Inpatient vs. Outpatient: What’s the Best Fit?

Medically Reviewed

Getting treatment for alcohol or substance abuse is a great decision, but it is only the first of many. People also have to decide between inpatient and outpatient rehab and how long they will stay in treatment. The cost of treatment is one of the main reasons why people delay getting help.

Inpatient treatment is usually the most comprehensive approach, but there are intensive outpatient programs that can be just as effective. When it comes to a decision between inpatient and outpatient treatment, it is important that people think about their goals before deciding which is the best fit.

Key Differences Between Inpatient and Outpatient Programs

The National Institute on Drug Abuse(NIDA) reports that treatment can be separated into two broad categories: inpatient and outpatient. Though both types of treatment have a lot in common, there are several key differences.

  • Outpatient treatment programs can differ in their treatment approaches. Some programs may only offer education, while other programs can be nearly as comprehensive as inpatient programs. Outpatient programs are usually a good fit for people with an extensive social network or for people who cannot take too much time off work to complete a residential program. As is implied, clients at outpatient treatment programs must commute to their treatment site.
  • Inpatient treatment programs have clients live at the treatment facility. Inpatient treatment is still divided into two types.
    • Long-term treatment: NIDA says that a therapeutic community (TC) is the most widely known type of long-term treatment. Such treatments plan for a client to stay between six and 12 months, and all aspects of treatment are meant to help individuals relearn social skills to deal with addiction. Activities are structured and meant to help clients become more responsible and balanced individuals.This treatment can be modified to treat clients will all kinds of needs. It can be tailored to suit the needs of women, teens, and other communities.
    • Short-term treatment: These treatments were first designed to treat alcohol misuse issues, but they have been modified to assist clients who are addicted to other substances, as stated by NIDA. Clients may stay in these programs anywhere from three to six weeks, but they will be expected to take part in outpatient treatment later on or to participate in ongoing self-help or peer support groups such as Alcoholics Anonymous. Aftercare is an important component of short-term programs.

How Effective is Inpatient or Outpatient Rehab?

NIDA’s Principles of Effective Treatmentstate that no one-size-fits-all approach works for everyone. Treatment must address a person’s specific needs. It must always be modified in accordance with the client’s changing needs.

A 2014 case study published by Psychiatric Services found that the intensity of a person’s addiction and their mental health influenced how successful treatment was. People who were addicted to cocaine or who dealt with suicidal ideation were more likely to do better in inpatient programs.

Data from the study also shows that people with severe drug misuse issues benefited most from long-term programs. Those with severe drug or alcohol use disorders fared better in residential programs than long-term programs that were not residential.

The study did mention that intensive outpatient programs were very effective in dealing with drug and alcohol misuse, especially when combined with residential treatment. Even so, the study determined that there were no major differences between outpatient and inpatient programs when controlling for intensity.

Outpatient programs had the advantage that people were able to live at home and put new skills into practice immediately.

Things to Consider When Choosing Treatment Type

Whether you choose an inpatient or outpatient treatment, you still need to discuss your plans with your insurance provider. The following factors can influence that cost of your treatment:

  • Inpatient vs. outpatient: If you live at an inpatient facility that will provide your meals, program activities, and have staff on call or on the premises around the clock, the costs are higher. Outpatient programs are cheaper because they only include care for a given schedule, and you do not live or eat there.
  • Amenities: Some treatments are conducted at very basic facilities, but many treatment centers offer extras, such as spas, gourmet meals, and other luxury add-ons. The more amenities you choose, the more treatment will cost. However, the quality of the education and workshops you receive should not be affected by the setting.
  • Location: Facilities in major cities may be cheaper than treatment in a secluded area or near the ocean.

In addition to considering cost, you should take the drug used, the severity of misuse, and possible co-occurring mental health issues into account. As a general rule, co-occurring disorders benefit from inpatient treatment as do severe or long-term substance use disorders. Your intake team will be able to advise you on which type of treatment is best for your situation.

What to Expect Regardless of Treatment Type

Whether or not you decide to seek treatment at a residential or outpatient facility, you should expect evidence-based treatment. Treatment may include:

  • Motivational interviewing. This allows a person to assert their needs in therapy and find their motivations for recovery.
  • Family therapy. This therapy is widely known for its positive effects on both teens and adults. NIDA says it can greatly improve a family’s dynamic.
  • Couples therapy. This therapy is meant to support a relationship and help couples overcome addiction together.
  • Cognitive behavioral therapy (CBT). CBT is meant to change the way clients think to change their behavior. It can also address depression, anxiety, and other mental health issues.
  • Medication. People who are addicted to opioids may be given medication, such as methadone or buprenorphine, to decrease cravings and manage withdrawal symptoms. Other medications, such as antidepressants, may be prescribed on an as-needed basis.
  • Detox. This may be the first step in treatment, though some facilities may expect you to be fully detoxed before starting treatment.
  • Assessments. These may be ongoing throughout treatment to identify the presence of mental health issues.
  • Relapse prevention. Relapse is known to happen in recovery. All facilities will be equipped to handle relapse should it occur. They’ll also give you the tools to avoid it.
  • Group therapy. These sessions are part of your treatment where you and your peers discuss issues about drug use while helping each other come up with strategies to stay sober.
  • Aftercare. The purpose of aftercare is to prevent relapse and help you find balance in recovery.
  • Medical tests. Tests may be given to detect HIV or hepatitis B and C, along with other diseases.

Whether you choose inpatient or outpatient treatment, choose a program that offers an individualized approach based on evidence-based treatment.

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