A person with a sore throat would visit a doctor for care, and then head home when the appointment is over to heal on the comfort of the family couch. A person with a heart attack, on the other hand, might expect to spend some time living inside the walls of a hospital, receiving around-the-clock care until the healing is complete.
These are cut-and-dried examples of medical decisions people all across the country make on a daily basis, and most people don’t think twice when they’re given a situation like this. They know the sorts of situations that require inpatient attention, and they know that some other problems are best handled on an outpatient basis.
If these people have an addiction, however, they may struggle with issues of setting. Is inpatient rehab best, or would an outpatient program provide more appropriate help? It’s a complicated question, and while there are no easy answers, families that read up on how these programs work may have an easier time when they’re asked to weigh in on this important decision.
Understanding the Concept
In strictly medical terms, the word “inpatient” refers to treatments that are provided within the walls of a medical community while the person is living inside that facility. The word “outpatient,” on the other hand, is used with treatments a person receives while continuing to live at home.
By this reasoning, a person having open-heart surgery would be getting inpatient care, because that person might need to spend a few days recovering inside the hospital, but a person getting a mole removed in a two-hour procedure would be getting outpatient care, because that person goes home when the appointment is over. Inpatient care is considered the more expensive option, as the fees cover everything from therapy to food to janitorial services. Since people in outpatient programs handle these issues on their own at home, the programs usually come with a smaller price tag.
Of people who get care for an addiction, the vast majority receives their care on an outpatient basis. For example, the 2011 National Survey on Drug Use and Health found that about 1.5 million people got substance abuse care at an outpatient rehabilitation center, and an additional 1 million got outpatient care at a mental health center. By contrast, only 1 million people got care in an inpatient rehabilitation facility, and only 871 got inpatient care in a hospital. These numbers make it clear that most people continue to live at home while working on their addictions, and it’s possible that cost does play a role. Insurance companies might only pay for outpatient care, and some families might not even have any insurance at all. For people like this, outpatient care makes a lot of sense.
The differences between inpatient and outpatient care go far beyond issues of payment and cost, however, and there might even be significant differences between the way individual inpatient and outpatient programs operate. As a result, families looking for treatment options may need to delve into the details of each plan they’re considering, just so they can ensure they’re making the right choice for the people they love.
Inpatient Rehab Basics
As mentioned, an inpatient program focuses on providing people with a safe and secure place in which to live while they heal from their addictions. All of the treatments are provided within the walls of the facility, so there are no appointments to keep and commutes to make. People can simply walk down the hall to their sessions, and return to their rooms in the evenings. No addictive substances are allowed on the grounds, so the risk of relapse is low, and the days might be chock-full of activities, including:
- Support group meetings
- Group therapy meetings
- Individual therapy sessions
- Experiential therapies
- Recreational therapies
- Art therapy programs
- Medical appointments
The days might be quite regimented, so people just don’t have the opportunity to think about drugs or plan on how they’ll take drugs when the program is complete. Some programs even provide people with lush and beautiful surroundings, so they can begin to see that pleasure doesn’t always have to come due to drugs.
This basic outline may not cover all of the attributes that make up an inpatient program, however, as these programs can vary in intensity and offerings. Some programs, for example, offer a short-term stay for people with straightforward addictions. Other programs are more intense. The Modified Therapeutic Community model, for example, is designed to help people with addictions and underlying mental health conditions. According to the Substance Abuse and Mental Health Services Administration, this program lasts for 12 to 18 months, and it places a heavy emphasis on the ability of peers to influence change. This treatment program is much more intense than a standard program, and it could provide deep benefits for people with very complicated cases of addiction.
In addition to treatment length and intensity, inpatient rehab programs may differ by their target market for care. Some focus on treatments that would be helpful for people who are business executives, for example, while others focus on helping new mothers or people of specific cultural groups. This kind of specialization could be vital to an inpatient program, as people are expected to live in these programs for long periods of time. If they dislike their peers, it might be harder to stay.
Outpatient Rehab Essentials
In an outpatient program, clients are often provided with many of the same treatments they’d get as members of an inpatient program. They might still have therapy sessions, support group meetings, recreational outings and more, for example, but they’ll be living at home while they’re getting this care. As a result, they might be able to stay in touch with their family members and attend to their responsibilities in the community, all while working on their addiction issue. Of all of the facilities that responded to the National Survey of Substance Abuse Treatment Services, 81 percent provided outpatient care to clients, demonstrating how common this mode of treatment is within the United States. But the care provided within each and every one of these programs might be just a little different and just a little special.
Outpatient programs can vary in intensity, for example. Some programs require only a few hours of participation each week, while others might require daily participation in the program. Some programs even customize time requirements by recovery stage, allowing people to taper down to fewer and fewer weekly obligations as they improve and learn. Programs might also vary by target audience, focusing their care on an age group or specific type of addiction, or they might vary by philosophy, focusing on alternative medicine, herbal medicine or more routine Western care. The choices really are vast.
In the past, it was assumed that people could only enroll in outpatient care like this if they had a high motivation to succeed and few factors that could lead to a relapse. Now, studies suggest that the picture is a little more complex. For example, in a study in the American Journal of Psychiatry, clients with substance abuse and psychiatric disorders were placed in outpatient care, and the researchers couldn’t tie the strength of their mental illnesses to the likelihood of client dropout. In other words, these clients succeeded or failed in treatment due to much more complicated factors that may or may not have had to do with mental illness. Studies like this seem to suggest that almost anyone could enroll in outpatient care, and perhaps anyone could succeed.
Outpatient care isn’t without its risks, however, and sometimes those risks are strong enough that they keep people out of these models of care. For example, in an outpatient program, clients have access to all of the stresses and temptations that led to the original addiction problem. All of their habits would be easy enough to simply start up once more, and the urge to simply go back to the familiar might be too strong to ignore. In a study of relapse rates during outpatient care, published in the journal Alcohol and Alcoholism, researchers found that 31 percent relapsed at least once during the treatment program. Studies like this suggest that outpatient care could be dangerous for some people who are dealing with an addiction, and these people might best be served in an inpatient program, where security is a little tighter and relapse is less likely.
Starting a Search
Addiction treatment professionals want their clients to succeed in rehab, and dropout and/or relapse rates may discourage them. Some experts have responded by developing sophisticated screening tools they can use in order to match clients with the proper level of care. A screening like this might take into account a client’s:
- Physical health
- Mental health
- Family ties
- Living situation
- Employment situation
- Prior rehab experience
- Payment ability
With an evaluation like this, families could make the right choice for the person they love, knowing that the care choice is based on hard facts and not mere opinions. At Michael’s House, we provide our clients with a comprehensive addiction assessment, as well as a psychiatric evaluation. We use this information to craft a customized care plan, and we offer both inpatient and outpatient care options for people in need. This approach allows us to deliver the right level of care to people, and we’d like to tell you more about it. Please call to speak to a counselor about our programs.