Alcohol addiction rehabilitation programs generally involve inpatient or outpatient treatment settings. The former, inpatient/residential treatment programs, are ideal for patients who have relatively more severe alcohol use disorder (AUD) and addiction-related issues or those who lack a safe, stable, and supportive living situation.1
Though there may be some distinctions in terms of exact clinical setting, the range and intensity of treatment offerings, as well as billing details, the concepts of “inpatient” and “residential” have some overlap. Both provide 24-hour supervision and care, while the more intensive inpatient programs may place additional focus on medical services, such as withdrawal symptom management during detoxification.2
Given their varying individual needs, patients entering rehab may at some point have to make a choice between long-term and short-term residential treatment. Many patients stay at a residential treatment facility for 7-30 days, though studies have shown that addiction treatment outcomes may be optimized when patients remain in a program for a substantial length of time—often 90 days or longer.3,4
Inpatient treatment can be especially beneficial for patients who:5
- Have severe addictions and a higher probability of relapse.
- Have unstable, unsafe, or unsupportive living environments.
- Have co-occurring mental disorders or physical health problems.
- Need a highly structured routine and more intensive care to manage their addiction.
Short-Term and Long-Term Residential Treatment
Historically, many short-term residential treatment programs involved a relatively short duration (3 to 6 weeks) of intensive treatment based on a modified 12-step approach.6 Patients who complete such a residential program are encouraged to continue with additional outpatient programming or other forms of aftercare programs to decrease the chances of relapse.6
Long-term residential treatment typically takes place in a non-hospital setting, with varying lengths of stay depending on the specific program.6 One approach to long-term residential care is the therapeutic community (TC) model, in which people may expect to reside and participate in treatment programming for as long as 6 to 12 months, as needed. A therapeutic community may aim to “re-socialize” the patient by providing the opportunity for therapeutic interaction with other residents, staff, and the social context of the program.
TCs can help recovering individuals build personal responsibility, accountability, while addressing pertinent psychological and social problems in the process.6 A therapeutic community can help treat individuals from a variety of different demographics with various mental health considerations.6
Often, patients will complete some form of initial residential treatment and, next, step down or move into relatively less intensive levels of care such as outpatient, where they are allowed to live off-site while still receiving treatment.7
Is Detox the Same as Inpatient Treatment?
Before much of the work of rehabilitation begins, patients must sober up and allow their body to clear itself of the lingering effects of alcohol through a process called detoxification.8 Though detoxification is an important first phase of rehab, and may take place in an inpatient setting, it is not a substitute for more comprehensive inpatient or residential rehabilitation. On its own, detox is unable to adequately address many of the psychological, social, and behavioral problems associated with addiction.8
Medical detox is often essential for people with severe AUD and significant physiological alcohol dependence, as unmanaged alcohol withdrawal can be dangerous. The detox process often consists of supervision, counseling and, when needed, medication to manage withdrawal symptoms.8
Alcohol withdrawal symptoms commonly begin within 8 hours after the last drink, but may not arrive for several days, in some cases.9 Alcohol withdrawal symptoms often peak in severity by 24-72 hours and subside after 4-5 days, though mild effects may last for several weeks.9
Characteristic symptoms of alcohol withdrawal may include:9
- Irritability and mood swings.
- Bad dreams.
- Tachycardia (fast heart rate).
- Excessive sweating.
- Shakiness and tremors.
- Hallucinations and severe confusion.
Benzodiazepines (such as diazepam and chlordiazepoxide) are often used to manage alcohol withdrawal symptoms and decrease the risk of dangerous withdrawal complications including seizures.8
One of the main goals of detox (besides ensuring patients’ safety as they withdraw) is to facilitate entrance into a rehabilitation program. Detoxification alone may be insufficient to produce the lasting behavioral changes needed for long-term recovery from alcoholism.8 Individuals benefit from learning positive coping mechanisms and behaviors in the next steps of rehabilitation to better reduce their risk of relapse.3
What to Look for in an Inpatient Rehabilitation Program
Addiction is a complex disease, and there is no one solution that will work for all individuals. However, many effective treatment approaches combine evidence-based behavioral therapy with prescribed medications (e.g., detox medications and, post-withdrawal, acamprosate, disulfiram, naltrexone, when appropriate).4, 10
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends considering the following when choosing a treatment facility:10
- The different treatment methods offered at the facility and how these are prescribed to the individual. A varied approach is often necessary when treating alcoholism; a rehabilitation center that relies on one method may be less effective than a facility that uses all available approaches.
- How the facility measures the success of the treatment. Success can be measured by different metrics. Look for treatment outcomes that can be used to compare across different facilities, if multiple programs are available.
- How the facility deals with relapse. Addiction is a chronic disorder and therefore it is common for patients to relapse after completing rehab. An effective treatment center will address relapse within their programming and may even offer support to getting patients into aftercare programs to prevent relapse once treatment is complete. Relapse does not necessarily mean that rehabilitation was unsuccessful—it may just mean that the program prescribed to the individual needs adjustment.
There are several other factors that may influence an individual’s decision as well. This includes:
- Whether the facility is equipped to treat co-occurring disorders as well as substance abuse. Dual diagnosis is very common among individuals suffering from addiction and studies show that treating all problems simultaneously is more effective than attempting to treat them separately. 5,11
Licensing and certification. Different states, cities, and counties may have different requirements for licensing or certification. For example, all treatment facilities in California must be licensed by the Department of Health Care Services (DHCS).12 There are several other optional certifications a facility may also have, including:
- Accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF), which demonstrates accountability and adherence to international standards for excellent care.
- The American Society of Addiction Medicine (ASAM) Level of Care Certification is given to rehabilitation centers that have been independently assessed and demonstrated the ability to provide evidence-based treatment to patients.
If there are alternative therapies provided at the facility. Many patients respond well to alternative therapies as a complement to evidence-based approaches. Alternative therapies may include:
- Art therapy.
- Music therapy.
- Horse-assisted therapy (or equine therapy).
- Yoga therapy.
- The amenities provided at the treatment center. These features can make a stay in residential treatment more comfortable for someone in recovery.
- Location of treatment. Some patients may prefer a facility that is close to home, while others may benefit from putting more distance between them and their home environment.
Inpatient Treatment With AAC
Often, taking the first step toward rehabilitation can be the hardest part of recovery. Alcohol.org is a subsidiary of American Addiction Centers (AAC), a nationwide provider of addiction treatment facilities, and we understand the need for safe, comfortable and supportive care for those seeking recovery. AAC’s facilities offer a combination of proven therapies and services to meet your individual needs.
Here’s what you can expect when choosing an AAC facility:
Upon contacting an admissions navigator, potential patients may be asked for their:
- Insurance information.
- History with substance abuse and the severity of the problem. This includes:
- How much and how often they drink.
- Whether they use any other drugs in conjunction with alcohol.
- Their family history with substance abuse.
- If they have any co-occurring mental health issues or medical concerns.
The admissions navigator will verify insurance, explain options for treatment, and make payment arrangements if needed. They can also direct individuals to other options if insurance won’t cover treatment at an AAC facility.
Since addiction treatment works best when it is tailored to the individual, AAC facilities provide specialized rehabilitation tracks for certain groups (available groups may vary depending on location). There are specialized tracks for:
- Veterans and first responders.
- People with chronic mental illness.
- Healthcare professionals.
People in these programs can benefit from the specialized treatment that these groups provide. For example, studies show that addiction treatment groups with specialized programs for gay and bisexual men fared better in treating those clients than non-specialized groups treating gay and bisexual men.12
The community in these groups is also uniquely supportive of their shared struggles. For instance, veterans may feel more comfortable sharing during group therapy surrounded by people that may have undergone similar traumatic experiences.
Once admitted to a facility, patients are:
- Greeted by staff upon arrival and shown to their rooms.
- Given admissions paperwork to complete.
- Given a health and psychiatric evaluation to determine if medical detoxification and other safety measures need to be taken.
- Prepared for their personalized treatment plan in a conversation with staff, who will go over the details and schedule.
While treatment methods can vary greatly based on the needs of the individual, one of the benefits of an inpatient program is that it entails a daily routine and complete immersion in a setting that supports recovery. Patients in residential treatment at an AAC facility have a set schedule, with time set aside for a variety of programs throughout the day, including:
- Group and individual therapy.
- Coping skills education.
- Relapse prevention classes.
- Alternative therapies.
After Completing Treatment with AAC
Since recovery is a lifelong process, many patients benefit from support maintaining sobriety after they leave inpatient treatment. Aftercare, or continued care, is important for all people in recovery, but it is especially vital that people with any co-occurring social, medical, or mental health issues continue to receive therapy and medication if necessary.7
The Center for Applied Behavioral Health Policy at Arizona State University outlines 5 pillars of effective aftercare. These include:13
- Coping strategies to help a person in recovery deal with social and emotional pressure.
- Relapse prevention.
- The opportunity to receive education or vocational training is essential to continued care.
- Continued therapy is needed for patients to create and respect boundaries for themselves and others.
- Patients must learn to take part in sober activities and create relationships.
Aftercare for some may mean transferring to a partial hospitalization program or other outpatient level of care following initial inpatient or residential rehabilitation. For others, self-help and peer support groups provide valuable aftercare support; the most well-known form being 12-step programs such as Alcoholics Anonymous.7
Many treatment programs will recommended that patients remain in aftercare programs for at least 1 year, though adolescents may benefit from longer durations of continuing care.14
Patients that complete residential treatment at an AAC facility often benefit from other forms of support as well, such as an alumni network that many treatment centers provide. These programs allow individuals in recovery to stay in contact with their peers and often hold sanctioned events and meetings in which alumni and their family members can participate.
Discuss Your Treatment Options
If you’re ready to seek treatment for alcoholism, American Addiction Centers can help. Our admissions navigators are available 24/7 to discuss your treatment options with you and all calls are 100% confidential.
We know the choice to get sober isn’t easy, but we’ll be with you every step of the way and can answer any questions you may have about treatment, addiction, life after rehab and long-term recovery support.
. National Institute on Alcohol Abuse and Alcoholism. (n.d). Why do different people need different options?
. National Institute on Alcohol Abuse and Alcoholism (n.d.). What types of alcohol treatment are available?
. Substance Abuse and Mental Health Services Administration. (2015). A Treatment Improvement Protocol No. 45. Rockville, MD. U.S. Department of Health and Human Services.
. National Institute on Drug Abuse. (2018). Principles of effective treatment.
. National Institute on Drug Abuse. (2019). Treatment approaches for drug addiction.
. National Institute on Drug Abuse. (2018). Types of Treatment Programs.
. Substance Abuse and Mental Health Services Administration. (2006). Treatment Improvement Protocol No. 47. Rockville, MD. Center for Substance Abuse Treatment.
. Hayashida M. (1998). An overview of outpatient and inpatient detoxification. Alcohol health and research world, 22(1), 44–46.
. U.S. National Library of Medicine. (2020). Alcohol withdrawal.
. National Institute on Alcohol Abuse and Alcoholism. (2014). Treatment for alcohol problems: finding and getting help.
. National Institute on Drug Abuse. (2020). What are the treatments for comorbid substance use disorder and mental health conditions?
. National Institute on Drug Abuse. Substance Use and SUDs in LGBTQ* Populations.
. Patton, D. and McDowell, T. Substance Abuse Aftercare Treatment. Arizona State University, Center for Applied Behavioral Health Policy.
. Substance Abuse and Mental Health Administration. (2014). What is Substance Abuse Treatment? A Booklet for Families. HHS Publication No. (SMA) 14-4126.