Inpatient vs. Outpatient Substance Abuse Treatment
With a large number of available addiction treatment options, individuals struggling with alcoholism or substance abuse are sometimes in doubt about which option is the right one for them. Generally, patients can choose between two main categories of treatment: inpatient and outpatient treatment.
When comparing inpatient vs. outpatient substance abuse treatment, one needs to take several factors into account. These factors may include the type of addiction, assessment of individual needs, medical condition, level of support that the person has in their environment, availability of treatment, and insurance coverage.
What’s the Difference Between Outpatient and Inpatient Treatment?
Inpatient Substance Abuse Treatment
Inpatient substance abuse treatment is often referred to as residential treatment. It provides 24-hour care, whereby an individual does not leave the treatment facility.
Long-term residential treatment provides around-the-clock care typically in a non-hospital setting, although there is medical support provided on-site. These programs can vary in length, but the best-known model is the therapeutic community (TC), which can last between 6 and 12 months. This model places emphasis on resocializing the individual through various activities that use the community of other residents and staff as a resource. The ultimate goal is to help the person achieve personal accountability and be able to lead a productive life.1
Short-term residential treatment tends to last shorter than three months, but the treatment does not end when the patient leaves the treatment center. The treatment is expected to continue through an outpatient program. These are offered both by specialized residential treatment facilities and hospitals.1
Outpatient Substance Abuse Treatment
Outpatient treatment programs offer similar services as inpatient programs, but the person does not stay at the facility all the time. The person lives at home and visits the facility for structured treatment sessions, typically a few hours per day, a few days per week.
Which Is Better: Inpatient or Outpatient Treatment?
When it comes to the effectiveness of inpatient vs. outpatient treatment, it is not possible to state that one type of treatment is more effective than the other one in all situations.
While it is clear that substance abuse treatment generally results in a reduction in substance use and abstinence, there seem to be no significant differences in recovery rates between inpatient and outpatient treatment settings. The positive outcomes of treatment are rather connected to the intensity and duration of treatment rather than a specific setting or patient population.2
Therefore it is important to consider the advantages and disadvantages of both types of treatment and make a decision depending on individual treatment needs.
Inpatient vs. Outpatient treatment: Advantages & Disadvantages
Advantages of Inpatient Treatment
There are more than a few important advantages that inpatient treatment brings when compared to outpatient treatment:
- 24-Hour care, which is important for patients who are intoxicated or are experiencing withdrawal. In some cases, these conditions can be quite severe and it is necessary that the patient is medically stabilized and supervised.
- The residential setting, which allows people to both physically and mentally move from an environment and the factors that triggered them to abuse substances. In an environment where there are no disruptions and opportunities for substance abuse, people can focus more on overcoming addiction.
- A supportive community of members that a person connects to and does not feel isolated when struggling with addiction.
Disadvantages of Inpatient Treatment
Some individuals may find the following factors as disadvantages of inpatient treatment:
- Leaving work/school/family for a period of time. As patients do not leave the treatment center, they have to be ready to be absent from their job or school. For some patients, being away from their family and not seeing them as often as they would like may be very stressful.
- In some cases, inpatient care may relieve patients of personal responsibilities and encourage unnecessary dependence on hospital staff.3
- Higher costs of treatment when compared to outpatient treatment.
Advantages of Outpatient Treatment
When it comes to outpatient treatment, individuals may receive the following benefits:
- Ability to carry on with daily life during treatment. People are able to keep going to work or school and take care of their children.
- Patients do not have to leave their home environment, which is an important benefit if this environment is supportive in fighting addiction.
- Ability to apply the newly acquired skills immediately in their everyday life and relationships.
- Lower treatment costs and a higher likelihood that insurance plans will cover for them.
Disadvantages of Outpatient Treatment
When comparing inpatient and outpatient substance abuse treatment options, one may see the following as drawbacks to outpatient programs:
- Risk of substance abuse. Alcohol and drugs are still available and the person may use them.
- Not safe for some patients. Outpatient treatment is not appropriate for patients with potentially life-threatening complications of withdrawal as well as for suicidal or homicidal patients.4
- Treatment facilities may not be easily accessible to everyone. Some people live in remote areas or are not able to travel on a daily basis due to family or job commitments. If accessing treatment is too demanding, there is a high risk that they will quit.
Frequently Asked Questions
In addition to the general pros and cons, the American Society for Addiction Medicine formulated a list of issues that need to be considered when deciding between inpatient and outpatient treatment. These are the factors that influence the choice of treatment:4
- Ability to arrive at the treatment site on a daily basis, which makes outpatient treatment possible.
- History of serious withdrawal symptoms, which makes outpatient treatment potentially risky.
- Capacity for informed consent. If a person does not have this capacity, then they need an inpatient environment.
- Existence of suicidal, homicidal, or psychotic conditions, which makes inpatient treatment necessary.
- Ability to follow treatment guidelines, which makes it possible to recommend outpatient treatment. If the person is not able or willing to follow treatment instructions, then inpatient treatment is preferable.
- Existence of co-occurring conditions such as mental health issues or chronic diseases such as diabetes or hypertension, which may require inpatient treatment.
- Presence of supportive persons in the immediate environment, which is advisable for outpatient treatment.
- Some outpatient treatment programs may cost less than inpatient treatment because they do not include residential services. Some treatments are partially or entirely subsidized by the government, while for others the person either needs to have private insurance or pay for treatment costs.
Most addiction treatment patients need long-term or repeated care in order to ensure abstinence and recover from addiction, regardless of whether they undergo inpatient or outpatient treatment programs. According to the recommendations of the National Institute for Drug Abuse, it is critical to stay in treatment long enough. In general, 90 days of treatment is considered minimal for positive outcomes for most cases.5
If a person undergoes an intensive inpatient treatment program, once they leave the facility, they are advised to continue with structured outpatient care in order to prevent relapse and get support in post-treatment reintegration.
It makes sense to make a comparison between inpatient and outpatient substance abuse treatment at certain points in the process to decide which one is more appropriate at which stage. However, it is more advisable to see these treatment options as a continuum of levels of care rather than opposing categories.6
1. National Institute on Drug Abuse. (2020). Types of Treatment Programs.
2. McCarty, D., Braude, L., Lyman, D. R., Dougherty, R. H., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014). Substance abuse intensive outpatient programs: assessing the evidence.Psychiatric services, 65(6),718–726.
3. Hayashida M. (1998). An overview of outpatient and inpatient detoxification.Alcohol health and research world, 22(1), 44–46.
4. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment. (Treatment Improvement Protocol (TIP) Series, No. 45)
5. National Institute on Drug Abuse (2018). How long does drug addiction treatment usually last?
6. Center for Substance Abuse Treatment. (2006). Substance Abuse: Clinical Issues in Intensive Outpatient Treatment (Treatment Improvement Protocol Series, No. 47).