Alternatives to Rehab: Your Treatment Options and How to Choose

When you think about treatment options for opioid use disorder (OUD), chances are, you picture a residential rehab scenario. You might imagine a month-long, or even longer, stay at a treatment center for yourself or a loved one. While residential rehab is one treatment option, it’s certainly not the only one or the best one. The best one for you or a loved one depends on many individual factors.

It’s possible you’ve ruled out residential rehab because of work, family, or responsibilities that can’t be put on hold. Or maybe you had a negative experience with rehab in the past, struggled with the abstinence-only approach, or thought your substance use wasn’t “bad enough” to need serious treatment. These reasons are all totally valid, and it should hopefully help you to know that residential rehab is just one level of care. 

You or a loved one might need a completely different approach to treatment, and residential rehab doesn’t even have to be a step in the recovery process at all. There are several alternatives to inpatient rehab available to you.

“I spent a lot of time believing there was only one ‘right’ way,” says Wesley Brewington, a peer recovery specialist at Boulder. “When I struggled with that path, it was easy to believe that I was the problem — not that the approach simply didn’t fit me. What changed my recovery was having options, choices, and the freedom to figure out what actually worked for my life.”

Alternatives to rehab include more flexible treatment options, including telehealth addiction treatment with the use of medications for opioid use disorder (MOUD). This article explores alternatives to rehab, so you can find the right fit for you or a loved one.

Safety resource box: If you are in distress, call or text the Suicide and Crisis Lifeline: 988. Stopping opioids abruptly and alone carries risks. Medical support makes stopping safer. 

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The term ‘rehab” covers a whole range of care — not just inpatient. Rehab really means “treatment,” and it can include partial hospitalization programs (PHPs), intensive outpatient programs (IOPs), standard outpatient addiction treatment, telehealth medication treatment (including online Suboxone), peer support groups, and recovery housing.

“Alternatives to rehab are important because people need a range of high-quality options for care that can fit their circumstances,” says Stephen Martin, MD, medical director for research, education, and quality at Boulder.

Medications for opioid use disorder (MOUD) may sound like something you “add” to other types of therapy. But MOUD is a type of treatment in its own right. In fact, it is the method with the strongest evidence behind it.

“The medication part is essential, and the behavior treatments can be added on,” Dr. Martin says. “This key order — medication first and added behavioral care when wanted — was made strikingly important in a key study.”

The study Dr. Martin refers to was published in the journal Drug and Alcohol Dependence in 2024. The researchers found that people who underwent residential treatment but no MOUD were more than 70% more likely to die from overdose than people who had no treatment at all. Meanwhile, people who were given MOUD, with or without residential treatment, were more than 30% less likely to die from an overdose.

“Going to rehab without MOUD can cause death compared with not having treatment at all,” Dr. Martin explains.

What the medications do

MOUD helps stabilize you or a loved one by reducing cravings, managing withdrawal, and blocking the effects of other opioids.

• Craving reduction: Some medications used to treat OUD activate opioid receptors, either partially or fully (as is the case for methadone).
• Withdrawal management: By binding to opioid receptors, some medications can greatly reduce or alleviate withdrawal symptoms.
• Blocking effects: Some types of MOUD bind tightly to opioid receptors, preventing other opioids from attaching. Naltrexone, for example, fully blocks opioid effects. And buprenorphine (a medication in Suboxone) partially blocks them. This helps reduce the “reward” effects of other opioids in the event of a return to use.
• Stabilization: When you or a loved one experiences the above benefits, you get out of the survival mode that substance use disorders and other factors place you in. Being stuck in survival mode can be a huge barrier to recovery and improving quality of life. Stability helps you focus on healing and the other treatment methods you might be engaging in.

Telehealth: starting medication without an in-person visit

In many cases, MOUD (including Suboxone, buprenorphine, and naltrexone) can be started with a video-chat visit (or a phone call), no in-person visit needed. 

“Telehealth literally meets people where they are,” Dr. Martin says. “They can keep the parts of their life that help them and have life-saving treatment at the same time. Patients and telehealth caregivers can then adapt to changing circumstances. If at some point a person’s situation changes and residential treatment with MOUD would be better, they can work together to make that work.”

Timing for starting MOUD matters to avoid precipitated withdrawal, which involves severe withdrawal symptoms. If you’re interested in learning more about telehealth for MOUD or getting started, Boulder can help.

Treatment is not a choice between doing “nothing” and “leaving your life” for a month or longer. Other treatment methods serve as residential rehab alternatives that also provide structure and care. You have a continuum of choices for yourself or a loved one. Here are a few examples.

Partial hospitalization and intensive outpatient 

Both partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs) provide structure.

PHPs involve intensive daytime treatment for several hours several times per week, but you or a loved one returns home or to recovery housing (if needed) at night. IOPs take a similar approach. They involve several care sessions per week while living at home.

Both PHPs and IOPs can also be done virtually in many instances, offering even more flexibility.

Individual therapy and counseling

Therapy or counseling might be a part of any of the treatment options you choose, whether inpatient, outpatient, or telehealth. Researchers have found that some therapy types are the most effective for OUD, including the following:

• Cognitive behavioral therapy (CBT) helps you or a loved one connect thoughts, feelings, and behaviors; identify triggers; challenge negative thought patterns; and improve coping strategies.
• Relapse prevention therapy (RPT) is a subtype of CBT that helps you or a loved one identify triggering situations and create strategies for avoiding or managing them. 
• Contingency management (CM) uses incentives and rewards to help reinforce recovery efforts.
• Motivational interviewing (MI) uses nonjudgmental communication to help you or a loved one explore mixed feelings about treatment and build motivation to engage in your treatment and recovery journey.

In addition to the treatment methods mentioned above, you or a loved one might be looking for peer or community support or even recovery housing. Several 12-step and non-12-step programs offer peer and community support, and some clinical programs provide peer recovery specialists as part of your care team. Recovery and sober living housing offers you or a loved one a safe and supportive living environment if needed. 

12-step programs

Traditional 12-step programs include Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). These programs apply a 12-step framework to recovery along with a spiritual reliance on a higher power.

Although they are rooted in abstinence, the key requirement is “a desire to stop using.” You are not barred from participating if you take MOUD, though stigma for MOUD still exists within NA.

Non-12-step options

The following are programs that do not follow a 12-step framework and do not involve a religious component.

• SMART Recovery: The acronym stands for self-management and recovery training. This four-point program focuses on building and maintaining recovery motivation; coping with cravings and triggers; managing thoughts, feelings, and behaviors; and building a balanced life. SMART Recovery supports MOUD.
• LifeRing Secular Recovery: This program is free of prayer or reliance on a higher power. It focuses on a 3-S philosophy: sobriety, secularity (non-religious), and self-empowerment. LifeRing supports MOUD.
• Women for Sobriety (WFS): This peer-based support organization is dedicated to providing a safe space for women on their treatment and recovery journey. Religion or a belief in a higher power is not a component. Although WFS is an abstinence-based organization, it does not explicitly ban MOUD. Taking MOUD as prescribed does not violate WFS rule about attending meetings “only if you are free from any substances that may impair you.”
• Refuge Recovery: This peer-led program is rooted in Buddhist principles with a focus on mindfulness to treat all forms of addiction. It is an abstinence-based program, but its prescription-medication policy spells out its acceptance of MOUD.

Peer recovery specialists

A peer recovery specialist is a trained person who also has the lived experience of having a substance use disorder. Some clinical programs, including Boulder, employ peer recovery specialists as part of your clinical care team. The goal is to pair you with someone who understands where you are coming from and who can offer support through treatment and recovery — because they have been in similar shoes.

Recovery housing and sober living

Recovery housing and sober living spaces are not treatment programs. Instead, they offer safe living spaces while you undergo treatment. They also serve as a transitional living option after residential rehab before you or a loved one lives independently. They may incorporate curfews and peer meetings for structure. These spaces require sobriety, but many accept patients on MOUD.

The treatment and recovery methods that are best for you or a loved one will depend on individual factors, and residential rehab is not the only choice.

“Start by talking to a doctor or therapist who is trained in addiction treatment,” Dr. Martin says. “They’ll assess your symptoms and recommend treatment and services that meet your unique needs. If you're not ready or able to talk to a doctor, you can assess your needs by using Shatterproof Treatment Atlas. The free platform helps you find and compare your options.

If you are considering Suboxone as a part of your recovery, Boulder Care offers same-day OUD treatment. Call 503-549-1222 to talk to a Boulder Care team member and learn more about your treatment options.