they are experiencing new feelings and new, difficult ways of life.
Although many of these life changes may be positive, they are also unfamiliar for many clients.
During outpatient treatment, group therapy could focus on the use of successful peers in
modeling helpful but difficult strategies such as stimulus control and counterconditioning.
Individual therapy will involve helping the client balance and coordinate recovery with other
issues, such as assessing client responses and concerns with case management, care coordination,
and child and family issues when relevant.
Stimulus control and counterconditioning are two strategies clients may find helpful. Stimulus
control helps clients restructure their environment so they can avoid circumstances that elicit
problem behaviors. There are three methods for managing tempting stimuli:
Develop a plan for managing the situation.
Manage the situation so the temptation does not occur. For instance, a person who knows
alcohol puts her at risk for unsafe sex will not drink when sex may occur.
Restructure the environment so that stimuli for more positive events occur and so clients
remain aware of people, places, and things that cause relapse.
In developing stimulus control strategies, consider developing questions such as the following:
What are the situations where you may be at risk of not using a condom?
How can you avoid them?
How do you stay safe when you have sex?
Where do you keep your condoms?
What are the situations in which you find yourself using substances?
Do you keep your own "works" with you?
When are you tempted not to bleach?
Counterconditioning involves exchanging risky behaviors with less risky alternatives in
situations that are not amenable to stimulus control. To develop counterconditioning strategies,
questions such as the following can be used:
If you found yourself in a situation where you were tempted to have sex without a
