There are multiple options regarding the type of treatment individuals can receive for alcohol use disorders. At the most basic level, individuals can become involved in either an inpatient treatment program or an outpatient treatment program. The difference between the two programs is the manner in which these programs allow individuals to receive treatment and then function outside of the treatment setting.
Technically, an inpatient treatment program is performed in a hospital or professional clinic. Individuals in inpatient treatment programs have some type of condition or situation that requires that they be monitored by a professional medical team (e.g., nurses, doctors, etc.) around the clock. There are numerous conditions that require this level of medical monitoring, including going through alcohol withdrawal, having a co-occurring mental health disorder that needs to be addressed, being suicidal, having a physical condition that needs medical treatment, having numerous relapses and unsuccessful attempts at recovery, etc. Residential treatment programs and partial hospitalization treatment programs differ from classical inpatient treatment programs as individuals in these programs do not require 24-hour medical monitoring and medical care. For simplicity sake, this article will consider inpatient, residential, and partial hospitalization treatment programs as belonging to the same category described as inpatient treatment. In these programs, treatment is generally provided in or very near the same facility where the individual lives.
Outpatient treatment programs are any type of treatment programs where individuals attend treatment in some office, clinic, hospital, etc., and then after the treatment is completed for the day, they return to their home or to some other arrangement that is separate from the treatment center. Individuals in outpatient treatment programs are allowed to visit family members at their convenience, go to work, engage in recreational activities, etc. Outpatient treatment as defined in this article also includes intensive outpatient treatment programs (IOPs) that often provide the same level of treatment as inpatient treatment programs.
Advantages of Inpatient Treatment for an Alcohol Use Disorder
Inpatient treatment programs will often have a limited duration. The duration will vary, depending on the specific issues being treated. The duration can be a week to 10 days, or it can be significantly longer; some individuals can be in residential programs for a year or longer.
For individuals with moderate to severe alcohol use disorders, getting involved in a physician-assisted withdrawal management program (medical detox) is a central tenant of treatment for several reasons. First, alcohol withdrawal can be potentially fatal due to potential seizures. Second, individuals undergoing withdrawal from alcohol may develop serious issues with cognition and reality due to the development of hallucinations and/or delusions that leave them open for harm. Third, relapse rates are extremely high during the withdrawal process.
According to the American Society of Addiction Medicine (ASAM), the largest professional organization of addiction medicine physicians in the United States, and the National Institute on Drug Abuse (NIDA), the advantages of using an inpatient withdrawal management program for an alcohol use disorder are outlined below.
- Close 24-hour medical supervision allows for immediate treatment of any complications during the withdrawal process, including emotional issues, physical symptoms, and/or cravings.
- The inpatient environment makes it extremely hard for individuals to get alcohol if they wish to do so.
- Individuals in an inpatient treatment program for withdrawal management are in the company of others who are experiencing the same issues. This provides much needed support.
- The structured nature and intensive treatment in an inpatient environment can help to distract the person from withdrawal symptoms and cravings or other issues that could spur a relapse.
- Beginning treatment in an inpatient unit can lead to a greater commitment to successful long-term recovery.
ASAM and NIDA also report other advantages to inpatient treatment for an alcohol use disorder.
- Individuals in inpatient treatment have better access to care for acute co-occurring mental health disorders or medical conditions.
- Inpatient treatment programs are highly structured.
- The treatment program utilized in most inpatient treatment environments is implemented by a multidisciplinary team of treatment providers who address clients’ issues from different viewpoints. The team often includes physicians (medical), therapists (psychological and social), social workers (psychological and social), occupational therapists (addressing practical functional issues), etc.
- Inpatient treatment programs are easily modified for clients with special needs.
- Inpatient treatment helps to foster a sense of personal responsibility and accountability for the client.
- Inpatient treatment units isolate individuals who have toxic environmental conditions, such as being homeless, living in an area where alcohol or drug abuse is rampant, being in an abusive relationship, etc.
- Inpatient treatment is especially suited to help individuals who have had multiple failures at attempting to remain abstinent from alcohol due to the intensity of the program and its multidisciplinary approach.
- Inpatient treatment programs help to develop confidence in individuals who are unsure of their ability to remain abstinent from alcohol.
- The legal system is more likely to accept inpatient treatment for an individual with an alcohol use disorder as at least a partial form of incarceration.
- The completion of an inpatient treatment program for an alcohol use disorder is a major accomplishment for most individuals. It can help strengthen the individual’s commitment to long-term recovery.
There are, however, some disadvantages associated with inpatient treatment.
- In order for inpatient treatment to be covered by insurance companies, it must satisfy the notion of medical necessity. This means that a less expensive and less restrictive form of treatment that can provide the same results or benefits, such as outpatient treatment, would be chosen over inpatient treatment. Medical necessity can be difficult to substantiate.
- Inpatient treatment is far more expensive than outpatient treatment. Most insurance plans do not cover the entire cost.
- Inpatient treatment programs are very restrictive. Individuals cannot engage in aspects of their normal daily lives while they are in inpatient care.
- Inpatient treatment programs are time-limited. Eventually, individuals will transition to some form of outpatient treatment.
- Most inpatient treatment programs are designed to meet acute needs. Simply completing inpatient treatment and not continuing with further treatment, such as aftercare, will often result in relapse.
Advantages and Disadvantages of Outpatient Treatment
Eventually, everyone in treatment for an alcohol use disorder will transition to some form of outpatient treatment. Outpatient treatment is the mainstay of all long-term substance use disorder recovery programs. Individuals who remain in treatment-related activities for a sufficient length of time increase the probability that their long-term recovery will be successful, and they will be often be involved in some form of outpatient treatment.
According to ASAM and NIDA, there are many advantages of outpatient treatment.
- Outpatient treatment programs allow individuals to continue with their lives and maintain important life commitments to family, work, school, etc.
- Outpatient treatment programs can be ongoing. They are not time-limited.
- Outpatient treatment programs allow individuals to immediately practice what they learn in the real world.
- Being in an outpatient treatment program protects confidentiality. When an individual goes into an inpatient treatment program, they must explain to coworkers, peers, etc., where they are going and why.
- Outpatient treatment programs provide the same services and the same quality of treatment as inpatient treatment programs.
- Outpatient treatment programs can be very intensive. For example, intensive outpatient treatment provides nine or more hours of intensive treatment per week.
- Outpatient treatment programs help individuals to develop a strong and diverse social support network of other individuals in recovery.
- Outpatient treatment is less expensive than inpatient treatment.
There are some general disadvantages to outpatient treatment programs.
- Outpatient treatment programs do not provide 24-hour medical care for individuals who need it.
- Emergency situations cannot be immediately addressed for individuals in outpatient treatment.
- It is much harder to monitor an individual’s abstinence from alcohol when they are in outpatient care.
- Outpatient treatment results in too much freedom for individuals who have had multiple relapses and unsuccessful attempts at recovery. There may be too many temptations initially, and this makes relapse more likely.
Inpatient treatment programs attempt to provide 24-hour medical supervision and medical care to individuals who require it. This is the main advantage of inpatient treatment. Inpatient treatment programs provide intensive treatment and are very useful at monitoring and controlling an individual’s withdrawal from alcohol. Inpatient treatment programs can provide an individual with a solid foundation for their recovery program that can help them once they are transition to outpatient care, but due to the time-limited nature of inpatient treatment programs, they only represent the beginning of recovery from an alcohol use disorder.
Outpatient treatment programs are the foundation of long-term recovery for individuals with alcohol use disorders. They provide individuals with intensive treatment, the ability to continue with aspects of their normal lives, flexibility, social support, and the opportunity to participate in treatment for years following their initial abstinence from alcohol. However, because outpatient treatment programs provide flexibility to individuals, there are more potential temptations that can result in increased potential to relapse. Nonetheless, every individual with an alcohol use disorder who does not have a serious medical condition or cognitive issue that requires lifelong hospitalization will need to learn to apply the principles of treatment to their life. Outpatient treatment supports this practice.
In the final analysis, inpatient treatment programs are generally equivalent to long-term outpatient treatment in terms of the quality of treatment they provide. Both types of programs have comparable success rates. Inpatient treatment programs are often more successful at helping individuals get through the withdrawal process from alcohol without relapsing, but once the individual has negotiated their withdrawal from alcohol, they must learn to develop a program of relapse prevention that will work for them outside of the treatment facility. Individuals who simply complete inpatient treatment programs and do not transition to long-term aftercare programs as outpatients often relapse.