by Dr. Elena Bagourdi
The information you encounter when deciding which program will provide you or a loved one the best path to recovery from substance abuse can easily feel overwhelming. But it’s crucially important to know the differences between models of care in treatment facilities. Whether they are specifically geared toward detox, substance abuse counseling, mental health services or all of the above, these facilities can be roughly divided into inpatient and outpatient programs. Within these two broad categories, there are further differences in the length of stay, intensity of treatment and types of treatment offered.
Here, we break down the key differences between the two, so you can use your knowledge to decide what type of treatment program will be the best choice for you.
Inpatient Programs: Putting Your Daily Life on Hold
Inpatient programs occur within a medical facility, such as a hospital or residential treatment center, meaning you or your loved one is completely removed from day-to-day life. Once you or your loved one has been admitted to the hospital or treatment center, they will remain under the care of doctors and medical professionals for the duration of their stay. A positive aspect of this type of care is the haven-like atmosphere of many inpatient facilities, in which the client is relieved for a time from the day-to-day grind of work and other obligations, creating space in their life for positive changes. In many treatment centers (especially those following a 12-step model) clients have little contact with the outside world. This temporary isolation can ease the difficulties of resisting temptation from old friends, familiar places and negative habits in the intense early stages of fighting addiction. Some do struggle to maintain recovery if they move straight from this protected environment back into their everyday life, however; which is why many professionals recommend sober living homes and outpatient treatment in conjunction with a completed inpatient stay.
One of the main purposes of inpatient treatment is detoxification. This process describes the physical and mental withdrawal from the alcohol or drugs to which a person has become addicted. Withdrawal symptoms can range from uncomfortable (e.g., headaches, sweating) to life-threatening (e.g., seizures, high blood pressure) and may require the use of medications or other medical interventions, which is why many choose to undergo detox in a completely supervised setting.
Your personal history of drug or alcohol use, along with your medical history, will determine whether you need inpatient detox.
Inpatient Rehab Programs
After detox, some people want or need a very structured environment in which to receive substance abuse counseling, therapies and education to start them on the path towards lasting sobriety. For those that decide this type of therapy, it is best for them to check into an inpatient rehab facility, where they will participate in an around-the-clock program lasting anywhere from 28 to 90 days. This intensive commitment makes the inpatient experience a great option for those who are looking for a complete break from the past and a fresh start for a substance-free life.
It’s important to note, however, that the “90-day rehab” experience is no guarantee of lasting sobriety. A person struggling with substance use disorder often has underlying mental, emotional and spiritual disturbances that can’t be “fixed” in a short period of time. In fact, studies show that up to 56 percent of rehab graduates will relapse in the first year after being discharged from an inpatient facility. This is why it is often recommended to step down into an outpatient program or a support group like Alcoholics Anonymous or Smart Recovery after completing inpatient.
Outpatient Programs: Integrating Recovery into Daily Life
The most fundamental difference between inpatient and outpatient programs is that those who choose to undergo outpatient treatment are not admitted to a facility for 24-hour care. Instead, they continue to live in their own homes or at a sober living home (a house or apartment building in which residents agree to support each other by remaining clean from drugs and alcohol while living together). Clients in an outpatient program near their homes may continue with work, school and family activities while also participating in a treatment and recovery program. Some people move out of their home state to attend outpatient programs, and they also profit from the outpatient program’s network of support, as they begin a new, addiction-free chapter of their lives. A positive effect of this model is that the client is still immersed in “normal” activities, so he or she can recognize and react to problems on the road to recovery as they arise in day-to-day life.
A common misconception about outpatient programs is that they are less effective than inpatient options. Though the effectiveness of any program depends on how well they meet the needs of each specific person, this couldn’t be farther from the truth. A 2014 study concluded that intensive outpatient programs have similar outcomes to inpatient or residential programs.
Partial Hospitalization Programs (PHP): Your New Day Job
The most intense type of outpatient program is a partial hospitalization program. Although someone in this type of program doesn’t check into a hospital full-time, he or she spends around 30 hours per week at the rehab facility, often attending from 9 a.m. to 3 p.m. every weekday with weekend programs sometimes available, as well.
A person just getting started on their journey to recovery from substance use and mental health problems may find this intense level of support and time commitment necessary as he or she digs into personal issues underlying addictive behaviors. Those who partake in PHP programs will also participate in group and individual therapy, begin to learn new ways of living sober, equip themselves with methods to resist triggers and find new sources of meaning in daily life.
Intensive Outpatient Programs (IOP): Incorporating Support into Daily Life
A step down from the intensity of PHPs are intensive outpatient programs, which require frequent client participation but fewer hours overall than PHPs. For example, Exis Recovery’s IOPs involve a minimum of three 3-hour sessions per week.
These types of programs still mandate the person in recovery dedicate a significant amount of time to work on their personal growth in sobriety. However, they allow for greater freedom to continue with work, family or school obligations and build a positive social life. Since those obligations may also include contact with people and places that trigger the desire to use, IOPs help the client integrate sober living strategies into real life situations as problems and temptation arise. This is not “recovery in a bubble” (a common criticism of inpatient care); instead, with outpatient care, it’s possible to mesh recovery with normal life events and to continue receiving substance abuse counseling and therapies for as long as necessary, improving the likelihood of long-lasting sobriety.
Choosing Your Path
The decision to use an outpatient or inpatient facility for beginning your recovery journey is highly personal and will depend on the factors that play into your history of substance use and mental health struggles. The questions below are just a few of the things to consider when deciding whether inpatient or outpatient treatment will be best for you or your loved one.
Do you need to begin with inpatient detox?
Do you need a complete break from your current living situation?
Are you responsible for supporting others and need to continue to hold down a job? Are you in school?
Do you want your recovery journey to progress alongside your current living situation? Do you want your treatment team to be there every step of the way, offering real-time support as life’s challenges arise?
Are you looking for a facility that will provide treatment for as long as you need it?
Are you looking for a facility that will help you create a network of support where you live, with new long-lasting friendships and support from individuals at similar stages of their recovery journey?
If you are able to answer these questions honestly, you should be able to narrow in on which type of treatment will best set you up for lasting recovery. From there, you can then focus on the specific environment offered by prospective treatment centers, and take a significant step towards overcoming substance abuse.
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