Realizing that ourselves or a family member has a substance use disorder is a big step – and many times comes as a shock. The next logical question we ask is: what should we do about it? Whether you’ve already discussed your options with a professional done some research on the topic, you may have heard the terms inpatient treatment and intensive outpatient rehab pop up more than a few times.
Inpatient rehab is done in a live-in environment, where treatment groups, social activities, and 12 step meetings are closely monitored. This level of care is more appropriate for those who have found it extremely difficult to stay sober in their typical home environment. Outpatient rehab is generally done in the evenings or afternoons, where participants are free to go home and are encouraged to seek their own outside 12-step meetings. It is also often recommended for those who have been through an inpatient or residential treatment program but are looking for a bridge into their long-term recovery process.
Though there isn’t a one size fits all answer to this question, we hope to offer some helpful guidance on this topic to maximize your chances of success.
Differences between outpatient vs inpatient rehab
We often receive questions from parents and family members about what level of care is right for an individual with a substance use disorder (SUD) or potential SUD. This can be an extremely complicated decision for family members to make, and advice on the topic can often be conflicting. Below we have highlighted some average features and benefits of each type of substance use treatment:
| Outpatient Substance Use Treatment | Inpatient Substance Use Treatment |
| 6-12 weeks, on average | 30-45 days, on average (some programs are up to 90 days in length) |
| 9-15 hours or therapy per week, on average, split over 3-4 treatment days | 6-8 hours of therapy per day, on average |
| Participants must seek their own outside 12-step meetings | 6-7 in-house 12 step meetings per week, on average |
| Participants must provide their own transportation | Transportation to and from outside activities is provided |
| Participants live at home | Participants live in the treatment center |
| Typically followed with 6-12 week aftercare programs | Typically followed by PHP or IOP programs |
The main difference between any form of outpatient or inpatient program is where the client lives while attending treatment. The other difference between these types of treatment is intensity and time spent in treatment on a weekly basis.
Keep in mind that these are averages. Individual programs can vary wildly on features, goals, and length of stay. For example, a standard outpatient will meet 1-3 days a week for 1-3 hours per session. So, it is possible that one program may only meet for 1 hour once a week, while another meets for 3 hours 3 times a week, and both are referred to as outpatient programs. Obviously, the intensity of these two programs would be vastly different, so it’s important to research each program’s treatment schedules.
When to choose Intensive Outpatient (IOP) Rehab
This is a common starting point for an individual who presents with a substance use disorder but has maintained some level of functionality in their life. It can also be appropriate for individuals who have obligations to meet and cannot afford to take time off.
Intensive Outpatient treatment is most appropriate for individuals who:
- Are not demonstrating life-threatening withdrawal symptoms
- Do not present with medical or psychiatric symptoms that warrant hospitalization
- Are capable of staying sober without being removed from their home environment
- Need help learning to stay sober in their home environment
- Have demonstrated a willingness to try to stay sober and seek 12-step support outside of the treatment environment
This can be confusing for some families, as they may think that starting with the most intensive option will increase the chances of long-term success. The reasoning behind this comes down to the most crucial elements of successful treatment, client willingness and personal “ownership” over treatment.
The “best” treatment in the world will not work for someone who isn’t committed to their own recovery, and the “worst” treatment will do wonders for someone who genuinely wants to change.
We have seen countless examples of parents who catch a family member using and immediately send them to a residential program, only to have the child return home and repeat the same behaviors. After working with these families later in their recovery journey, it became clear that the individual went through inpatient treatment without fully identifying their problem.
In other words, they thought their problem was that their family members overreacted rather than identifying their own substance use as the problem. They may learn a lot of valuable information in residential treatment, but they lacked internal understanding of why they were there in the first place.
It is for this reason that even if residential treatment or inpatient is available or seems appropriate, when safe, it can be beneficial to start treatment at an outpatient level and then move to a higher level of care if necessary. If utilized correctly, this method allows a individual to begin treatment at a less intensive level, with the knowledge that if they struggle to make progress in treatment or maintain sobriety, they will need to attend a higher level of care.
If the person does not wish to leave home, miss work / school, or miss any other commitments, then those things will serve as motivation to complete treatment goals and maintain sobriety. If the participant can make progress in IOP with these motivating factors, it’s a win-win.
The individual can begin their recovery journey and move towards a healthier lifestyle while avoiding having to put life on hold while in residential. It also allows families to retain financial resources which keeps options open if further treatment becomes necessary in the future.
If, on the other hand, it becomes clear that the person does need a higher level of care, the time spent in IOP should help provide the person with a sense of ownership and willingness. The person will be going to residential with the knowledge that they are going not because their parents caught them, but because they failed to make progress in their IOP program. This gives their counselors a solid place to start when working through issues with patients.
Intensive outpatient treatment also allows the individual and their family to begin utilizing recovery tools in the home setting, which is necessary for long term success. This often overlooked portion of the early recovery process is important, regardless of their level of care.
When to choose Residential Treatment or Outpatient Rehab
Obviously, there is no cookie cutter formula for treatment, and some individuals with SUD’s need inpatient treatment immediately. Because the individual lives in the treatment center, inpatient treatment has the benefit of providing an optimal environment for individuals to focus on their recovery without the distractions of daily life.
Inpatient rehab is most appropriate for individuals who:
- Are using more dangerous drugs such as strong opiates or benzodiazepines regularly. (A daily opiate user has a significant chance of overdosing during a relapse, so placing them in a residential may be necessary for safety)
- Do not have a home environment is not conducive to recovery.
- Have a history of relapse or haven’t had success in IOP programs in the past.
- Need around the clock accountability for their whereabouts in order to avoid relapse during the first phase of early recovery.
If their ease of access to drugs and alcohol is too high in the home environment, it can be very necessary to leave the home environment entirely in order to avoid relapse. These situations are often volatile, and require case-by-case planning to ensure the individual has a safe and sober place to live once they leave the relatively safe inpatient environment.
Other factors may include the participant’s willingness to attend treatment, physical access to treatment, or history of defiant behavior (such as running away or violence).
One element of particular importance is that we do not recommend looking at inpatient and outpatient treatment as an either / or choice. Inpatient treatment allows an individual to focus entirely on recovery for a while – extremely useful for those who need it. However, these individuals will often face unexpected challenges once they leave the treatment environment.
It is still important to continue the treatment journey after leaving inpatient rehab. This is often in the form an IOP or PHP (partial hospitalization) program.
Necessary Factors for Successful Treatment
Regardless of the level of care you choose, there are number of elements to seek out in treatment options. For treatment plans to be successful, there are a few requirements, which are as follows.
The counseling programs, therapists, family members, and affected individuals should have consistent and effective communication. This can be a major hurdle for an early recovery journey. If someone is referred to residential for a higher level of care, or referred to an IOP for aftercare, communication between programs and families is essential. Without it, the transition between programs can be disorganized and ineffective.
It is important for the goals of treatment to remain consistent between programs, and this cannot happen without communication. When possible, it is preferable to keep treatment philosophies similar between programs. For example, if an inpatient program uses a 12-step or alternative peer group model, then the follow-up IOP program should also utilize a 12-step or alternative peer group model.
In conclusion
As stated before, there is no perfect answer to which level of care you should choose. If you’re currently weighing the options on outpatient rehab vs inpatient drug rehab, we recommend that you discuss your concerns and weigh your options with a medical provider or therapist in your area.
Those trained in responding to addiction will help you choose the best option for your individual situation. If you are anywhere near the Phoenix or Sacramento areas, give us a call. We would be happy to set up a no cost evaluation with you and your family member in order to help determine a course of action and begin your family’s path to recovery.