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Inpatient vs. Outpatient: How to Choose the Right One

Addiction treatment brings different images to mind, mostly involving a jail-like setting with strict rules and no-nonsense authority figures. But this is not true of all facilities or the programs they offer. Getting help for a substance use disorder is not what most people imagine it would be like. Different programs are designed to meet different needs, depending on who needs treatment.

Two commonly offered options are inpatient and outpatient treatment, and there are key differences between them both. Much of addiction recovery is personal, so it’s important to research different treatment programs.

Knowing about each program’s benefits can help make it easier to place a person in the right setting based on their needs.

Inpatient Treatment

Inpatient treatment (also known as residential treatment) is appropriate for substance users who need a higher level of addiction care. Inpatient rehab requires at least a 30- to a 90-day stay at a live-in treatment facility, depending on the person. Professional medical staff and addiction care specialists are on site to provide clients with 24-hour personalized care and support.

This structured, monitored setting is often recommended for people who are battling addictions to alcohol, cocaine, methamphetamines, and opiates/opioids (OxyContin, heroin).

People who use more than one addictive drug at the same time are also encouraged to enter an inpatient program as it allows them more time to work through a more complex situation.

The inpatient treatment setting is appropriate for people who:

  • Are far along in their addiction and require intensive treatment
  • Have severe substance use disorders and need medical treatment
  • Have a mental health disorder along with a substance use disorder (dual diagnosis)
  • Have not achieved their recovery goals in other treatment settings
  • Have relapsed and need a structured setting and support to get back on track
  • Seek ongoing aftercare to support their sobriety and avoid relapse

Some treatment facilities start inpatient treatment with medical detoxification to properly wean clients off the substances used and bring them to medical stability. When stability is achieved, then the appropriate treatment plan can be recommended.

People who enter inpatient treatment also need:

  • Monitored medical interventions to address chronic behavioral and psychological issues
  • A structured living space that requires them to address their addiction head-on without stress or distractions
  • A supportive space that promotes sobriety and a successful recovery
  • Therapies that are offered as part of the inpatient/residential treatment process
  • Access to 12-step programs such as Alcoholics Anonymous or Narcotics Anonymous.

Residents typically have a day structured with activities and therapy sessions they must attend. Families are also encouraged to meet with their loved ones and move forward together in addressing addiction. 

There are inpatient/residential rehabs that think ahead to the time when clients leave treatment. Aftercare planning focuses on helping clients make the transition from life in rehab to life in the outside world. This assistance can involve housing, job placement support, or an alumni program that allows recovering users to stay connected when treatment ends.

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Benefits of Inpatient Treatment

Inpatient treatment is seen as a treatment of last resort for those with a severe substance abuse issue. The clients that attend inpatient generally have much more severe symptoms, which include psychiatric comorbidities relative to outpatients. These clients are much more complex, and a higher proportion of those seeking treatment will never walk through the doors. For the people that do end up walking into treatment, many will exit prematurely.

Due to the social nature of inpatient drug rehabilitation programs, it has been argued by professionals that social anxieties can decrease the likelihood of an individual entering treatment, or increase the risk that they leave before treatment is completed.

Treatment, however, becomes more effective when secondary mental health problems, such as anxiety, are addressed as a part of therapy. Inpatient treatment is beneficial for those addicted to drugs and also struggle with mental illness, such as schizophrenia, depression, bipolar disorder, cyclothymic disorder, and borderline personality disorder, among others.

Drawbacks of Inpatient Treatment

Inpatient treatment offers a very structured environment, and it may be difficult for some people to adjust to this kind of setting, even if there is need for this as part of an individual’s recovery process. In this controlled environment, daily activities are scheduled, including wake-up, meal times, group and individual therapies, and sleep times. Planning of services occurs to assist individuals with development of and acclimation to having a daily routine, and even free time includes a high degree of structure. For some, inpatient treatment may not be a feasible option to meet their needs.

In addition, inpatient treatment requires a commitment to care, as those who enter an inpatient setting will remain in this structured environment until the completion of their inpatient treatment episode. This kind of commitment may inhibit ongoing participation in employment or academic pursuits, requiring arrangements to be made so that an individual can focus on their treatment and recovery process while in an inpatient setting.

Lastly, inpatient treatment is more challenging to get approved by insurance than other types of programs. Inpatient is considerably more expensive than outpatient, and you may or may not be covered; however, cost should never be a factor for treatment.

If you are someone who needs help, you must evaluate all options and ensure you get the treatment that you need. There are government programs, such as The National Institute on Drug Abuse (NIDA) available to assist with information about treatment.

How to Choose an Inpatient Treatment Program

choosing an inpatient program

Effective inpatient treatment programs tailor addiction recovery to the client’s needs and offer the proper length of time to allow people to recover from substance abuse. Before choosing an inpatient rehab center, vital factors to consider are:

  • Current and former substance use and substance abuse history
  • Drug or drugs of choice
  • Family history of substance abuse
  • Existing comorbid or co-occurring disorders (dual diagnosis, or when a substance use disorder and a mental health disorder are present at the same time)
  • Earlier attempts at treatment and sobriety

Because of the seriousness of the situation, it can be easy to get overwhelmed by all the decisions that have to be made about treatment. When it comes to picking the right inpatient rehab, it’s important to keep in mind factors such as the facility’s location, whether it offers alternative therapies in addition to the standard ones, and if it’s affordable timewise and moneywise.

Inpatient programs require a considerable time commitment. In addition to taking time off from work, school, and other personal obligations, on-site costs, such as room and board, can make inpatient rehab an expensive option. One’s inability to pay for addiction treatment is not a reason to pass up a chance to get help, so be sure to examine all financial options.

Outpatient Treatment

In a nutshell, outpatient treatment programs are somewhat the opposite of inpatient treatment when it comes to flexibility, especially where time and financial costs are concerned. Outpatient treatment programs are low-to-moderate in intensity and offer more flexibility than an inpatient program does.

The outpatient treatment setting is appropriate for people who:

  • Are in the early stages of addiction or have a mild substance use disorder
  • Want aftercare services after residential or inpatient treatment ends
  • Want to include it in a long-term recovery program
  • Can’t pay for inpatient/residential treatment at this time
  • Are committed to their recovery goals and have a routine schedule
  • Need support as they transition from a sober-living home and back into the world

Outpatient clients are not required to live in a 24-hour monitored treatment facility for an extended period. This helps keep costs down and allows them to have more control over their schedules. They either live at their residence or a sober-living facility. This arrangement also affords them some level of privacy as well.

The lack of a structured, monitored environment is one of the most significant differences between inpatient and outpatient, and this is a factor that must be weighed with consideration.

Addiction is a chronic illness that requires lifelong management for most people. If you or your loved one is considering this level of treatment, keep in mind that people who live outside of a rehab center must rely on themselves to keep their surroundings clear of drugs and alcohol, and any triggers and temptations that could lead to relapse. They also must rely on themselves or an outside supportive network to keep sobriety as the goal.

Outpatient programs are less restrictive than inpatient programs.  They offer access to the same kinds of therapies, programs, and services.

Clients are still required to attend therapy for a minimum of nine hours a week. During these hours, they attend therapy sessions that cover tools and strategies that are designed to help people in recovery overcome early-stage addiction.

This treatment approach can involve any combination of these disciplines:

  • Substance abuse education
  • Cognitive Behavioral Therapy (CBT)
  • Cravings and triggers management
  • Mental health treatment
  • Therapy (individual and group)
  • 12-step fellowship programs
  • Referrals for transitional living arrangements (sober homes)
  • Relapse prevention education

Outpatient programs offer more flexibility on the program length as well. Clients who pursue this option can attend outpatient rehab for anywhere from 90 days or more than a year if needed. Longer treatment periods are recommended because research suggests clients have a better chance of recovery if they spend at least 90 days in either an inpatient (residential) or outpatient program.

How to Choose an Outpatient Treatment Program

As with an inpatient program, important factors to consider are:

  • Current substance use and substance abuse history
  • What drug or drugs are being used
  • Family history of substance abuse
  • Existing comorbid or co-occurring disorders
  • Previous treatment or attempts to achieve sobriety

Before choosing an outpatient rehab, the severity of one’s substance use disorder, as well as where they are in their recovery must be reviewed as well. There are differences between outpatient programs as well.

Intensive outpatient programs (IOPs) are designed for people who recently relapsed and need time to recover and people who are transitioning from a day partial hospitalization program who need support as they transition to living in sobriety full time. How long IOP treatment lasts depends on the person receiving treatment. 

Inpatient Vs. Outpatient – Comparing Costs

Your life should never have a cost attributed to it.  Sometimes, it’s not an option to afford treatment. Cost is a significant factor when choosing between an inpatient and outpatient program. 

Inpatient treatment costs much more than outpatient programs because of how much more is involved. Inpatient programs can cost roughly $10,000 to $40,000 USD per month. Luxury programs are even more. Insurance will cover some of these costs, depending on the situation, but if you’re paying out of pocket cost is going to be relevant to you. 

Outpatient programs will run under $10,000 and provide many individuals with an affordable option for rehab.

Sources

National Institute on Drug Abuse, (January, 2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). National Institute on Drug Abuse. Retrieved August, 2018 from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-long-does-drug-addiction-treatment

National Institute on Drug Abuse, (January, 2018).Treatment Approaches for Drug Addiction. National Institute on Drug Abuse. Retrieved August, 2018 from https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction

National Institute on Drug Abuse, (July, 2015).Therapeutic Communities. National Institute on Drug Abuse. Retrieved August, 2018 from https://www.drugabuse.gov/publications/research-reports/therapeutic-communities/what-are-therapeutic-communities

National Institute on Drug Abuse. (n.d.). Funding. Retrieved from https://www.drugabuse.gov/funding

Treatment, C. F. (1970, January 01). 3 Keys to Successful Programming. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK64185/

National Institute on Drug Abuse. (n.d.). What is drug addiction treatment? Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/what-drug-addiction-treatment

Borderline Personality Disorder. (n.d.). Retrieved from https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml

Perugi, G., Hantouche, E., & Vannucchi, G. (2017, April). Diagnosis and Treatment of Cyclothymia: The "Primacy" of Temperament. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5405616/

Staiger, P. K., Kyrios, M., Williams, J. S., Kambouropoulos, N., Howard, A., & Gruenert, S. (2014, February 17). Improving the retention rate for residential treatment of substance abuse by sequential intervention for social anxiety. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3936994/

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