Inpatient vs. Outpatient Treatment. Which Is Right?
When a person struggles with addiction, it is important to find a program that can help the individual overcome this problem and manage the disease on a long-term basis. Many rehabilitation programs view addiction as a chronic illness, and they offer a host of medical and therapeutic services that help the individual detox from the substance, learn more about their addiction, and find coping strategies for triggers or stress. The good news is that such a wide variety of programs means everyone can find an option that will truly work for them; however, the variety can seem overwhelming at first.
>While the ultimate program choice is between the individual and their treatment team, programs basically fall into two categories: inpatient and outpatient. Each type of program has subcategories and different program offerings, and each can benefit different people.
Inpatient Rehabilitation Programs
Inpatient treatment involves either hospitalization or a stay at a facility that offers residential services. Clients are completely immersed in the program, as they live in the facility, eat meals there, and have very structured activities that typically include therapy, medication management, skills training, and more. This immersion encourages a radical change in how individuals make choices, and how they think about themselves and substances of abuse.
Residential programs range in length from 30 days to 90 days, and they can vary in intensity depending on length of stay, the client’s medical requirements, and the individual’s emotional capacity for stress. Some programs can last as long as 6-12 months, although these programs are less common.
People who need to completely remove themselves from their environments due to stress or access to substances of abuse can greatly benefit from inpatient programs.
- Long-term residential treatment: This is care offered 24 hours a day, seven days per week; however, care is offered in a nonhospital setting, with medical guidance from nurses and an onsite doctor. These programs can last beyond 90 days, and often focus on rebuilding a person’s social structure and interaction with their community. The main components are a combination of individual (one-on-one with a therapist) and group therapy. Therapists will help clients overcome self-destructive behaviors and learn to accept personal responsibility for their actions.
- Short-term residential treatment: These programs can either be part of a hospital setting or in a specific residential facility. Once a person goes through this type of short-term talk therapy-based treatment, they can be sent home, but they are expected to continue rehabilitation through an outpatient program. While the stay in the short-term residential part of the program tends to be short – less than three months – the residential part of the program is actually part of a larger, longer-term program. The primary focus of short-term residential treatment is detox from the substance and an introduction into talk therapies.
- Sober living homes: These group living situations do not offer treatment for the early stages of addiction treatment; for example, they do not offer detox or medication management services. Instead, sober living homes are residential facilities that help those living there maintain sobriety by living in a strictly sober environment. People residing in sober living homes should have jobs, pay rent, and maintain their own therapy schedules. The sober living home staff, however, maintains the quality of the facility and ensure that no one living there, nor their guests, bring intoxicating or addictive substances into the home. People who live in sober living homes typically do so for six months to two years, although there is no set time limit on when they must leave. Sober living homes are best for people who have already been through an inpatient or intensive outpatient program and need additional support to maintain their sobriety.
How Long Are Inpatient Rehabilitation Programs?
The National Institute on Drug Abuse (NIDA) recommends a minimum stay of 90 days for inpatient or residential treatment programs. Less than that has been shown for most people overcoming addiction, especially for the first time, to be less effective. However, ultimately the type of inpatient program, and the length of stay in that program, is between the individual and their overseeing doctor. Sometimes, the doctor may recommend or prescribe a shorter program, because their patient can successfully transition to a sober life. For people who have struggled with addiction for a long time, a longer residential treatment program might be more effective.
Benefits of Inpatient Rehab
There are many benefits to inpatient rehabilitation programs. Some of these include:
- Around-the-clock access to care
- A structured schedule to keep the mind off the substance
- Removal from potentially triggering environments or outside access to drugs
- Therapy programs focused on understanding the addiction
- Some programs are focused on religion or spirituality, while others specifically avoid those topics; people entering these programs can be very specific about life philosophies when choosing a program.
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Downsides of Inpatient Rehab
Because there are so many different program combinations offered through inpatient or residential treatment programs – from intensive short-term to long-term for social reintegration – there are very few downsides for many people entering these programs. However, here are a few to consider:
- People entering an inpatient program will not be able to see their friends or family very often, due to structured schedules.
- Those entering inpatient rehabilitation will not be able to maintain a job or maintain regular school schedules.
- Inpatient treatment programs can be expensive, although there are many payment options worth investigating.
Who Does Best in Inpatient Rehab?
- Those who need extensive, consistent medical oversight for detox
- Those with home, work, school, or personal relationships that are too triggering without more support
- Those who have been unsuccessful in outpatient rehabilitation programs
- Those who don’t live near an outpatient program or cannot easily commute there
- Those with additional physical or mental health issues that also require medical assistance
Outpatient Rehabilitation Programs
Outpatient rehabilitation programs offer many of the same services as inpatient programs, but in an environment that allows people to live at home. Some programs are therapy-based and only involve a commitment of a few hours per day, a few days per week, so the person is able to maintain a job, family commitments, or school attendance. Other programs are more intense, but for a short period of time.
Often, people overcoming addiction combine inpatient and outpatient rehabilitation programs over a long period of time, so they gain the skills necessary to overcome their addiction. However, as with many decisions regarding addiction treatment, this ultimately comes down to a personal discussion between the individual and their overseeing physician.
Some types of outpatient programs include:
- Partial Hospitalization or Intensive Outpatient Treatment: While these two programs are not the same, they offer many of the same benefits and structure. The person involved in the treatment program is able to go home at the end of their daily session, but they are typically required to attend medication management, group therapy, and individual therapy for several hours per day, many days per week. This can range from four hours per day, three days per week, to eight hours per day, five days per week, with structured breaks. Most of these programs spread a 20-hour-per-week requirement over a few days. A person typically enrolls in these programs after successfully withdrawing from their substance of abuse, which can involve a stay in the hospital.
- Other types of outpatient services: These can be prescribed by a doctor, and they can be found at hospitals, university medical centers, or on their own in separate, specialized facilities. Each program involves a group therapy component and focuses on actively involving the individual’s family, friends, and community in their recovery. For those prescribed buprenorphine or other medications to ease detox or withdrawal, overseeing physicians will also require visits as part of the program. In general, outpatient services that aren’t as intense as a PHP or IOT fall under this category.
- Peer support or 12-Step Programs: While 12-Step programs are not technically outpatient treatment, they are often viewed under this umbrella. They do not constitute professional care, however, and they should be used in conjunction with a larger treatment program.This type of recovery program first became popular in the 1930s, as a method for overcoming an alcohol abuse disorder. The program changed how addiction and substance abuse were viewed, because now there was a way for people to work on their problem and, in a supportive and structured environment, learn about their negative habits and overcome these impulses. Since their inception, 12-Step programs have exploded in popularity, and they remain very popular today. A person joining the program goes to regular meetings and finds a sponsor, who will help them remain accountable for their recovery. These are peer-led programs that are not accredited by hospitals, but the social setting can provide good support structure.
How Long Are Outpatient Rehabilitation Programs?
NIDA recommends a 90-day minimum commitment to any rehabilitation program; however, outpatient services range much more in length of involvement compared to inpatient services. For example, Partial Hospitalization Programs typically involve participation for 3-5 weeks, while other forms of outpatient treatment remain open to members for years and are often used for life.
Benefits of Outpatient Rehab
- A greater level of privacy and anonymity, since the person rarely has to miss much work or school
- A greater ability to maintain commitments to family and career
- The ability to maintain current community ties and enlist the direct help of the community during the course of treatment
- Staying in the comfort of one’s home at the end of the day
Downsides to Outpatient Rehab
Outpatient treatment programs are generally less expensive, and can often be more easily covered by insurance or government programs, than inpatient treatment. However, there are downsides to outpatient treatment too, including:
- Being responsible for transportation to meetings, doctors’ appointments, etc.
- Easier access to substances of abuse, because no one monitors the person once they return home at the end of the day
- Greater potential earlier in the process to face stress or triggers that might lead to relapse
- Less structure during the day gives the mind time to wander
- There are some outpatient programs who offer detox, but many do not, so this process may still need to be managed through an inpatient hospital or rehabilitation stay.
Who Does Best in Outpatient Rehab?
The scheduling freedom offered by an outpatient program can be a benefit or a negative point, depending on the individual. People who work best in outpatient programs include:
- Those with children they need to take care of
- Those who show a great ability to maintain abstinence from a substance and structure in their time outside of therapy and doctors’ appointments
- Those who have stable home lives
- Those who can transport themselves easily and consistently to meetings, appointments, etc.
- Those who can’t quit or don’t want to quit their jobs
Regardless of the type of treatment program chosen, overcoming addiction and substance abuse is vital. Speak with a doctor or other treatment professional to determine whether an inpatient or outpatient program would work best for your situation. Getting help increases a person’s chances of successfully maintaining sobriety, developing and maintaining healthy relationships, staying out of criminal trouble, and maintaining employment. It can also lengthen life and enhance overall quality of life greatly.