Treatment programs for drug and alcohol abuse generally fall into one of two broad categories – inpatient or outpatient care. Both can be effective forms of rehabilitation and recovery, but they take different approaches.
Inpatient rehab is an intensive program designed to treat serious addictions in a residential setting. Outpatient rehab is a part-time program, designed to allow the recovering user to live at home and continue going to work or school during the day
It is important that both the addicted person and his or her loved ones understand the differences between the inpatient vs. outpatient approach before deciding on a treatment program. Choosing the right option for every situation is critical because it can mean the difference between getting clean and staying clean or suffering a relapse after therapy is over, and reverting to addictive behavior again.
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What is the Difference Between Inpatient and Outpatient Treatment?
Effective treatment for substance abuse addiction can be offered in an inpatient setting (in hospitals or specialized clinics, on a residential basis) or in an outpatient setting (in medical buildings or generalized clinics, on a walk-in/walk-out basis). Each approach is beneficial for certain groups of people.
Both inpatient and outpatient care have the same goal: sobriety. They also utilize the same methods to achieve it: detox, therapy, self-analysis, and support from family and peers both during treatment and afterwards. The main difference between outpatient and inpatient is where they are offered.
Inpatient treatment, because it takes place in a closed, protected environment, is often more thorough and intensive than outpatient treatment because it allows fewer chances for relapse during the trying early weeks of therapy.
That said, outpatient programs are more suitable for people whose responsibilities or financial situation prevent them from checking in to an inpatient facility. Factors that prevent someone from attending an inpatient program can include:
- Childcare duties – Parents who have young children at home but no viable childcare options may find that an outpatient situation is their only option.
- Elderly parent care – Those who have elderly parents who rely on them may also have to return home at the end of the day to resume their duties.
- Insurance issues – In some cases, patients may not be able to get insurance coverage for an inpatient facility. While these costs are sometimes covered for those who have a real need, many inpatient rehabilitation centers simply aren’t affordable for those who have no or limited insurance coverage.
- Lack of availability – Residential rehab facilities are available in most areas, but some smaller or rural areas may have limited availability for treatment. Many aren’t able to travel to the nearest facility because of time restraints or limited funds.
In most cases, addiction treatment experts recommend inpatient treatment as the better option for those who have a serious addiction. This is especially true for anyone who has co-occurring disorders (a mental or physical health problem in addition to an addiction problem) or an addiction that has lasted many years.
Those who are casual or social users, or those who have only recently acquired a dependence may do well in an outpatient facility, although this can pose some risks. In the following sections, we explain what the difference is between outpatient and inpatient care.
What Is Inpatient Rehab Treatment?
Inpatient rehabilitation is a treatment program for addicts carried out in a residential setting. The most defining characteristic of this approach is that the person checks in to the facility and lives there while receiving intensive counseling and professional medical help.
Inpatient treatment may be offered either in a discrete and isolated wing of a larger hospital or health complex, or in a standalone facility. One is putting the life “on hold” for the period of time in rehab, and commit to staying for an agreed-upon period of time. Most residential substance abuse treatment programs last from 28 to 90 days, depending on the needs of individual patients.
Inpatient treatment – taking a kind of “time out” from the pressures and temptations of daily life – can be very effective for those who really want to become sober, especially for those who have tried other outpatient approaches that didn’t work for them. Patients in an inpatient setting typically receive much more thorough and intensive counseling and therapy, because they do not go home at the end of the day. They also have access to medical and mental health professionals at all times. This type of intensive treatment also has the benefit of keeping addicts away from distractions and triggers, so they can focus solely on the healing process.
What Happens in an Inpatient Rehab Center?
Individual treatment regimens vary, but one can typically expect the following:
- A full physical and psychological examination. This will help the doctors and counselors design a treatment program that is tailored to patients needs and that gives them the highest likelihood of success.
- A period of initial detox. The first week of staying in a residential treatment center will probably involve a period of medically-supervised detoxification. This is usually the most difficult part of recovery, because the body has to deal with the effects of stopping substance use. These effects – withdrawal – can be unpleasant, so if necessary they are managed with the help of medications administered by physicians experienced in recovery.
- Access to phones and email may be restricted in some facilities. In others, especially those providing treatment options longer than 30 days, individual computers and phones may be allowed.
- Contact with friends and family may be limited. This isn’t to cause isolation or loneliness, but to help the patient focus entirely on getting better and working on himself or herself during that time. When friends and family are brought back in, they are often given counseling alongside the addict so any issues related to the addiction can be discussed and overcome before the patient returns home.
- Individual therapy. Depending on the facility and the treatment plan, individual counseling and therapies will be provided, which can include one-one-one counseling, group therapy, family therapy, and cognitive behavioral therapy (CBT) to eliminate destructive patterns. There is also follow-up care, in which the patient is introduced to programs he or she can continue with after the period of residential treatment is complete. Such programs increase the person’s chances of successful rehabilitation when they leave the facility and transition back to “life in the world.”
Pros and Cons of Inpatient Care
Potential benefits of inpatient treatment include:
- A stable, sober environment. Because treatment takes place in a private facility with no access to the outside world, patients are not able to take drugs unless they are administered by medical professionals to ease detox. This makes relapse during rehabilitation much less likely, if not impossible.
- Monitoring by medical and psychiatric professionals during detox and recovery. This is important for people with long-standing addictions or who have co-occurring mental health issues.
- Intensive group and individual therapy sessions. Support from both staff and other patients to help the patient reach and maintain sobriety.
- A higher likelihood of success.
- Potential drawbacks of inpatient treatment include:
- The need to take time off from work, school, or family responsibilities.
- Higher cost of treatment because room and board are provided.
- Limited access to the outside world and potentially limited visiting time from family and loved ones during treatment.
What Is Outpatient Rehab Treatment?
Outpatient alcohol treatment centers provide an excellent option for those who know that they need help to combat their addiction, but are unable to stop working or forego other responsibilities to get that help. Non-residential programs to treat alcoholism are offered in community health clinics, in doctors’ or psychologists’ offices, or in some residential addiction centers that are equipped to additionally support outpatient care.
Outpatient treatment is appropriate for those whose addiction is not severe, whose lives are fairly stable, and who are willing to participate in and commit to the treatment plan. Outpatient treatment is also often recommended as a form of “continuing care” for those who have successfully completed an inpatient treatment program, to help maintain the long-term effects of recovery and prevent relapse.
In addition, the lengths and intensity of outpatient treatment programs (number of sessions per week) can often be flexible, which makes them more suitable for people who are unable to take extended absences from work or responsibilities. Outpatient treatment also tends to cost much less than inpatient care.
Outpatient care means that the person receives counseling and other therapies during the day, usually at set appointment times, and then leaves to go home after their sessions. Outpatient care may include one-on-one or group counseling sessions, the supervised use of medications to handle initial detoxification issues, and many forms of behavioral therapy. Behavioral therapy can be an extremely effective treatment method in outpatient settings, because it encourages patients to take control of their addiction. Some common forms of this type of therapy include:
- Individual or group counseling. Individual sessions may focus on ways to stop alcohol use and manage aspects of the life like a job and family relations. Group counseling sessions can also be effective due to the reinforcement one gains from peer discussion and support.
- Family counseling can provide a safe environment in which the entire family can learn how to deal with the pain and suffering that results from addiction.
- Cognitive behavioral therapy (CBT). This type of treatment helps to prevent relapse by increasing understanding of the triggers of substance abuse and its consequences. CBT trains how to recognize states of mind that make a person susceptible to relapse, and how to handle them when they arise.
- Motivational enhancement therapy (MET). This type of therapy aims at increasing patients’ self-motivation for positive change and recovery.
Pros and Cons of Outpatient Care
Potential benefits of outpatient treatment include:
- Reduced costs, because there is no need to pay for room and board.
- Ability to continue working, attending school, and/or taking care of family responsibilities during recovery.
- Increased support from family and friends.
- The opportunity to practice relapse prevention techniques in the real world during the treatment process.
Potential drawbacks of outpatient treatment include:
- Distractions. It is often better to have less contact with family and friends who might cause stress or become triggers for abuse during recovery. Ideally, the addicted person’s full focus should be on getting better, but this isn’t possible with outpatient counseling.
- Temptations. When in an inpatient facility, patients have no option but to stay clean. There is no access to drugs or alcohol, so there is no temptation to use. If patients returns home after counseling each day, they will have access to drugs or alcohol, and relapse is more likely.
- Lack of medical supervision. When coming off certain drugs, withdrawal symptoms can be uncomfortable or painful, and at times they can even be life-threatening. Patients should not detox without medical supervision, and this isn’t possible at home and is better achieved through an inpatient rehab.
Determining The Best Rehab Option For A Loved One
Once patients have weighed the options between outpatient vs. inpatient care and decided which is the best choice for a loved one, the next step is to choose where to get treatment. It is important to not make a rushed decision when choosing a rehab option, because the more comfortable patients are with the chosen program, the better it will works.
Questions to Ask Before Making the Inpatient – Outpatient Decision
There are many factors to be analyzed before settling on a rehab program and course of treatment. Experts recommend that a loved one should ask themselves these questions before choosing between inpatient and outpatient:
- Is a current living environment stable and supportive of sobriety? That is, one is exposed to drugs or alcohol at home, and are there any have family members who will continue to drink or take drugs?
- Do they have a strong support network at home which will help to stay sober?
- Can patients leave their job, school, or home duties for an extended period of time?
- Do any co-occurring medical or mental health issues that may require treatment are present in a patient, in addition to a substance abuse problems?
- If one chooses outpatient care, are they able to commute from the home to the facility several times a week?
Identifying the specific needs is the first step to choosing a treatment plan that will work, whatever treatment model it uses. The next step, after one has made the in patient vs. out patient choice, is which facility/clinic/provider to trust in.
How to Choose the Best Rehab Provider, Whether It’s Inpatient or Outpatient
It is recommended to “do the homework” and investigate several different rehab options. Use the opportunity to ask a number of important questions. For example:
- Always ask about accreditation. Are all staff (and the facility itself) licensed and accredited on a state or national level?
- Ask for a list of therapies and treatments provided. Make sure they treat both the physical and the psychological aspects of substance abuse addiction.
- Ask what the goal of the program is. Different treatment programs have different goals of their own; make sure the facility’s goal is the same as patient’s.
- Ask about inpatient vs. outpatient rehab success rates. Both inpatient and outpatient programs should be able to supply relapse rates for patients who have completed their programs. Ask what they do to prevent relapses.
- Do they offer ongoing support groups after the main course of therapy? These programs can greatly increase the chances of recovery.
- Make sure one can afford the care they offer. For example, one needs to ensure that their insurance covers all or most of the treatment. Be sure to ask about copays and other costs.
How Is Rehabilitation Paid For?
Many times insurance providers, Medicare, or Medicaid programs can help cover the cost of inpatient and outpatient care. For those who do not have medical coverage, payment arrangements may be an option. Availability will depend on the hospital, clinic, or organization providing the treatment.
- National Institute on Drug Abuse. Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide. 2014. https://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/treatment-settings.
- Pettinati H. M., Meyers K., Jensen J. M., Kaplan F., Evans B. D. Inpatient vs outpatient treatment for substance dependence revisited. Psychiatric Quarterly. 1993; 64(2): 173-82. https://www.ncbi.nlm.nih.gov/pubmed/8391147.
- National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). 2018. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states/types-treatment-programs.