Since the early days of widely accessible addiction treatment, people have debated whether or not there was a real “need” for inpatient rehab. In other words, people have objected that outpatient rehab can be just as effective as inpatient rehab for patients with substance use disorders. However, the definition of success varies widely and as a result researchers conclusions have also varied. Here, we are going to look at some of the most relevant studies on the matter to make sense of the difference between inpatient and outpatient care.

One commonly cited study by Miller and Hester found there to be no significant advantage to inpatient treatment. However, upon further review, researchers noticed that the study had important flaws in its methods that resulted in uneven populations being compared. More recent studies with a more focused scope found that regardless of addiction severity, outpatients were 400% more likely to result in early treatment failure.

In other words, patients in outpatient rehabs were likely to relapse within the first few weeks of their treatment. These results are not surprising as early recovery is the most vulnerable time for relapse. As a result, inpatient rehab offers the advantage of a temptation-free environment to build an early foundation.

While total abstinence is the goal of treatment, it is not the only way to measure success. For many patients, longer periods of sobriety between relapses, less overall drug use, and improvement in mental health are all measures of success. One study that compared cocaine users specifically, found that inpatient treatment resulted in less drug use and less severity in psychological problems than outpatient.

This result was true even though the group that admitted to inpatient treatment initially had more severe substance use problems, less stable social lives, and more severe mental health issues. Importantly, even among the patients who did not maintain total abstinence after treatment, overall quality of life improvement was better for inpatient rehab.

More research is needed to determine success beyond simply long term sobriety. Frequency of emergency department visits, acuity of mental health services, rates of overdose, and likelihood of legal trouble are all evidence based markers of improved quality of life.

Among those who debate the benefits of inpatient vs outpatient rehab, there is one thing that almost everyone agrees on: inpatient detox is an essential part of substance abuse treatment. Additionally, there is a consensus that while inpatient detox is vital medical treatment, it is not sufficient on its own.

When patients begin feeling physically better after detox, they often decline further treatment and end up in a cycle of relapse followed by short stays in detox. Some refer to this cycle as a “spin dry”. As a result, experts agree that patients who continue some form of treatment after detox fare much better than those who do not. In other words, while the most effective type of care is debated for some populations, treatment programs in general greatly improve success after detox.