Inpatient vs. Outpatient Rehab: What Are the Differences?

Are you asking yourself if you need inpatient vs outpatient rehab?

Getting help for drug and alcohol abuse is going to change your life for the better. Right now, it’s hard to imagine life without substances, but recovery is possible. Once you’ve decided to get help, the next step is determining what type of treatment you need. Guidance from a physician or mental health professional and your own evaluation of your needs will make the answer clearer.

People get treated for addiction in inpatient and outpatient recovery programs. An inpatient program is also known as residential treatment. You live at an addiction treatment facility and attend full days of treatment. In the evenings, you participate in recovery activities before sleeping in the treatment center residences. In outpatient treatment, you attend treatment at a recovery center but live at home or in a sober-living residence. There are a few different types of outpatient rehab.

Knowing the differences between inpatient and outpatient addiction treatment can help you decide where to start:

What Is Inpatient Treatment Like?

The thought of putting your life on hold and moving into a rehabilitation center can feel intimidating. The truth is, early recovery is tough. Dealing with the temptations and triggers to drink or use while trying to get sober is too much for many people.

When considering inpatient vs outpatient rehab, a huge benefit of a residential treatment center is that it puts space between you and many of your triggers. This allows you to focus on yourself without outside stressors and easy access to drugs or alcohol.

Here are some aspects of inpatient treatment:

Drug or Alcohol Detox

If you’ve been abusing drugs or alcohol regularly, you’ll likely require medical detox. This is not like the detox frequently portrayed in movies and television. You’re not left in a bare room by yourself to go through a painful withdrawal process. Medical detox takes place in the treatment facility, either in a separate section or within the regular residences. You may have a roommate or a private room. Either way, you’ll have a comfortable bed, a television, and furnishings. There are often common areas you can hang out in as you feel better.

While drug or alcohol withdrawal is never pleasant, medical detox makes the process much more comfortable. A 24/7 medical staff monitors your vital signs and comfort level around the clock. They:

• Provide medications to ease withdrawal symptoms and cravings
• Keep you hydrated and medically safe
• Alleviate as much discomfort as possible           

Where You’ll Live

Inpatient treatment facilities may have apartment style living, where you share a room with one or more people that includes a living area, dinette, bathroom, and bedrooms. Many are set up more like dorms, where you share a room with another client. These rooms usually have their own bathrooms. There is often a common kitchen and living area that clients share. Some residences include extras like:

• Game rooms
• Recreation rooms
• Outdoor grilling areas
• Other amenities

Family Visitation and Involvement

Most residential treatment facilities have weekly visitation hours for loved ones. Often, there is a period at the beginning where you cannot have visitors. This allows you to integrate more into your environment, set your focus, and become part of the treatment community. Inpatient treatment centers usually offer family therapy. Some may offer more intensive family involvement like family groups or family programs.

Group Therapy

A major component of addiction treatment is group therapy. Addiction thrives in isolation. Group therapy cuts through that isolation as you see your stories in others who share similar struggles.

Group therapy will be a large part of your day. There are several different types of groups, formats, and focuses. Some are process groups, during which you talk about challenges or a certain addiction-related topic. Other groups could be more experiential, like psychodrama, which involves role-playing and exercises or an art therapy or music therapy group. Psychoeducational groups on addiction, mental health disorders, and relapse prevention are also common.

Individual Counseling

You’ll meet with an individual therapist regularly. Some addiction treatment programs offer individual therapy one time a week, while others may offer it three or more times. One-on-one therapy helps you develop a trusting relationship with your counselor and a space where you can explore the reasons you’ve been abusing substances. These often include underlying issues like:

• Trauma
• Unhealthy relationships
• Grief and loss
• Excessive stress
• Lack of appropriate coping skills
• Depression, anxiety, or other mental illnesses

Individual therapy is a place where you can discuss topics you’re not comfortable bringing to group therapy yet. It can also help you further process issues that come up in group therapy.

Specialized Approaches and Groups

Recognizing that trauma and mental health disorders are key contributors to substance abuse, many treatment centers offer therapies specific to these co-occurring disorders. Specialized treatments may include eye movement desensitization and reprocessing (EMDR), cognitive behavioral therapy, cognitive processing therapy, and neurofeedback. These approaches can help you heal from past trauma without having to relive the trauma. They can also teach you to identify and change dysfunctional thought patterns that may contribute to depression, anxiety, and other mental health disorders.

Continuing Care

Addiction treatment occurs on a spectrum. The highest level of treatment is residential rehab, also known as inpatient rehab. For some people, it can feel jarring to go from the structure and 24/7 recovery support of inpatient treatment to the stressors and triggers of everyday life. That’s why addiction professionals recommend a gradual transition from treatment to independence. An outpatient program bridges the transition. You continue to receive treatment and support but live at home or in a sober-living residence. As you get more confident in your sobriety, you attend fewer hours of outpatient treatment.

Recovery is something you will work on long after treatment. Addiction treatment will connect you with resources that help you continue receiving recovery and behavioral health support after treatment. This may include:

• Individual therapy appointments
• Support groups
• Doctor and psychiatrist appointments
• Sober-living residences
• Fitness and nutrition support
• Alumni groups and events

What Is Outpatient Treatment Like?

Obviously one the biggest differences in inpatient vs outpatient rehab is outpatient is when you attend outpatient addiction treatment, you live at home or in a sober-living residence. Depending on the type of treatment, outpatient rehab can involve several hours of treatment a day or just a few hours each week.

Many people enter outpatient treatment after residential rehab. Outpatient treatment helps you further work on your recovery and strengthen skills that can prevent relapse. You have one foot in treatment and one foot in your everyday life so you can put learning into practice with the support of addiction professionals and peers in recovery.

Types of Outpatient Rehab

The type of outpatient treatment you attend determines how many hours of care you have a week and the variety of therapies available. The highest level of outpatient rehab is a partial hospitalization program (PHP). There are a couple of levels after a PHP that provide decreasing hours of treatment each week until you’re fully independent in recovery.

Partial Hospitalization Programs

A partial hospitalization program (PHP) provides most of the same treatment services as residential rehab. The main difference is that you live at home or in a sober-living residence instead of at the treatment facility. You attend a full day of treatment and leave in the evenings. Partial hospitalization programs sometimes follow the same day schedules as residential programs. You’ll typically attend programming such as:

• Individual therapy
• Group therapy
• Family therapy
• Psychiatry appointments
• Specialized sessions for trauma or co-occurring disorders
• Mind-body-spirit activities like yoga, mindfulness, adventure therapy, art therapy, or music therapy

Sober-Living Residences

Treatment centers with partial hospitalization programs often have their own sober living residences or work closely with a nearby recovery home. Transportation is provided to and from treatment, should it be off campus. Sober-living residences are similar to on-site living at a treatment center. Accommodations may be apartment-style or dorm-like. Other sober-living options are set in large residences within neighborhoods.

Sober-living residences usually include amenities like:

• Full, common kitchen
• Indoor and outdoor gathering areas
• Recreation rooms
• 24/7 onsite staff
• Evening groups or transportation to 12-step meetings
• Social activities and outings

Living at home where you’re exposed to the same triggers that fuel your substance use makes it that much harder to refrain from drugs and alcohol during the early days of recovery when the risk of relapse is high. That means a sober-living home may be a critical component of your sobriety if you’re in an outpatient program.

Intensive Outpatient Programs

An intensive outpatient program provides daily treatment but allows you enough free time to begin working, going to school, or attending to home responsibilities again. Most intensive outpatient programs meet for at least 10 hours a week. These hours can be split up over five or three days, depending on the program. Some intensive outpatient programs offer both morning and evening options so you can choose what works best for your schedule and outside responsibilities.

During an intensive outpatient program, you live at home or in a sober-living residence and come to the treatment center for daily programming. Treatment offerings are mainly group therapy with occasional individual therapy. The goal of an intensive outpatient program is to help you create the structure and support in your outside life that help you stay sober. At the same time, you’ll reinforce relapse-prevention skills and continue working on the underlying issues of your substance abuse.

Outpatient Treatment

The last difference of inpatient vs outpatient rehab is outpatient treatment. This is the last step in an addiction treatment center setting.

Whereas intensive outpatient treatment meets at least 10 hours a week, an outpatient program may only meet 1 to 3 hours a week. At this point in formal addiction treatment, you are fully emerged back into everyday life, whether that entails working, volunteering, going to school, or managing your household.

Outpatient treatment provides a home base of sorts. You are living life with all its stressors and triggers and applying the skills and practices you learned in treatment to cope with them. Outpatient treatment occurs at a regular time and place every week, where you can get help with challenges to your sobriety. It provides support and accountability in early recovery and helps you manage difficulties without drugs or alcohol. It also serves as a litmus test. For instance, if you’re struggling, you may need to return to a higher level of care or add more outpatient services to your routine. The staff in an outpatient program can see if you’re struggling and help you determine if you need more intensive support.

Outpatient treatment may include:

• Group therapy
• Individual counseling as needed
• Recovery support resources
• Referrals to care for behavioral health or physical needs

Do I Need Inpatient or Outpatient Treatment?

Everyone’s route to long-term recovery is different. This decision is where many people get confused when trying to decide between inpatient vs outpatient rehab.

The type and duration of addiction treatment you need is based on factors like:

• How long you’ve been abusing drugs or alcohol
• The amount of substances you’ve been using
• If you’re using more than one substance (i.e.. alcohol and opioids)
• Your physical and mental health
• Co-occurring medical conditions or psychiatric diagnoses
• Your support system
• How conducive your living situation is to refraining from drugs and alcohol

While inpatient rehab seems like a large commitment, some people need to carve out that time and space in their lives to get sober and stay sober. The time and financial commitment of a residential treatment program pales in comparison to the time and money your addiction has cost you and will continue costing you. Beginning with the highest level of care can make the difference between gaining the time, support, and skills you need for long-term recovery or relapsing.

Sometimes outpatient treatment is the only option. If you do not have relatives or friends who can help with your children or you have responsibilities that under no circumstance allow you to take time away, outpatient treatment is the answer. A partial hospitalization program will provide the most thorough outpatient treatment. If you have flexibility during the day, but need to be at home in the evenings, this is the best option. If your behavioral health professional believes you do not need a higher level of care based on your history of addiction, support system, and outside resources, an intensive outpatient program can be helpful.

Clinicians often look to The American Society of Addiction Medicine (ASAM) levels of care resource to guide their treatment recommendation. It is a set of criteria put together by medical and behavioral health professionals that helps determine appropriate levels of care.

ASAM criteria includes six dimensions:

1. Acute Intoxication and Withdrawal

Factors that determine whether you need to begin addiction treatment with medical detox include:

• The frequency with which you drink or use drugs
• If you’re experiencing withdrawal symptoms
• History of seizures or other severe withdrawal symptoms
• When you last used alcohol or drugs
• Support system in the case of severe withdrawal symptoms

2. Biomedical Conditions and Complications

Clinicians explore circumstances that could affect drug or alcohol withdrawal and addiction treatment. This may include:

• Physical illnesses
• Chronic conditions
• Ability to self-manage these conditions
• Necessity of additional medical or psychological help

3. Emotional, Behavioral, or Cognitive Conditions and Complications

This category considers mental health or psychiatric issues that can make treatment complex or increase your risk of relapse, physical issues, or mental health issues. Assessment includes:

• Diagnosing mental health disorders
• Assessing the severity of psychological symptoms
• Determining if psychological symptoms are a result of drug or alcohol use
• Evaluating your ability to function in everyday life, manage tasks, and your coping skills

4. Readiness to Change

This criterion assesses your willingness to change. This readiness for recovery is also known as The Stages of Change. Where you are in your motivation to recover is based on both internal and external factors and your self-awareness of your addiction.

Readiness to change can include:

• Awareness of the need to change
• How committed you are to change
• Your cooperation and engagement in treatment
• If you recognize the negative consequences you’re experiencing because of substance abuse

5. Relapse/Continued Use, Continued Problem Potential

Relapse is often a normal part of recovery, but this criterion assesses your risk for chronic relapse. It explores your history of drug and alcohol use, coping skills, and impulse control skills. Factors may include:

• The severity of addiction and the probability that you will continue using without treatment
• The presence of coping skills in the face of substance abuse, psychological symptoms, or suicidal thoughts
• Your risk of immediate danger from mental health or substance abuse issues
• Your awareness of triggers
• The skills you have to cope with impulses, triggers, and cravings

6. Recovery and Living Environment

Having support in recovery is critical to relapse prevention. If your home environment and relationships are triggering, getting sober will be more difficult. Assessments in this category include:

• Your support system
• If the people you live with use substances
• Issues with childcare, housing, transportation, or employment
• Involvement in 12-step groups or 12-step alternatives
• Adequate finances, healthy relationships, and educational or vocational resources to aid your success in recovery
• Criminal, vocational, or legal circumstances that are motivating your decision to get treatment
• Work, school, living situation, or loved ones that present challenges to treatment

After assessing these six dimensions, the ASAM provides specific rankings that help guide the clinician’s recommendation for the level of care you need. Consult your physician, therapist, or a recovery specialist to determine whether you should enter treatment at the inpatient or outpatient level.

Does Insurance Cover Drug Rehab?

Major private insurance providers are required to offer coverage for behavioral health treatment. They should cover it in the same way they cover treatment for medical conditions. What insurance pays for drug rehab varies by plan and provide, especially when you’re considering inpatient vs outpatient rehab.

You may need to meet a deductible, pay a copay, or pay coinsurance. PPO insurance plans cover in-network drug and alcohol rehabs at a higher percentage than out-of-network providers. Contact our admissions specialists if you’d like help determining your insurance’s benefits for drug and alcohol rehab.

Looking for Addiction Treatment?

If you or a loved one is struggling with drugs and alcohol, we can help. If your stuck on deciding between inpatient vs outpatient rehab, Vogue Recovery Center offers both inpatient and outpatient treatment options. We accept insurance, and our admissions process is simple and stress-free. Call us for a free, confidential consultation.

References

https://www.asam.org/asam-criteria/