Inpatient versus Outpatient Treatment

 In a nutshell, what do these two terms mean?

Well, inpatient treatment is when a person who suffers from substance abuse and addiction is admitted into a residential treatment facility that provides a comprehensive primary care program. Clients choosing to undergo inpatient care commit to a certain length of time within that residential treatment facility, and they live there during that time. This stay is often between 30 and 90 days. Some drug rehabs offer a longer stay that could last up to 18 months, and usually those rehabs also offer transitional care, which provides clients with recovery tools, such as life skills and coaching. These important tools help ease the transition between being in a drug rehab and going back into society.

Some drug rehabs provide dual diagnosis support, which treats co-occurring disorders like depression, anxiety and other mental health disorders. Many inpatient drug rehabs include detox, which is provided at a separate facility. Sometimes the detox takes place in a separate unit inside the residential treatment facility. Detox is best served on an inpatient basis, because acute withdrawal can present life-threatening symptoms like delirium tremens. During detox, clients are provided with around the clock, medical care and some clients receive medication-assisted treatment, which helps them deal with the painful withdrawal symptoms.

An outpatient substance abuse and addiction treatment facility allows clients to participate in daytime treatment and then go home at night. This type of treatment works best for those who can’t commit to over nights at a drug rehab. This absence of commitment can be due to many legitimate reasons including being single parents who can only get a daytime babysitter, or those who have to work or even those clients who can’t find a pet sitter to take care of Rover, the scary pit bull or Cleo the mean cat. Outpatient offers various levels of care including partial hospitalization programs (PHP), intensive outpatient programs (IOP) and outpatient. Some outpatient programs offer ambulatory detox.

Before participating in any form of primary care in an outpatient or inpatient program, it is mandatory that the client has undergone detox. During the initial assessment process, the intake coordinator will discuss detox to appropriate clients. Also, prior to admittance, potential clients have to undergo drug and alcohol screenings.

PHP often includes a 25-hour weekly curriculum. At times, the curriculum varies per client, but usually treatment includes comprehensive group and individual therapy, experiential therapy including yoga, equine therapy and biosound therapy (offered at high end rehabs), and attendance at recovery support group meetings. Drug rehabs that provide dual diagnosis support for co-occurring disorders will hook up clients with a psychiatrist, who might prescribe non-addictive medications like selective serotonin reuptake inhibitors (SSRI’s) for depression and anxiety. Most psychiatrists avoid prescribing benzodiazepines (benzos) to newly clean and sober clients, because of their nature and highly addictive properties.     SSRI’s include Celexa, Zoloft, Paxil, and Prozac. Clients who are diagnosed with bipolar disorder are prescribed medications like Lamictal and other mood stabilizers. Sometimes when a client is newly clean and sober, it’s hard to make an accurate mental health diagnosis because many clients, especially those who have been drinking and using for a long time, experience sub acute withdrawal syndrome, which manifests symptoms of depression and anxiety in clients.  Also, alcoholism and drug addiction has effects on the brain and its chemistry.

That’s why group and individual therapy is so important to newly clean and sober men and women. Therapy gets to the root of problems, and many times clients are able to figure out why they started drinking or using in the first place.

Besides PHP, outpatient drug rehabs offer IOP, which is less time intensive. This typically provides nine hours of weekly group therapy, and individual therapy is scheduled per client’s needs. Some outpatient facilities encourage or mandate that clients attend a certain number of weekly recovery support group meetings, usually AA/NA meetings. They must get sponsors and work their steps. This helps them connect with a Higher Power, and by going to meetings, they are able to build a peer support network.

The outpatient schedule is less time intensive, and usually includes one group therapy, as well as one individual therapy session per week. For those who are trying to get clean and sober, outpatient is a good option to pursue as an aftercare protocol, or after primary care has been completed in either an outpatient or inpatient program.

Some inpatient programs, as well as outpatient programs offer a SMART Recovery protocol instead of the traditional 12-step approach. Faith-based programs mandate that clients attend Church, or go to Celebrate Recovery meetings. These non-12-step options are gaining wide popularity, as there are many people who seek alternatives to the 12-step approach.

There are also Buddhist-based programs that encourage clients to participate in mindfulness and meditation practices, and clients attend Refuge Recovery meetings.

Despite all these alternatives to AA/NA, the 12-step approach is the most popular recovery support group protocol offered today.

So which is the better option for attendance? Should an alcoholic and/or drug addict receive inpatient or outpatient care?

Ideally, inpatient care is the way to go. Clients are in a safe and secure environment that helps them focus on their recovery. They are also away from many triggers that might cause potential relapse. Sometimes the home situation can be very stressful, and it’s really hard for a person to stay clean and sober when they are in an old familiar environment where they are used to drinking or using. If a single parent can get a responsible family member to watch their child, or if the employee can get some time away from work or if Rover’s and Cleo’s owners can possibly put their fur babies in kennels or get some experienced house sitters to watch Rover and Cleo, the long term results for these people will be very beneficial. And chances are if they are willing to get help for their alcoholism and/or drug addiction, people will want to help them, too.

And in the long run, once these individuals get grounded in recovery, they will have healthier relationships with their loved ones, work associates and maybe get good pet trainers for Rover and Cleo.

But some people can’t commit to inpatient care, and as long as they uphold the responsibility of attending their IOP or PHP protocols, then an outpatient program might be the way to go.

Additionally, attendance at 12-step or other recovery support meetings will help them maintain their recovery.

Also, while health insurance can offset the costs of going to a drug rehab, outpatient programs tend to be more economical so that is another factor that often comes into play.

But sometimes they have no choice as to what option they can pick. This is usually the case with people who get DUI’s, or get into another legal issues while they are drinking. Often it is up to the courts to determine what substance abuse and addiction treatment program they will attend. Additionally, many DUI clients are also mandated to attend 12-step meetings, and get attendance cards signed by the meeting’s secretary.

But whether they are ordered by the courts to get help or have decided to go into treatment on their own, they are on the right track, as long as they stick to their program, whether it’s an inpatient or outpatient program.