If you or someone you love is considering detoxing, treatment, or rehabilitation from drugs or alcohol, one of the first questions to consider is whether you prefer inpatient or outpatient treatment. Inpatient means that the addict stays overnight, usually for many consecutive days, in a treatment facility.
Many of these facilities combine detoxing—or the process in which the drugs and/or alcohol are completely metabolized by the body—with a lengthier treatment or “rehab” program. Every addict is required to detox before beginning treatment, but depending on the severity of their addiction and withdrawal symptoms, they may or may not detox in a facility. Bear in mind that it is always safest to detox in a medically-supervised inpatient facility.
What is an Inpatient Rehab Program?
The term “inpatient” simply refers to the fact that the treatment program requires the patient to live in the facility. However, the types of treatments available can vary greatly. It’s important to do your research to find the type of treatment that will be best for the addict in your life.
A long-term residential treatment facility is usually in a non-hospital environment and provides support via a therapeutic community or “TC.” TCs are the most widely used treatment model for addicts. Most addicts stay at the treatment center anywhere from 6 to 12 months. The goal is to re-socialize the addict in a healthy community and to equip them with the skills and tools necessary to navigate real life upon completion.
One of the biggest reasons an addict returns to drug use or abuse is being in an unhealthy environment where usage is rampant and encouraged. Another danger is not understanding how to live a drug-free life.
In a TC, everyone involved plays a role in the treatment of the patient and this includes staff as well as fellow residents. The social aspect of a TC plays a big part in helping the addict discover and hone new ways to manage their life in a healthy manner. There is a focus on both the psychological and social facets of addiction, and much of the treatment stresses the importance of an addict’s responsibility and accountability.
In any inpatient program, structure is foundational. It’s essential in helping to pinpoint and re-direct dangerous patterns and beliefs. Simultaneously, addicts are taught new, alternative ways to handling stress and obstacles. Similar approaches are taken in outpatient treatments, but they are not always as effective.
It can be very challenging for an addict to spend a few hours per day in treatment only to return to their “normal,” pre-treatment life—particularly if this life is filled with temptations, high stress, and the pressure to return to their addiction.
Features of an inpatient program include:
- A semi-clinical, but not hospital setting
- A relatively short-term stay (less than six months)
- More structure than a residential rehab
What is Residential Rehab?
You might hear the terms inpatient treatment and residential rehab used interchangeably, but there are some big differences between the two. Both are aimed at helping addicts recover. However, when a person refers to “treatment,” they usually mean an inpatient treatment program. While in an inpatient treatment program, a patient resides in accommodations that are very residential-like. They need to stay there during the program, and considering most inpatient treatments aren’t in a hospital, the living arrangements mimic a residential space.
Some inpatient treatments are certainly “residential” by definition, but in the world of residential rehab, these living arrangements are long-term. There are some short-term inpatient treatments that last just a few weeks. “Residential” also suggests that the space is the patient’s “home” and not somewhere they are staying temporarily.
If a person is living in a treatment home, it’s likely a residential rehab program. These programs are usually reserved for those with severe addictions, those who will especially struggle returning to their normal life, and/or those who have no other living options (often because their addiction cost them their finances, home, and family).
You may also notice some modifications within residential rehab facilities. For instance, some might specialize in detox while others might be called something like “intensive treatment.” The latter can refer to a wide range of things, and usually focuses on a program that helps teach recovery skills and may even help with tasks like finding employment or family therapy.
There are also residential transitional treatment programs, which aren’t as highly structured as an intensive treatment and focus more on helping addicts transition back to their normal life.
The various names can be confusing. As you try to figure out which is best for you, it’s helpful to start at the beginning. Do you or the person in your life who needs treatment prefer inpatient or outpatient? One of the biggest factors for many patients is cost. Of course, inpatient costs more than outpatient. However, many insurance plans help with drug and alcohol treatment. Ideally, a decision on inpatient vs. outpatient should not be based on cost alone. Many quality treatment programs will liaise with insurance agents on your behalf or work with you to arrange a payment plan.
Features of residential rehab include:
- A completely non-clinical environment that is “homey”
- Long-term treatment (at least six months)
- Less structure
- Patients consider this their permanent home
Effectiveness of Inpatient Rehab for Addiction Treatment
Unsurprisingly, inpatient treatment—whether residential (long-term) or not—is more effective than outpatient. These programs simply offer more and provide constant support 24/7. There is very little risk of a relapse during an addict’s most difficult time of recovery. Temptations are minimal, and simply being out of an addict’s normal environment for an extended amount of time can give them the distance they need to start a good recovery journey.
Although some inpatient programs have set timeframes, that is not true of all. Some are open-ended, and a patient completes their treatment at their own pace. No two addicts are going to recover at the same rate. Those who have repeatedly relapsed in the past are more prone to do so again, and those with a strong genetic link to addiction may also need a little more time to improve. One of the benefits of an open-ended treatment is that the patient doesn’t feel rushed or pressured to meet certain time-specific milestones.
Residential treatments are sometimes considered a little more casual than shorter inpatient treatments. The environment is less clinical, and since many of the patients live in the space long-term, it can feel much more like a home. This can help some patients adjust more easily to life post-detox.
Although there is a gray area between inpatient and residential, one of the easiest ways to differentiate the two is environment rather than program length. If the facility seems like a comfortable, shared group home, it’s more likely to be a residential treatment facility. Many inpatient facilities are not in hospitals, but they still have elements of a clinical setting. In addition to figuring out if shorter or longer treatments are necessary, you may also want to consider environment when deciding on inpatient vs. residential. Some patients are naturally more drawn to a cozy residential facility, while others find comfort in the clinical atmosphere of an inpatient program.
A lot of patients move from a detox program or even an inpatient treatment program to a residential facility when they or their family realize they need more, prolonged help. As such, many residential rehabs don’t focus as much on making sure patients are medically stable. This is taken care of during earlier parts of treatment, such as detox. It’s also why the atmosphere is homier.
When a person enters residential rehab, they have usually achieved the earliest stages of detox and recovery and now need to focus on skill-building to continue a sober life. Therapy, exercise, and counseling are all popular aspects of residential rehab programs.
It’s important to remember that in most cases, there are more regulations for inpatient treatment compared to residential rehab. This is simply due to the natural differences in the programs. Since inpatient treatments are usually working with patients at earlier stages of recovery, there will be more monitoring.
Some residential rehabs are home to addicts who have been in recovery for several months. This is not to say that inpatient is “better regulated” than residential rehab, but rather that there are simply more rules related to more intensive treatments. Both inpatient treatment and residential rehabs will have all of the necessary licenses required by their state.
Inpatient vs. Outpatient Care
When an addict completes detox, they almost always continue with either inpatient (or residential rehab) or outpatient care. It is nearly impossible for someone with an addiction severe enough to require a detox facility, to successfully continue a sober life without ongoing care.
If you or someone you love is entering detox, the facility will likely go over the options for inpatient and outpatient care afterward. Sometimes detox facilities offer these services themselves. Other times, they have certain facilities they recommend. However, you can always research and choose your own ongoing treatment.
Many addicts require ongoing care that specializes in caring for patients with a dual diagnosis. There are many co-occurring disorders often found in addiction. Most often, these include mental disorders such as anxiety and depression. Drugs and alcohol can exacerbate or suppress these disorders, which in some cases is part of what drew the patient to the drug in the first place.
A correct and full diagnosis of all disorders and issues is a must prior to starting any treatment. If a co-occurring disorder, such as bipolar disorder, is affecting a person’s addiction, it must be treated in tandem with the addiction.
Many facilities can modify treatment plans to address a dual diagnosis. Other treatment facilities might specialize in particularly co-occurring disorders. If you already know of co-occurring disorders, you will want to make sure the detox facility and any ongoing treatment facility is also aware and is equipped to address unique situations.
Whenever possible, inpatient treatment is preferable to outpatient. Even if an addict has a loving, drug-free, and supportive home life, they simply will not get the same constant, steady, and expert care as they can in an inpatient facility.
Therapies Used in Inpatient Rehab
Many types of therapies may be used in inpatient rehab. Some of the most common include:
- Behavioral therapy: Psychoeducation, training in relaxation and assertiveness, and functional analyses are all used in behavioral therapy to help the patient un-learn dangerous behaviors and develop new ways of addiction management. Banishing unwanted behavior is at the heart of this therapy.
- Cognitive-behavioral therapy (CBT): Behavioral therapy is also at the core of this approach, but there is also a focus on a patient’s feelings and thoughts (not just their behaviors). It stresses the power of negative and positive thinking, and the therapist helps the patient re-learn behaviors and self-talk.
- Contingency management: This is a specific kind of behavioral therapy used for key addictions that are easy to access (i.e. alcohol, nicotine, opioids). Patients are rewarded for good behavior.
- Rational Emotive Behavior Therapy (REBT): REBT is similar to CBT but instead of thoughts being at the core, REBT focuses on beliefs. This type of therapy suggests that poor beliefs are at the heart of addiction and psychological issues, such as a person believing that they simply cannot live without alcohol.
These are just a few of the common therapies you might find in inpatient treatment programs. Researching various therapies and getting an idea of what resonates with your situation can be a helpful way of choosing a treatment center.
If you or someone you know is struggling with addiction, know that help is available. Start considering an inpatient or residential rehab program following detox for the best recovery path.