A helpful way to understand inpatient treatment as compared to outpatient treatment is to first consider the basic structure of rehab programs. As the National Institute on Drug Abuse (NIDA) explains, the first phase of drug addiction treatment is medical detox. This process may last 5-7 days, but it can be longer. Medical detox can occur at a rehab that offers this service, a hospital, or a standalone detoxification facility. NIDA correctly cautions the public that medical detox is not a treatment as much as it is a step in the drug treatment process.
The next step (and it should happen immediately) is primary treatment for the addiction. Whereas medical detox focuses on the biological components of addiction, primary treatment for the addiction addresses the psychological and emotional states underlying the addiction (i.e., those that motivated and perpetuated the addiction). As NIDA explains, therapy (individual and group) is the core of primary treatment for addiction. The following are some research-based therapies that have proven to be effective in the drug treatment context:
Although therapy is a staple of treatment, there are a range of supportive services that rehabs offer (the rehab services that are available depend on the particular programming at the rehab). The following are some of the supportive services a rehab may offer:
- Medication-assisted treatment (MAT): At present, this treatment service applies to recovery from opioids, alcohol, and benzodiazepines. When MAT is provided, it can be used in the medical detoxification and primary treatment phases, depending on the recovering person’s needs.
- Group recovery meetings: Based on the principle of mutual aid, these groups may be modeled after the Alcoholics Anonymous 12-Step approach (faith-based) or take another approach, such as that employed with SMART Recovery (non-faith-based).
- Family therapy: According to the Substance Abuse and Mental Health Services Administration (SAMHSA), family therapy can be especially helpful to recovery because addiction is considered to be a family disease.
- Holistic treatment (also called complementary treatment or wellness services): This can include yoga, massage, acupuncture, and acupressure. Holistic approaches seek to improve the overall health of the recovering person and thereby support abstinence maintenance.
- Aftercare: Before completion of a rehab program, it is particularly helpful for a recovering person to learn about how to self-manage the aftercare process. As HBO explains to the public as part of its commitment to raising awareness about drug abuse, there are numerous strategies available for a person to put in place to promote abstinence. Rehab services may include an aftercare education program that teaches recovering individuals some of the skills needed to live drug-free life outside of rehab.
Now that the fundamentals of rehab programming have been established, a fuller understanding of inpatient versus outpatient treatment can be reached. Inpatient and outpatient treatment are program types. These types relate, most basically, to whether a person lives at the rehab center (inpatient treatment, also called residential treatment) or regularly visits the rehab center for rehab services (outpatient treatment). But there are more differences to highlight between inpatient and outpatient treatment than the number of hours (24/7 versus part-time) involved in each treatment setting.
Inpatient or Outpatient Treatment?
It is helpful to note that a person who is seeking rehab services does not need have to decide at the outset whether to go into an inpatient or outpatient program. Rehab centers conduct an extensive intake process, either at the time of initial consultation or during the admissions process. The admissions counselor will ask targeted questions and collect information that will be used to create a tailored treatment plan. There may be a recommendation for an inpatient or outpatient program. In some instances, individuals may already know that they want to do an inpatient program or that they can only engage in an outpatient program (for example, due to work or family commitments). The treatment center will work with clients to accommodate their needs while at the same making the best professional recommendations for treatment.
Inpatient and outpatient treatment overlap in some significant ways, while at the same time, there are differences between these two settings. At the outset, it is helpful to discuss the potential costs of each program. In 2011 the Clean Slate Addiction Site (CSAS) conducted a review of the costs of 32 inpatient drug rehab programs. CSAS found that an average inpatient drug rehab program with a detox facility on site cost $27,399. The average cost of inpatient treatment for rehabs without an onsite detox facility was $15,491. The difference between the two costs does not reflect the average cost of medical detox. CSAS also looked at outpatient programs and found the average cost of a 10-week program to be about $7,000.
While the cost of rehab may understandably be a concern, paying for rehab should never stop a person from seeking addiction treatment services. There are options, including applying for state-funded health insurance (Medicaid), finding a publicly funded rehab, or getting help from a local nonprofit that may be able to find a free charity bed at a private program. Addiction treatment is always an option for anyone seeking help.
Beyond costs, the following are some of the main highlights of an inpatient program:
- Treatment typically lasts at least 28-30 days, though it may be 60 days, 90s days, or longer.
- Remaining in the program is voluntary, even though it is the person’s temporary residence. There is a universal advisement not to leave a recovery treatment program before the end of the recommended term.
- Most rehab programs will provide inpatient clients with a daily schedule of therapy sessions as well as supportive services, which can include all of the types described above as well as exercise and complementary therapies.
- A person may select inpatient treatment rather than outpatient treatment for a variety of reasons. In some instances, a person has undergone treatment in an outpatient program but experienced a relapse and is now seeking the more intensive treatment setting, which an inpatient setting offers.
- As an inpatient program is 24/7, all facets of client needs are taken care of, including housing, food, and laundering of clothes.
- The structured environment acts as a bulwark against relapse. Since recovering clients do not reside outside of the rehab facility, their ability to encounter drug cues is limited.
- To help recovering individuals maintain contact with family and friends, inpatient rehab programs may include social events, such as family day.
- Since the program is residential, there is a strong opportunity for the residents in recovery to bond and deepen their support of one another.
- Compared to inpatient programs, outpatient programs implicitly provide recovering individuals with greater mobility because they reside outside the treatment center. Outpatient clients can meet obligations that they have outside of treatment. However, there is a general advisement that outpatient clients manage their personal schedules in a way that does not conflict with treatment. For example, a person with childcare needs may be able to arrange with a family member or friend to help out during the outpatient program, such as picking up a child from school. In this way, the recovering person wouldn’t feel the stress of having to be at a certain place at a specific time each day.
- Since the recovering individuals return home each day, they can maintain their privacy. When a person is absent for 28 days or more, people in the surrounding environment are bound to ask questions. The decision to attend a rehab program is a personal one, and the right to maintain privacy is a personal right.
- As outpatient clients live outside of the rehab center, they can put the skills they learn in rehab into use right away. Clients in inpatient rehab may be concerned about returning to the “real world.” This is likely not to be as much of a concern among outpatient clients.
- Outpatient clients can begin to build their support network outside of rehab right away. For instance, an outpatient client may go to local Narcotics Anonymous meetings on a regular basis.
- The outpatient client’s family can start integrating into the process right away. If the recovering client is close with family and friends, they can be brought into the everyday workings of the program. For instance, a weekly family dinner may become alcohol-free as a way of supporting the recovering person’s abstinence.
Ultimately, the quality of a program and a person’s readiness to heal the addiction are strong factors in the recovery process. There are benefits to each type of treatment setting, and neither should really end up being the cause for recovery or relapse. The treatment setting, be it inpatient or outpatient, provides one of many opportunities for a person to recover from the emotional and psychological forces that fueled the addiction. Both treatment settings can provide effective programming and treatment.