Inpatient vs. Outpatient Treatment Options
Many different types of treatment are available for substance abuse rehabilitation. Both inpatient and outpatient approaches can be helpful, and the appropriateness of each is determined by individual circumstances. In each case, treatment of addiction must be tailored to the individual who needs it.
Inpatient or residential treatment takes place at a specialized treatment facility. This type of treatment requires the individual to stay at the facility for a set amount of time, ranging from weeks to months. Outpatient treatment allows the individual to continue living at home while spending a certain amount of time at a treatment facility or in therapy, with the amount of time varying between programs and treatment plans. Partial inpatient or intensive outpatient programs may involve several hours in treatment per day, usually decreasing over time as the person progresses in recovery.
The first step of most addiction treatment programs is detox. NIDA defines this as the process by which the body rids itself of drugs or alcohol. This process is often accompanied by uncomfortable physical and psychological withdrawal symptoms.
Alcohol Health and Research World reported that people with milder withdrawal symptoms may do well in an outpatient detoxification program. Individuals experiencing tremors, sweating, heart palpitation and nausea can safely detox as an outpatient, in a program that is less expensive and time-consuming than its inpatient counterpart. Outpatient detox can also offer more social support than inpatient programs, because the individual remains in contact with their outside support system of friends and family. However, outpatient detoxification also presents an increased risk of relapse due to easier access to the addictive substance. Those suffering from certain types of addictions, such as addictions to opiates, alcohol, and benzodiazepines, are not eligible for outpatient detox; detox from these substances can be severe, and medical detox is needed.
Inpatient detox offers those more severe withdrawal symptoms proper medical care. Alcohol Health and Research World estimates that approximately 10 percent of people experiencing detoxification require inpatient treatment. Inpatient settings provide less opportunity for relapse into substance use, as well as constant medical care. In addition to those suffering from addiction to alcohol, opiates, and benzos, those who are at risk of serious complications during the detoxification process require treatment as inpatients.
While inpatient and outpatient detox settings can support different medical needs, long-term outcomes of treatment do not seem to depend upon the setting in which a person receives detox treatment; rates of sobriety remain similar for both groups.
Inpatient or residential treatment involves 24-hour care, with the person remaining at the treatment facility for several weeks to months. NIDA reports that residential settings typically use a model of treatment emphasizing relationships and social support, involving both other individuals at the treatment center and outside support systems like friends and family. This treatment approach is known as the therapeutic community.
Within this modality, addiction is seen within the context of environment and other contributing factors. The therapeutic community approach emphasizes personal responsibility and addresses unhealthy patterns of thought and behavior. Individuals in treatment learn to analyze their negative thoughts and self-concepts in order to form new, healthier patterns.
Inpatient treatment centers often provide additional services as well,
including employment training and other life skills training workshops. While both inpatient and outpatient treatment can be effective, inpatient treatment may provide advantages to some individuals; a study published by the U.S. National Library of Medicine found that participants in outpatient treatment were four times more likely to relapse during the course of treatment than those in an inpatient program.
Inpatient treatment is offered in both long-term and short-term formats. Long-term programs may last several months, while short-term programs typically last several weeks. A study published in the Journal of the American Medical Association found that both long-term and short-term programs can be effective, but long-term programs may be somewhat more successful in certain areas of recovery.
Both formats generally involve a gradual reduction in the amount of time spent in treatment, transitioning to an outpatient program after completion of the residential program. This assists in the maintenance of sobriety and helps prevent relapse. NIDA recommends continuation of outpatient therapy and participation in support groups after the completion of an inpatient program.
Residential treatment is sometimes accompanied by the use of medication to lessen withdrawal symptoms or encourage sobriety. According to SAMHSA, these medications work in various ways, often by mimicking the effects of the addictive substance. Other drugs block the positive effects of the substance or produce negative effects when taken with the substance. Some treatment facilities offer medication only during detoxification, and others use medication throughout treatment to help prevent relapse. Medication has most commonly been used in the process of opioid recovery, but some medications can help during recovery from alcohol or other drugs.
Outpatient treatment programs vary in length and intensity, generally decreasing in intensity over time. Outpatient programs can offer certain advantages over inpatient treatment; for example, a study published by the Health Research and Educational Trust found that outpatient treatment was significantly more cost-effective than inpatient treatment.
According to NIDA, outpatient programs typically involve individual counseling, group counseling, and treatment for any disorders or health problems that occur in tandem with the addiction. Intensive day treatment, also called partial inpatient or partial hospitalization, involves spending several hours a day at a treatment facility.
These programs offer a comparable level of treatment and support as inpatient programs, but individuals return to their homes at the end of each day. Other programs are less involved, ranging all the way to low-intensity programs focusing on drug education. Individuals who complete more intensive programs generally then move into programs that require fewer hours.
Individual counseling is typically a large component of outpatient treatment. This type of treatment addresses the addiction, underlying causes for the addiction, and factors that may contribute to substance use, such as relationships and social problems, employment, or other stressful life events. Individual counseling helps people develop healthy coping skills and patterns of behavior.
SAMHSA lists Contingency Management, Cognitive Behavioral Therapy, and Motivational Enhancement Therapy as a few of the many counseling approaches that can be helpful to someone struggling with addiction.
Group counseling is another component of treatment often utilized in outpatient settings. These programs can provide additional social support, which can be very helpful in maintaining sobriety. NIDA reports that group counseling can increase the likelihood of positive outcomes from addiction treatment when it is used in combination with individual counseling. A study published by the Taylor and Francis Group supports these findings; when attended at least weekly, group therapy was found to significantly increase rates of sobriety.