Inpatient or Outpatient? An Overview

Many types of drug rehabilitation programs are available, but generally under 2 basic categories: inpatient and outpatient. A comparison of inpatient vs. outpatient recovery programs requires a general understanding of the goals and purposes of both programs. An inpatient (long or short term) program requires the patient to live at a facility 24 hours a day.  Outpatient therapy usually refers to full daytime treatment within a facility and the patient returns home at night.

Outpatient treatment programs are useful and effective for patients who require a lower level of supervision. Outpatient counseling and group meetings take place at rehab facilities, mental health centers and clinics in many communities. Services are generally provided during daytime or evening hours, and patients go home at night. Such treatment costs less than residential or inpatient treatment and often is more suitable for people with jobs or extensive social supports. Outpatient treatment varies in the types and intensity of services offered. It should be noted, however, that low-intensity programs may offer little more than drug education. Other outpatient models, such as intensive day treatment, can be comparable to residential programs in services and effectiveness, depending on the individual patient’s characteristics and needs. In many outpatient programs, group counseling can be a major component. Some outpatient programs are also designed to treat patients with medical or other mental health problems in addition to their drug disorders.

While the cost of outpatient care is usually lower than the cost of residential services, the lack structure and supervision places patients at a greater risk of relapse in clients with minimal structure and social support, therefore this option must be assessed thoroughly on an individual basis.

Short-term residential programs provide intensive but relatively brief treatment based on a modified 12-step approach. This option, followed by outpatient therapy, is particularly beneficial to those for whom physical substance withdrawal should be medically supervised.  The original residential treatment model consisted of a 3- to 6-week hospital-based inpatient treatment phase followed by extended outpatient therapy and participation in a self-help group, such as AA. Following stays in residential treatment programs, it is important for individuals to remain engaged in outpatient treatment programs and/or aftercare programs. These programs help to reduce the risk of relapse once a patient leaves the residential setting.

Long-term residential treatment provides care 24 hours a day, generally in non-hospital settings. The best-known residential treatment model is the therapeutic community (TC), with planned lengths of stay of between 6 and 12 months. TCs focus on the “resocialization” of the individual, utilizing the entire community—including other residents, staff, and to a limited extent the local community—as active components of treatment. Addiction is viewed in the context of an individual’s social, physical and psychological impairments.  Treatment is highly structured and can be confrontational or highly emotional at times, with activities designed to help residents examine damaging beliefs, self-concepts, and destructive patterns of behavior and adopt new, more harmonious and constructive ways to interact with others and accept accountability.

Treating patients with a Dual Diagnosis — a mental health condition combined with an addictive disorder — requires an intensive, integrated approach to therapy. In Dual Diagnosis patients, the presence of a mental health disorder like bipolar disorder, depression or post-traumatic stress disorder (PTSD) makes it more difficult to recognize the symptoms of addiction. People who struggle with a mood disorder or chronic Depression may manage their moods with drugs or alcohol, a form of self-medication. When a Dual Diagnosis is involved, it can be hard to distinguish between the symptoms of psychiatric illness and the signs of drug or alcohol addiction.

Residential rehab facilities provide a structured environment for these individuals who face special challenges in their journey to recovery. At a residential treatment center, where the stressors and distractions of daily life are removed, the patient devotes time and increasing self-awareness to learning new coping skills and building a stronger sense of self-worth.

In a study published in Drug & Alcohol Review, researchers at Dartmouth Psychiatric Research Center compared the effectiveness of residential treatment programs with outpatient programs for Dual Diagnosis patients. Their study showed that outpatient care was less effective than residential treatment in up to 50 percent of cases. Participating in outpatient rehab requires a higher level of motivation and compliance, which may not be present in a patient who has a mental illness or minimal social support. The structured setting of a residential community provides a sense of security and safety unavailable in an outpatient clinic or treatment center.

The Drug Abuse Treatment Outcome Studies (DATOS) were initiated in 1990 by the National Institute on Drug Abuse (NIDA) to evaluate drug abuse treatment outcomes and emerging treatment issues in the United States.

The overall goal of DATOS was to advance scientific knowledge about the effectiveness of drug abuse treatment as it is typically delivered in the United States. From a historical perspective, DATOS is the continuation of an unparalleled effort by NIDA to evaluate drug abuse treatment outcomes in each of the last three decades. Primary issues include shifting public concern and expectations for treatment, changes in the funding and organization of treatment programs, and significant advances in research on the neurobiological, cultural and social aspects of addiction. DATOS researchers studied a wide range of questions of scientific and policy relevance. These include:

The results can be seen in the one-year follow-up study and do find that long-term residential treatment, while unfortunately not an option for many if not most addicts, is considerably more
effective in terms of long term outcomes.