The Elements of Inpatient Treatment for Substance Abuse
While outpatient treatment may be adequate for some individuals struggling with substance abuse, people who have suffered from severe or long-term addiction might need residential or inpatient treatment instead. This form of care provides 24-hour assistance that reduces distractions and may help these individuals achieve lasting sobriety.1
However, it is important to note that not all inpatient substance abuse treatment programs are the same. In order to provide the appropriate level of care, inpatient treatment should include certain components that help increase the patient’s chances of achieving and maintaining long-term recovery.1
What Should Inpatient Substance Abuse Treatment Provide?
Every patient is unique, which is why inpatient treatment facilities should offer various forms of residential treatment that can meet their specific needs. In general, however, inpatient treatment for substance abuse should include the following aspects:
Research-based treatment is a crucial element of any inpatient program for substance abuse. If a treatment option is backed up by research, it means that its effectiveness has been observed and studied before application and has shown measurable results. For instance, the National Institute on Drug Abuse indicates that effective treatment usually combines behavioral and medical therapies in addition to social support structures and building strategy assistance. An inpatient treatment program for substance abuse may also be more effective if these treatment aspects are backed up by sound research.2
When a person enters residential treatment for substance abuse, one of the first steps is to detoxify their system and guide them through the challenging withdrawal process. Withdrawing from an addictive substance can be dangerous, which is why managing the withdrawal symptoms in a safe and controlled manner is a key aspect of a successful residential rehabilitation treatment program.3
Withdrawal from any substance is likely to involve some discomfort, but certain substances such as opiates, benzodiazepines, and alcohol may produce potentially life-threatening symptoms.3 This is why it is essential for individuals addicted to these substances to refrain from attempting to detox on their own. Instead, the withdrawal should be managed under the supervision of a qualified professional who can provide the patient with adequate medications that can help prevent the worst withdrawal symptoms.
Some individuals may be more likely to maintain abstinence from a substance with the help of medication until they are able to manage their recovery on their own.4 Maintenance medications may help reduce cravings and provide the individual with the tools and resources that can help them avoid situations and behaviors that may trigger relapse. However, as these medications often have their own unique risks, they should be administered by a professional in a controlled residential setting where the use of medications can be adequately supervised.
Comprehensive Therapy Options
Therapy is another important component of inpatient substance abuse treatment. Social and psychological forms of therapy, such as cognitive behavioral therapy (CBT), can help the patient understand the contributing factors to their substance abuse and manage them appropriately.5 Therapy may be particularly helpful for individuals with co-occurring mental health issues, such as anxiety or depression.6 Some forms of therapy in inpatient treatment may include:7
- Individual therapy. It has been shown that the rapport established between a client and counselor in individual counseling can lead to a higher chance of achieving continued recovery after treatment. This is just one of the reasons why individual therapy is an essential part of effective inpatient treatment for substance abuse.8
- Group therapy. Having support from other individuals with similar substance abuse issues can provide the patient with a way to gain insight, confidence, and relief during recovery. This is why many residential treatment facilities offer various forms of group therapy to their patients.9
- Family and couples therapy. During residential or inpatient treatment for substance abuse, it can be helpful to involve the patient’s family and/or partner in therapy. Couples and family therapy can encourage the members of the patient’s family to support their newly learned behaviors and skills upon completion of the treatment.10
Considerations After Inpatient/Residential Treatment
Post-treatment strategies are another practical component of inpatient substance abuse treatment. Teaching an individual how to practice and use the skills and resources they acquired during inpatient treatment for drug or alcohol abuse can help set them up for success. Strategies such as follow-up interviews and encouraging the patient to join mutual recovery groups or fellowships (e.g. 12-step programs) can help the patient maintain long-term recovery after treatment.11
Overall, residential or inpatient treatment should provide individuals suffering from substance abuse with medically-assisted detox and maintenance, research-based treatment, and therapy options, as well as increase the likelihood of long-term recovery through effective post-treatment strategies. However, it is important to keep in mind that each person has unique treatment needs and the chosen rehabilitation treatment program should be tailored to meet them.1
Frequently Asked Questions
The need for inpatient substance abuse treatment is typically determined based on the severity of the patient’s substance abuse and any biomedical or psychosocial complications that may be involved. The American Society of Addiction Medicine (ASAM) provides guidelines for assigning patients to four levels of care upon being evaluated along the following six criteria dimensions:12
- Acute intoxication and/or withdrawal potential. Based on the ASAM criteria, it is assumed that an acutely intoxicated person cannot be adequately monitored in an outpatient setting and would require more intensive care. As for the withdrawal potential, it is important to consider whether the person may experience potentially life-threatening withdrawal symptoms and if they require medication and other forms of support to ease these symptoms.
- Biomedical complications. Inpatient treatment levels are often indicated when continued substance abuse may put the person at risk of health complications. For instance, a pregnant woman dependent on alcohol may benefit from inpatient treatment or other intensive level of care.
- Behavioral and emotional complications. The patient’s mental health status is essential for determining the appropriate level of care. Individuals with co-occurring conditions, such as depression or anxiety, typically need special attention during treatment which often requires a higher level of care. Additionally, individuals who exhibit suicidal ideation or other signs of imminent risk often require 24-hour monitoring and care.
- Treatment acceptance/resistance. The patient’s willingness to cooperate and comply with treatment regimens can greatly influence the choice of treatment. Patients with greater treatment resistance may require higher levels of care in a residential treatment setting.
- Relapse potential. Since substance abuse tends to involve recurrent behavioral patterns, relapse is a common and natural risk. The patient’s personal and social background contributes to the relapse potential. If the individual’s social environment and mental health status impede their behavioral control, inpatient treatment may be justified.
- Recovery environment. As mentioned, the person’s family and social environment can increase the likelihood of relapse as well as facilitate recovery. If a patient is in a supportive social setting, a lower level of care may be justified. However, higher levels of care may be the better choice if their social environment is compromised (for instance, by higher levels of family stress or friends who regularly use addictive substances).
Medically-assisted detoxification is often administered to patients suffering from substance use disorders if they show signs of tolerance (needing larger amounts of a substance to achieve the desired effect) and are at risk of experiencing withdrawal symptoms.13
The exact withdrawal symptoms will depend on the substance in question.14 These symptoms may range in severity and may even be life-threatening in the case of certain substances. Because of this, medically-assisted detox should be administered by a professional in a controlled setting such as a residential/inpatient facility for substance abuse treatment.
Recovery from substance abuse is a long-term process that doesn’t stop after inpatient treatment is over. Residential treatment facilities often employ various post-treatment strategies to increase the patient’s chances of maintaining lasting recovery. A well-developed aftercare plan can help the person anticipate future challenges and devise solutions on their own post-rehab.15
Some common forms of aftercare include 12-step meetings, counseling, sober living, and outpatient care. Their family and friends can also provide support after treatment by encouraging their healthy habits and participating in various self-help fellowships designed for relatives and friends of people in recovery.15
1. National Institute on Drug Abuse. (2019).Treatment Approaches for Drug Addiction DrugFacts.
2. National Institute on Drug Abuse. (2020). Treatment and Recovery.
3. Substance Abuse and Mental Health Services Administration. (2016).Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health [Internet]. Chapter 4, Early Intervention, Treatment, and Management of Substance Use Disorders. Washington (DC): US Department of Health and Human Services.
4. Douaihy, A. B., Kelly, T. M., & Sullivan, C. (2013). Medications for Substance Use Disorders. Social Work in Public Health, 28(3-4), 264–278.
5. McHugh, R. K., Hearon, B. A., & Otto, M. W. (2010). Cognitive Behavioral Therapy for Substance Use Disorders. The Psychiatric Clinics of North America, 33(3), 511–525.
6. Center for Substance Abuse Treatment. (2005). Substance Abuse Treatment for Persons With Co-Occurring Disorders. (Treatment Improvement Protocol (TIP) Series, No. 42.) 6 Traditional Settings and Models. Rockville (MD): Substance Abuse and Mental Health Services Administration.
7. National Institute on Drug Abuse. (2021). Types of Treatment Programs.
8. George, W. J., Simpson, D. D., Dansereau, D. F., Rowan-Szal G. A. (2001). Relationships Between Counseling Rapport and Drug Abuse Treatment Outcomes. Psychiatric Services, 52(9), 1223-1229.
9. Center for Substance Abuse Treatment (2005).Substance Abuse Treatment: Group Therapy. (Treatment Improvement Protocol (TIP) Series, No. 41.) 1 Groups and Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration.
10. Center for Substance Abuse Treatment. (2004). Substance Abuse Treatment and Family Therapy. (Treatment Improvement Protocol (TIP) Series, No. 39.) Chapter 1 Substance Abuse Treatment and Family Therapy. Rockville (MD): Substance Abuse and Mental Health Services Administration.
11. Ouimette, P. C., Moos, R. H., & Finney, J.W. (1998). Influence of Outpatient Treatment and 12-Step Group Involvement on One-Year Substance Abuse Treatment Outcomes. Journal of Studies on Alcohol, 59(5), 513-522.
12. Morey L. C. (1996). Patient Placement Criteria: Linking Typologies to Managed Care.Alcohol Health and Research World, 20(1), 36–44.
13. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment. (Treatment Improvement Protocol (TIP) Series, No. 45.) 1 Overview, Essential Concepts, and Definitions in Detoxification. Rockville (MD): Substance Abuse and Mental Health Services Administration.
14. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment. (Treatment Improvement Protocol (TIP) Series, No. 45.) 4 Physical Detoxification Services for Withdrawal From Specific Substances. Rockville (MD): Substance Abuse and Mental Health Services Administration.
15.Patton, D. & McDowell, T. Substance Abuse Aftercare Treatment. Arizona State University, Center for Applied Behavioral Health Policy.