What is the difference between inpatient and outpatient drug rehab?
An inpatient treatment program involves making a commitment to putting your life on hold temporarily. While the restrictions of inpatient rehab will vary from one facility to another, it is impossible to continue with your daily life routine while being checked in to an inpatient rehab.
Yet, a change from the routine of daily life may be a good thing for some people. If restricting substance abuse seems impossible while living at home and going to work, checking in to a residential treatment program for a week, or a month or more, may be the break that you need to get started on a treatment program.
Still, outpatient treatment programs can be highly successful. The success of an outpatient program depends on the individual, the type of addiction, social support, and various other factors.
For example, if you are addicted to opioids, and you continue to live at home with your family and you go to work every day, you may be interested in a medication assisted treatment (MAT) outpatient program. MAT programs allow for you to continue with your daily routine without having to go away to an inpatient facility.
Making a decision about which treatment facility to go to can be difficult. Should you choose an outpatient substance abuse treatment program? Or is inpatient addiction treatment more appropriate?
Is the choice for addiction treatment with MAT the same at an outpatient clinic and residential rehab?
Regarding MAT and outpatient vs inpatient drug rehab, in the past, people have had to make difficult choices. They could visit a local Suboxone doctor, or check in at an inpatient residential rehab.
Inpatient treatment programs not only did not provide Suboxone therapy, they also discouraged it. The reason for the anti-Suboxone policy at most rehabs was that the typical inpatient rehab program was based on the Alcoholics Anonymous 12-step program.
Additionally, the related Narcotics Anonymous program also has had great influence on traditional inpatient programs. Many people in Alcoholics Anonymous believe in a full abstinence program, which means that they are personally against the use of medications, such as Suboxone.
Narcotics Anonymous takes the unofficial policy of many AA members a step further. the NA program is officially, at the top level of the world services organization, against the use of Suboxone and any other medication used to treat addiction.
If you check in for inpatient care for a month or so, you will find that a regular activity at the rehab center is a trip to a local 12-step meeting. Depending on the number of residents and local meeting options, you will pile in with your fellow treatment clients to a small bus, a van, or a car, and take an evening trip to a scheduled meeting.
Inpatient rehabs utilize 12-step facilitation.
The process of going to local 12-step meetings is part of a process that the rehab industry considers to be evidence-based, known as “12-step facilitation.” 12-step facilitation means that inpatient treatment programs introduce 12-step meetings as an important component of your long-term recovery.
Because of the entrenchment of these major 12-step programs into most inpatient programs, Suboxone treatment is often frowned upon. Since buprenorphine, the main ingredient in Suboxone, is technically an opioid, rehab administrators consider the treatment to be trading one drug for another, and not a legitimate form of addiction recovery.
Fortunately, with the strength of evidence and clinical experience behind medication-assisted treatment with drugs such as Suboxone, ZubSolv, Sublocade, Vivitrol, and others, MAT is gaining acceptance at more inpatient rehab programs. While we still have a long way to go towards full acceptance, it is an important first step.
There have been various models proposed for MAT continuity of care in which an inpatient rehab center is able to initiate treatment and then refer patients for outpatient rehab. It is important that patients started on medication at an inpatient rehabilitation program are able to continue long-term on their medication with supervision from an outpatient care program.
Inpatient vs outpatient drug rehab: What is the difference? Which addiction treatment program is best?
To answer this question of inpatient vs outpatient, we must first look at the different types of outpatient addiction treatment programs that exist. As I have already described, there are outpatient clinics that provide specialized medical treatment for specific types of addiction.
In addition to MAT for opioid dependence, there are also medication assisted programs for alcohol addiction. Patients who have alcohol use disorder often respond well to treatment with naltrexone, or one of several other medications, such as acamprosate, topiramate, gabapentin, ondansetron, or baclofen.
Other types of addiction may also be improved with medical treatment. There are even medication assisted programs for methamphetamine addiction.
While there are outpatient rehab programs that are focused on the use of evidence-based medical therapy, there are also outpatient programs that are more similar to the traditional residential rehab model. An outpatient rehabilitation facility of this type would work just like inpatient, with the main difference being that the patient goes home every evening.
In fact, these abstinence-based outpatient rehab programs that closely resemble inpatient therapy are typically closely coupled with an inpatient program. The plan is typically for the patient to step down from one program to another, with each program progressively requiring less time per day and per week for therapy.
The therapy most often employed is group therapy. Patients sit in a circle with a certified addictions counselor acting as moderator.
Partial Hospitalization Programs are most similar to inpatient treatment. A Partial Hospitalization Program, or PHP, requires that the patient spend most of their day, as long as eight hours, in the program. And, they are required to attend usually 3-5 days per week.
Intensive Outpatient Programs are similar to PHP, but the requirements of hours per day and days per week is less. When a patient enters IOP treatment, they are often ready to start working at a part time job as part of a plan to reintegrate into society.
Intensive outpatient treatment is often combined with a Sober Living home, so the patient has a structured place to live. Sober Living facilities provide relapse prevention strategies, including regular drug testing, 12-step meetings, and more to ensure that the residents have the best chance of maintaining sobriety.
What about inpatient vs outpatient treatment for alcohol use disorder (AUD)?
Regarding outpatient vs inpatient alcohol treatment, as discussed above, there are effective medical treatments for alcoholism. Many people who have struggled with alcohol addiction for much of their lives have been to at least one rehab facility to receive intensive treatment.
After completing inpatient detox and the rehab program, the patient is enrolled in aftercare, continuing with group meetings at the rehab center for months after rehab graduation. Yet, many rehab graduates find that, months after completing the inpatient program, that they are confronted with intense alcohol cravings.
The problem with inpatient and outpatient detox programs that quickly help a client get into an alcohol-free state, is that the alcohol deprivation syndrome sets in weeks, or months later. This condition is a response from the reward centers of the brain, trying to return to the familiar state of active addiction.
While outpatient therapy and peer support can help a person to get through this dangerous period in their recovery, many people succumb to the alcohol cravings that arise after rehab and end up relapsing. An outpatient treatment program that uses traditional abstinence-based treatment for AUD must be prepared to address the problem presented by the alcohol deprivation syndrome.
Medication Assisted Treatment for alcohol use disorder can help a person gradually reduce and stop drinking.
Fortunately, there are alternatives in outpatient rehab that can help to avoid both a dangerous cold-turkey detox and the alcohol deprivation syndrome. The way this works is by using a harm-reduction-based protocol, known commonly as “The Sinclair Method,” or TSM.
TSM is a way of treating alcohol dependence where the doctor prescribes the patient the opioid-blocking medication, naltrexone. The patient then takes naltrexone one hour before having a drink.
Due to an effect known as pharmacological extinction, the reward center of the brain is retrained by the combination of naltrexone and alcohol. Over time, the patient’s alcohol addiction subsides, with less and less craving, obsession, and compulsion to drink.
Eventually, the patient reaches a state known as extinction. This means that the alcohol habit has been diminished to the point where the patient completely loses interest in drinking alcohol.
Is an inpatient program better when there are behavioral health issues?
If a patient has a serious mental health issue, then an outpatient rehab program may not fully meet the needs of the patient, depending on psychiatric severity. Starting medication management for mental illness may be best managed with hospitalization and then an inpatient rehab which provides addiction treatment as well as behavioral health services.
It is important to find a substance abuse treatment program that can handle dual diagnosis cases because mental health problems require specialized individual therapy as well as medication management. Group therapy sessions are helpful for addressing addiction issues, but they are not as helpful in treating mental health problems.
If a patient has ongoing mental health issues for which they are already receiving treatment, and now they have an addiction problem, it may be possible to treat them in an intensive outpatient program, or with outpatient services with partial hospitalization. Inpatient treatment may not always be necessary if mental health issues are already adequately treated.
Intensive outpatient therapy may involve individual therapy and medical treatment, depending on the facility. The main difference in treatment service in outpatient vs inpatient is the availability of around the clock nursing and monitoring in the inpatient setting.
Regarding outpatient vs inpatient nursing, inpatient is usually the better choice. However, concerge addiction treatment services may also include around the clock nursing, which can be provided in the patient’s home.
What kinds of therapy are provided in both the inpatient and outpatient setting?
Regardless of the treatment setting, whether it is an adult intensive outpatient program, or residential rehab program, specific types of therapy are often provided. For example, cognitive behavioral therapy is often integrated into both inpatient and outpatient programs.
Cognitive behavioral therapy, or CBT, is a form of psychological treatment that involves identifying and dealing with triggers that lead to unhealthy behaviors. CBT is an important treatment modality in addiction treatment.
CBT, and other forms of therapy, such as dialectical behavioral therapy and family therapy, are important modalities typically found in any high quality intensive outpatient treatment program. Family therapy is becoming more popular in both inpatient and outpatient programs.
Of course, the issue with involving the family in addiction treatment is that family is not always helpful in addiction recovery. While family support can be very important and helpful, if the patient is involved in a toxic family situation, it may be best to not include family therapy as a part of the program.
Outpatient vs inpatient cost: Which is more expensive?
When it comes to outpatient vs inpatient billing, as you can imagine, outpatient tends to be more affordable. It makes sense that going to a private doctor, or attending a day program would be less expensive than a place where you live for a month or more.
Inpatient rehab is very expensive. The typical cost for a month of rehab ranges from around $30,000 to as high as $75,000 and up. Why is rehab so expensive?
Is rehab expensive because patients are seeing a doctor and a psychologist every single day? Is it the 24-hour nursing?
Surprisingly, inpatient rehabs rarely include regular doctor visits with a psychiatrist, or even a general practitioner. Standard protocol is to have each patient see a primary care doctor, or nurse, once at admission.
There are also usually no psychologist visits, or even nurses around the clock. Rehabs are staffed by addiction counselors with certificates in addiction counseling.
While many counselors may have college educations, going to college is not a requirement. The prerequisites for becoming an addiction counselor are a desire to help rehab clients to get sober, and a certificate program.
How are the costs for rehab justified?
I have heard of people becoming certified as addiction counselors in as little as a month. While there are certainly more rigorous programs out there, there does seem to be a lack of standardization in requirements for rehab staff.
The typical salary for a substance abuse counselor is around $15/hour. Addiction counselors make a salary on par with a gym staff member.
Gyms often employ many staff members to help gym members to work out safely and keep the gym clean and organized. Yet, gyms do not charge members $30,000 per month. Gym memberships are typically around $25-$50 per month.
Of course, people do not live in the gym, and a gym relies on many members to support the costs of running the business. While I understand that they are two very different business models, it is difficult to comprehend why rehab is so expensive.
Outpatient programs, such as PHPs and IOPs are less expensive than residential rehab, but they are still expensive. Often, the way people are able to afford these programs is to use their health insurance.
A 2008 law, the Parity Act, a part of the Affordable Care Act, requires that health insurance companies cover the cost of addiction treatment programs. Hence, large programs have dedicated billing companies which agressively enforce their legal right to have their client’s care covered.
What alternatives exist for addiction treatment for people who do not have insurance?
Even with the Parity Act, some insurance companies still find loopholes, or simply refuse to cover addiction services. And, there are still many people who do not have health insurance coverage.
A much more affordable form of addiction treatment is office-based outpatient therapy, or for opioid addiction treatment, the programs are known as Office-Based Opioid Treatment Programs, or OBOT.
For patients who are addicted to opioids, going to a private doctor’s office, even a vip concierge Suboxone doctor, will be much more affordable than inpatient and outpatient rehab. Additionally, Suboxone treatment has a much higher success rate compared to abstinence-based rehabs.
For years, it seemed as if the only form of addiction that could be treated with medication was opioid addiction. However, there are now medication-assisted treatment protocols for alcohol addiction, and even meth addiction.
Before considering inpatient vs outpatient substance abuse treatment, you may want to schedule a visit with your family doctor first. If your family doctor does not provide addiction treatment at all, consider seeing a private concierge addiction doctor who will work with you to overcome your addiction without the need for complicated inpatient or outpatient rehab.
The difference between outpatient and inpatient rehab is often simply whether or not the patient sleeps in the facility and gets their meals prepared there. Yet, outpatient can also describe private doctors and clinics that provide affordable, and highly effective medical treatment for addiction.
If you live in Florida, consider scheduling a visit with the best concierge addiction treatment services Miami has to offer. With telemedicine services, we are able to help patients all over the state of Florida.
And, if you are interested in learning more about inpatient vs outpatient alcohol rehab or drug rehab, please contact us for more information.