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The Age-Old Debate: Inpatient vs Outpatient

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.

Inpatient Drug Rehab

Inpatient drug and alcohol rehab consists of two phases. First, patients go through the detox phase. During detox, patients receive 24-hour care from an experienced medical team. The focus during this period is to eliminate addictive substances from the body safely and comfortably.

Importantly, medical detox can reduce the painful and dangerous effects of withdrawal. As a result, patients are less likely to relapse within their first week of recovery. They are also more likely to continue their treatment. Second, patients enter the residential treatment phase. During residential treatment, patients undergo intensive therapy to address the mental and emotional factors that lead to substance use.

Drug and alcohol detox programs vary from one person to the next. Not all patients have the same needs for a variety of reasons. As a result, your detox experience will be unique and so will the care you receive. Factors that influence detox include:

  • Drug of choice
  • Method of abuse
  • Amount of the drug you typically use
  • How long you have been using the drug
  • Your family history and genetics
  • Additional medical concerns
  • Co-occurring mental health diagnoses

The goal of a drug detox program is to keep you safe and comfortable while you begin your recovery. However, as mentioned earlier detox alone is not enough to effectively treat addiction. For this reason, many patients find it helpful to continue their inpatient rehab in a residential treatment facility.

Residential Treatment

Lasting change takes place during residential treatment. For this reason, residential programs are just as important a component of inpatient rehab as detox. At a residential treatment facility, patients who have completed detox begin to address the reasons that they drink and use drugs. Because they are in a safe and therapeutic inpatient environment, they are receptive to treatment methods that may not be as effective otherwise.

During residential treatment, patients have the opportunity to advance through important clinical phases. First, they must identify the harmful patterns and ways of thinking that have shaped their past. Next, they begin to learn new ways of thinking and new skills that will allow them to control their reactions to common triggers.

Then, they will be tested by their therapists and peers to see that they are effectively utilizing their new coping mechanisms. Finally, once they can see how their behavioral changes are contributing to improved mental health and outlook, they can contribute by helping other clients who continue to struggle.

This progression occurs during inpatient rehab because of the therapies and treatments that patients participate in. These types of therapy:

  • Individual counseling with a licensed therapist
  • Behavioral therapies like CBT and DBT
  • Group therapy moderated by addiction experts
  • Family therapy mediated by psychologists
  • Medication management overseen by addiction psychiatrists
  • Participation in support groups like Alcoholics Anonymous

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1 Solution Detox inpatient rehab puts patient care at the center of everything we do. We believe that each patient’s rehab experience should be as unique as their needs. All of the our accommodations are designed to provide patients with a comfortable environment in which they can recover and grow.

 We recognize that addiction doesn’t just affect patients. Family members and loved ones need to heal as well. Therefore, our services are not limited to the patients staying at our rehabilitation center.

 We extend help to friends and family so that our patients can return to a healthy environment when they leave treatment. This not only gives our patients a better chance of success, it also improves quality of life for their loved ones.

Addiction is a matter of life and death, so our treatment team maintains the highest standard of patient care at our Palm Beach drug rehab

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Have Questions?


Information on Miller & Hester Review from Psychiatric Quarterly

Information on cocaine use study from page 77  Substance Abuse Treatment: Options, Challenges, and Effectiveness by Sylvia Mignon

Information on detox from pages 72-73 Substance Abuse Treatment: Options, Challenges, and Effectiveness by Sylvia Mignon