The terms “inpatient” and “outpatient” aren’t unique to the field of addiction. In fact, these are terms that could be applied to almost every single type of medical or mental health intervention a person could get, and they have a deep impact on the overall cost and treatment outcome of someone who needs care. Experts like those at Medicare encourage all health care consumers to understand the difference between inpatient and outpatient care, so they’ll know what charges they’re responsible for and can make good decisions about their health. But when it comes to addiction care, the choices can be a little confusing. In fact, it might be difficult for families in need to really understand what differentiates one type of care from another, and they may be equally unsure about which type of care is best for the person with the addiction. This article might help to clear up that confusion.
In a way, this makes sense, as outpatient programs provide very real treatment for people with addictions, without removing them from their careers, families and communities. People who participate in programs like this work with providers located in their local areas, and they obtain care during daytime hours, and they return home at night. There’s no hospitalization involved, and no change of address is required, but people do have the opportunity to work with experts on their issues of addiction.
Outpatient programs can vary significantly in terms of intensity and time commitment. For example, people who participate in so-called “intensive outpatient treatment” programs are often required to spend up to 30 hours each and every week in their treatment programs, according to the Substance Abuse and Mental Health Services Administration, and they might also have 24-hour access to a team in case of a crisis.
As part of their involvement in this program, they might access:
- Individual counseling
- Family counseling
- Addiction education
- Substance abuse monitoring
- Vocational training
- Medication management
- Case management
- Parenting skills training
- Psychotherapy
- Psychiatric evaluations
- Support group integration
Participants in programs like this might continue to live at home, but it’s clear that they’re required to do a significant amount of work on a daily basis in order to overcome their addictions. They might not be able to work, care for the family or otherwise return to their day-to-day lives while they participate in a program like this, but they might have free time on the evenings and weekends in which to live a life that seems relatively unimpeded.
Low-intensity programs, on the other hand, might provide a significantly smaller amount of therapeutic contact. Clients who participate in programs like this might be assigned to a counselor, and they might go to sessions multiple times per week and do support group work in the evenings, but they might be able to work, spend time with family or otherwise live a life that’s similar to the life lived before the addiction took hold.
Since all outpatient programs provide at least some level of free time for people who have addictions, they’re best for people who have a strong support system at home and a deep-set desire to get better. Experts refer to these people as high-functioning addicts, as they’re able to keep some of the most detrimental aspects of addiction from impacting their lives. They still need help in order to get better, but they also tend to have the strength to continue to live at home and face their daily demons while they’re trying to recover from an addiction. This isn’t the case for all addicts at all times, but for some, this kind of care is best.
These additional therapies can provide people with skills they can use to beat back stress, and they can put people in touch with their inner strength and creativity, and that might also be protective when an urge to use begins to strike.
Inpatient programs also provide around-the-clock supervision in a way that’s just not possible in an outpatient program. People living on the grounds of a treatment facility can’t just slip out to meet a dealer or buy a quick drink. They live in a totally sober environment with help available at all hours. For some, this makes all the difference. In fact, it could be vital for people who have very severe cases of addiction that just couldn’t be mended through less-intensive techniques. They need intensive care, and they’ll get it in an inpatient program.
While people who participate in outpatient programs continue to live at home, those who choose to enroll in inpatient programs move out of their homes and into a treatment facility that can provide them with comprehensive care. These are people who are putting the rest of life on hold, taking a step back from the people, places and situations that might spark a return to drug use, and they’re taking a stand against the addiction that is causing them such severe stress and strain.
Inpatient programs tend to last for a slightly shorter period of time, when compared to outpatient programs, and they tend to be associated with a smaller dropout rate. For example, according to the Treatment Episode Data Set, the median length of stay in 2010 in an outpatient program was about 120 days, while a long-term residential program lasted for about 90 days. Dropout rates for the long-term option stood at about 30 percent, while the outpatient option had a 60 percent dropout rate.
It’s hard to make sweeping generalizations about these numbers, as people who have addictions might drop out of their programs for all sorts of reasons. But it’s possible that people who participate in inpatient programs stay in those programs because they’ve made a deep commitment to sobriety. They’ve chosen to give things up, and they’ve made a clean break with the past. It’s possible that this provides them with the strength they need to see their treatment through until the end.
While the setting of care can be an important part of the success of an inpatient program, the therapies provided can also be remarkably helpful.
- Exercise therapy
- Adventure therapy
- Yoga
- Therapeutic massage
- Equine therapy
- Art therapy
These additional therapies can provide people with skills they can use to beat back stress, and they can put people in touch with their inner strength and creativity, and that might also be protective when an urge to use begins to strike.
Inpatient programs also provide around-the-clock supervision in a way that’s just not possible in an outpatient program. People living on the grounds of a treatment facility can’t just slip out to meet a dealer or buy a quick drink. They live in a totally sober environment with help available at all hours. For some, this makes all the difference. In fact, it could be vital for people who have very severe cases of addiction that just couldn’t be mended through less-intensive techniques. They need intensive care, and they’ll get it in an inpatient program.
Pros and Cons
Research from the journal Addiction suggests that comparative studies about the effectiveness of one form of treatment over another aren’t really helpful, as many studies use different criteria in order to determine intrinsic value. In addition, each person with an addiction might be slightly different than his/her peers and might need slightly different therapy types as a result. Comparing very different people to one another in terms of lasting sobriety might not provide the sort of information that anyone could benefit from. However, there are some easy-to-understand pros and cons of each type of treatment that might make the selection process a little easier.For example, news reports suggest that some people have been forced to wait weeks or even months for openings in certain local outpatient addiction treatment centers. If a person with an addiction lives in a community in which drug use is rampant, and there are few clinics to handle the treatment demand, that could translate into long delays between the person’s acceptance of the need for care and the beginning of that care. For people
like this, enrolling in an inpatient program in another location could allow them to get care with no delay at all. That could be tremendously helpful for some.Outpatient programs do tend to be less expensive than their inpatient counterparts, however, and the ability of an addicted person to continue to work could push the cost yet lower. That might mean that some families are forced to go with outpatient care, as they can’t afford types of care that would impede the family’s budget yet more.
The social aspect of care could also be a factor for some people. Those with many drug-using connections may find that stepping away from the community allows them to make new friends who can function as sober role models, outlining how a truly sober life can be. However, those with tight family connections might find that leaving their social supports behind is much too difficult, and it might even be harmful. For people like this, staying at home and learning on the fly is vital.
How to Make a Selection
It’s clear that there are a number of different factors to take into account, when choosing a treatment program, and some people might find it difficult to make a choice when there are so many factors to consider. In general, it’s best to let an expert help the family to decide on the proper treatment placement. Psychiatrists, counselors and interventionists can assess the severity of the addiction and the person’s willingness to get better, and they can make detailed recommendations about which method of care would be just right for the person in need.
Just as someone with a medical problem isn’t required to decide whether to have a surgery on an inpatient or an outpatient basis, someone with an addiction isn’t required to know whether to cut drugs out of life via inpatient or outpatient programs. An expert can help with that.
If you’re struggling with this decision, please know that you’re not alone. In fact, we’d like to help. Please call us, and our admissions coordinators can connect you with a Foundations Recovery Network treatment program that can help you to understand your options and make an informed choice concerning care. The calls are free and confidential, and we’re always here to help. Please call, and we’ll tell you more.
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.
Reviewed by: Kim Chin and Marian Newton