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Outpatient vs. Inpatient Addiction Treatment

photo of a person standing at a crossroads with two arrows pointing in different direction

When a person suffering from a substance use disorder (SUD) makes the life-changing decision to accept treatment, one of the first choices he or she must make is whether to receive inpatient or outpatient treatment. Inpatient addiction recovery treatment refers to a person remaining at a facility for a predetermined amount of days (lengths vary depending on facility and recovering patient), going through detoxification, counseling and enjoying round-the-clock care.

Outpatient treatment refers to addiction patients receiving treatment at a recovery facility, but remaining at home, at work and in their normal routine.

Both inpatient and outpatient treatments involve many of the same services, with the primary difference being that individuals at inpatient facilities cannot return home until their treatment is concluded. People using outpatient treatments must report to the facility every day except weekends and holidays.

Both treatment strategies can be effective in the right situation and for the right person. In this article we will examine the positives and negatives of both modalities, compare research about each’s efficacy and provide a guideline to allow you to make an informed decision about addiction treatment for yourself or someone you love.

Fundamentals of Addiction Recovery

Before delving into the different advantages of inpatient and outpatient recovery, we must first understand the basic principles of a successful addiction recovery. While every person’s journey to sobriety is unique, each individual’s addiction must be addressed on multiple levels:

  • Physical – This includes the process of expelling toxins from the body through detox, treating the symptoms of withdrawal and a reversing of the damage caused by substance abuse through the use of several physiological therapies.
  • Emotional – When did you first start using? Does addiction run in your family? How do you respond to stress? Do you have any co-occurring disorders like depression or anxiety? These are some of the questions that a patient must answer for an addiction care professional to provide effective treatment.
  • Spiritual – Addiction recovery has long been linked to spiritual growth. This does not mean that a person in recovery must believe in God, but it does involve finding a connection in something greater than yourself.
  • Social – For many, substance abuse was a large part of their social life. Without alcohol, cocaine, heroin or any other drug of choice, individuals in recovery often struggle to be in social settings. Addiction recovery services address this by reeducating people about how to enjoy themselves without substance abuse and through confidence building exercises.
  • Environmental – A person who has struggled with addiction likely has a lot of environmental triggers, including old hangouts, certain situations and even a nostalgic song. While a person can avoid some of these triggers, it’s impossible to eliminate them all. People in recovery must be taught how to recognize and then overcome these environmental triggers.

While each addiction recovery strategy may differ from facility to facility, any effective approach will address all five of the fundamentals of addiction recovery. Whether a person is choosing inpatient or outpatient care, he or she must be certain that the program has techniques in place to provide healing and education for the whole person, not just his or her addiction.

The Benefits of Inpatient Addiction Treatment

The immersive addiction recovery structure provided by inpatient treatment is the primary advantage of this technique. This protective environment removes access to drugs and alcohol and provides a healthy and healing atmosphere that may allow people in recovery to thrive. Inpatient addiction treatment is the best choice for individuals with a history of substance abuse,  or co-occurring disorders, or living in an unstable environment, or if they have already tried outpatient rehab. [1]

As a general rule of thumb, inpatient care is reserved for patients whose substance abuse and addiction have become obvious dangers to themselves and others around them.

Inpatient treatment creates a healthy and healing atmosphere that allows people in recovery to thrive.Inpatient or residential programs provide safe havens for people with addictions, free of distractions, triggers and other circumstances that may create urges for them. With negative factors removed from a person’s life, he or she can focus completely on building health and getting sober. Residential recovery programs also often include an intensive level of care that involves life skills training, nutritional counseling and family therapy and education, among many other forms of guidance.[2]

Additionally, inpatient programs tend to last for shorter periods of time than outpatient and are associated with smaller dropout rates. In 2010, the median length stay in an inpatient recovery program was 90 days, compared to 120 for outpatient. The dropout rate for outpatient programs was 60 percent, compared to just 30 percent for inpatient.[3]

There are also some advantages for a person entering recovery and going through the detoxification process in an inpatient setting. When drugs and/or alcohol are being expelled from a patient’s body, an inpatient environment guarantees that the individual in detox cannot get his or hands on any alcohol or drugs. Additionally, since many withdrawal symptoms are painful, debilitating and even life-threatening in some cases, the 24-hour medical supervision available at most residential treatment facilities is invaluable. There is also a higher likelihood that a recovering patient fully completes the detox process in an inpatient setting as opposed to an outpatient.[4]

The Benefits of Outpatient Addiction Treatment

While outpatient and inpatient recovery strategies share many similarities in treatment, there are some distinct differences worth noting. Outpatient treatment requires patients to report to a recovery facility on a daily basis, minus weekends and holidays. They are not shielded by the protective environment found at inpatient facilities and must contend with their everyday lives and situations while working on their recovery at the same time.

Outpatient care is often reserved for patients who are only in danger of mild or moderate withdrawal symptoms.Outpatient care is often reserved for patients who are only in danger of mild or moderate withdrawal symptoms. They tend to be a little less intensive than inpatient, which may also be an attractive draw for families and individuals considering treatment options.

The primary advantages of outpatient treatment is its affordability and the freedom enjoyed by patients in these programs. Some inpatient facilities charge as much as $60,000 for a month – a significant difference when compared to outpatient treatments, which generally reach as high as $10,000 per month.[5]

When you add the cost of an inpatient facility to the loss of income by not working (due to being in rehab), outpatient treatment is often the best option for middle and working class families who aren’t covered under their insurance plans. Responsibilities such as child care, elder care and education are also factors for many people when deciding which option is best. Not everyone has a job that will allow them to take a month or longer off of work, many can’t afford to lose income for that long, and familial responsibilities will always come first when a person doesn’t have help or support.

Of course, if outpatient treatment proves ineffective, the lesser cost becomes moot.

Another important factor of outpatient treatment is the ability to remain close to friends, family members and pets while remaining in the comfort of your own home. This is potentially a large positive for patients who are uncomfortable with the idea of being away from home and their loved ones for so long.

Choosing Between Freedom and Accountability

Those making the decision between inpatient or outpatient treatment are often determining whether they need more accountability or more freedom. On one hand, the accountability can’t be higher at an inpatient facility. Most search incoming recovery patients for any drugs and/or alcohol and the facility is always 100 percent substance free. Additionally, regularly prepared meals and constant supervision ensure that patients are maintaining their health.

However, the loss of freedom by being removed from the real world is no small thing to overcome. Being away from friends and family in an unfamiliar place is not easy to endure. Outpatient treatments allow people with drug and alcohol addictions to live their lives as they would normally, with the exception of a minimum amount of hours per week in a facility.

For some, this is great, as it makes it possible for them to remain employed and to continue contributing to their household. However, this also puts extra pressure on the person in recovery. Instead of alcohol or drugs being unavailable, the only thing stopping a person from getting their fix is willpower. This problem is exacerbated when friends and families are also substance abusers.

Substance abusers with mental health disorders or those who live in a toxic environment can benefit greatly from the specialized services available at inpatient facilities.

Additionally, outpatient programs often lack the specialized therapies available at inpatient facilities. This may not be an issue for some who are recovering from addiction, but substance abusers with mental health disorders or those who live in a toxic environment can benefit greatly from the specialized services available at inpatient facilities.

Comparing Success Rates from Inpatient and Outpatient Programs

Since all people and their addictions are different, and each rehabilitation facility and strategy is different, creating a true comparison among success rates from each type of program is impossible. Far too many variables exist to make a fair and accurate statistical analysis. However, several past studies have given some indication that inpatient treatments are more effective than outpatient.[6]

One 1993 U.S. study by the Carrier Foundation examined the success rates of 183 inpatients against 120 outpatients. It concluded that alcohol and cocaine addicted patients with high psychiatric severity and/or poor social and familial support were better suited for inpatient treatments. Individuals in the opposite situations would benefit most from an outpatient setting. It also concluded that outpatients, regardless of psychiatric severity, were four times more likely to experience early failure in treatment. The study did not include long-term results.[7]

A 2009 Switzerland study mirrored these findings. Researchers examined 915 alcohol addiction treatment patients at Forel-Hospital, the largest clinic of its kind in the country, between January 1, 2004 and December 20, 2006. The researchers concluded that at least 75 percent were better suited for inpatient treatment due to severe psychiatric, somatic or social irregularities.[8]

Not All Inpatient Rehabs Are Created Equally

Part of the reason inpatient services may be more beneficial to people with severe addictions or co-occurring disorders is because of the availability of unique therapies that help individualize patients’ treatments. Many inpatient facilities offer advanced therapies to help heal patients on mental, physical and spiritual levels. Some of these therapies include:

  • Equine Assisted
  • Neurofeedback
  • Eye Movement Desensitization and Reprocessing
  • Yoga
  • Aromatherapy
  • Massage Therapy
  • Expressive Writing
  • Acupuncture

Inpatient facilities that don’t provide these types of therapies do not offer the same advantages normally associated with residential care. Additionally, in an industry that’s worth over $35 billion, there are many unregulated and unlicensed addiction treatment centers. The facility you choose is just as important, if not more so, than whether you attend on an outpatient or inpatient basis. 

Discussion, Conclusion and Recommendations

The difference in the effectiveness of inpatient or outpatient addiction treatments is highly dependent on the recovering patient. People dealing with a weak support system, a long history of substance abuse and mental illness are likely to benefit most from inpatient treatments. Also, the removal of drugs, alcohol and life distractions can only serve as a benefit to anyone entering recovery, no matter how severe his or her addiction.

For those who are unsure of which strategy would work best for them, answering a few questions about yourself and your situation may provide guidance:

  • Are you exposed to drugs or alcohol in your immediate environment?
  • Do you have friends or family members who engage in substance abuse around you?
  • Do you have a strong network of support to help prevent relapse?
  • Do you have the flexibility to leave your job, school or home duties for extended periods of time?
  • Do you need treatment for a co-occurring disorder?
  • Do you have the ability to commute to and from your home to a facility on a daily basis?
  • Do you need specialized therapies and/or services?

Your needs in recovery and your current lifestyle and situation should determine whether inpatient or outpatient is the best option for you. Being that alcohol and drug addiction is, and should be treated as, a chronic illness, it may be best to combine both strategies during treatment. Following a 30 – 90 day stay at an inpatient facility, a person recovering from addiction still has a lot of work to do. Going to 12-step meetings and working with support groups are ways of continuing addiction treatment in an outpatient setting.

[1] https://addictionresource.com/treatment/inpatient-vs-outpatient/

[2] http://psychcentral.com/lib/differences-between-outpatient-and-inpatient-treatment-programs/

[3] http://archive.samhsa.gov/data/DASIS/TEDS2010D_Web.pdf

[4] http://pubs.niaaa.nih.gov/publications/arh22-1/44-46.pdf

[5] https://www.addictioncenter.com/rehab-questions/cost-of-drug-and-alcohol-treatment/

[6] http://www.nytimes.com/health/guides/disease/alcoholism/treatment-for-alcoholism.html

[7] http://www.academia.edu/24288999/Inpatient_vs_outpatient_treatment_for_substance_dependence_revisited

[8] https://ijmhs.biomedcentral.com/articles/10.1186/1752-4458-3-16

This article was written by addiction care experts at Behavioral Health of the Palm Beaches. We are committed to offering the most comprehensive addiction treatment services in the nation and being thought leaders in the addiction recovery community.