There are varying levels of rehab provided based on the needs of the individual being treated. Two of the broader options for treatment are residential, or inpatient treatment, where the person lives at the treatment center for the duration of the rehab program, and outpatient treatment, where the person being treated is able to live at home but participates in regular treatment therapies and programs.

The determination as to the most appropriate treatment type is usually made by the addiction treatment specialist based on the individual’s substance abuse severity and various other needs, such as treatment for co-occurring disorders and relapse risk management. However, many individuals who are placed in treatment don’t have information on the reasons they are placed in one level of care compared to the other. The following comparisons of inpatient and outpatient treatment can help to illuminate how and why each level of care is used.

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Inpatient Treatment

Ideal Client for Inpatient Treatment

According to the American Society of Addiction Medicine (ASAM), inpatient treatment is ideal for people who are in need of 24/7 living support and structure for their addiction treatment. This includes those individuals who have a higher risk of relapse, have an unstable living environment at home, or require medical treatment during rehab.

This type of service can range from clients who are relatively self-sufficient but need psychological supervision to those who are in crisis due to their addiction and require care by nurses and medical doctors in order to withdraw from the drugs being used.

Types of Treatment Programs

Inpatient treatment programs typically involve 24-hour, residential care that provides:

  • Monitored abstinence from substance use
  • Medical treatment for withdrawal, if needed
  • Behavioral therapies, such as family therapy and Cognitive Behavioral Therapy
  • Exercise and nutrition programs to help recover physical health
  • Integrated treatment for co-occurring conditions
  • Motivational therapies to encourage the desire to change behaviors
  • Support group programs, such as 12-Step meetings, that can continue after treatment

These treatment programs are arranged in a daily schedule that keeps the person focused on the goal of recovery all day, every day. As described by the National Institute on Drug Abuse, (NIDA) programs can last from two weeks to six months or longer. Often, the longer the treatment, the more likely it is that the person will be able to emerge from rehab with the skills needed to stay abstinent for the long-term.

As stated above, the programs range from those with minimal supervision of clients to those where daily medical supervision and oversight are necessary, such as hospitalization. Ideally, the degree of inpatient treatment is determined based on the individual’s treatment needs and relapse risk.

Cost of Inpatient Treatment

The cost of inpatient treatment is higher, based on the higher levels of service along with the cost of room and board for clients in this type of treatment. Those who require intensive medical care are even more likely to incur high expenses.

On the other hand, for people with severe substance abuse, the cost of treatment can be offset by the lowered risk of health and financial complications after treatment is over. For these individuals, the cost of continued addiction may be much higher than the cost of completing a research-based treatment program with aftercare and support in recovery. Most reputable treatment programs have payment options that can make it easier to afford this type of rehab, and a number of insurance plans will cover some parts of rehab, if not all of it.

A number of states have free or low-cost inpatient programs that can offset the challenges of getting inpatient treatment. However, care must be taken in these programs that they provide the correct level of care that is more likely to result in recovery. As described in NIDA’s Principles of Effective Treatment, longer terms of treatment are more likely to result in the person being able to maintain long-term recovery.

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Outpatient Treatment

Ideal Client for Outpatient Treatment

According to ASAM, the ideal client for outpatient treatment as one who has a lower relapse risk and a higher degree of motivation to change addictive behaviors. This person likely has a stable home environment and a social circle of family and friends who are supportive of the person’s journey to recovery.

It is expected that this person is less likely to return to substance use during or after treatment due not only to the preventive factors of the person’s surrounding environment, but also to the person’s sincere desire to learn to manage cravings and triggers, and stop abusing the drugs that have disrupted that person’s life. Research shows that these individuals are most likely to achieve long-term recovery, as described in Alcohol Research and Health.

Types of Treatment Programs

As defined by ASAM, outpatient services range from low-intensity treatment plans of fewer than nine hours per week to higher-intensity intensive outpatient or partial hospitalization plans that range from nine hours to more than 20 hours per week of services.

These programs include combinations of:

  • Support group programs, such as 12-Step groups, for motivation and support
  • Individual or group behavioral therapies
  • Educational programs and presentations
  • Family therapy, as needed

The higher-intensity programs may have more therapy sessions and may include motivational therapy. Regardless of this, individuals are able to live at home and access the support provided by family and friends for recovery, as well as keep up with job, school, and other daily responsibilities over the course of treatment.

Outpatient services can often be used as a follow-up to inpatient treatment in order to help individuals with high risk of relapse to transition more slowly back into daily life after rehab.

Cost of Outpatient Treatment

Outpatient treatment is less expensive than inpatient, mostly because of the ability to get treatment without also having to cover room and board. Some forms of outpatient treatment, such as 12-Step program elements, can be free. However, partial hospitalization and intensive outpatient services generally incur higher costs.

Insurance plans often cover certain aspects of outpatient treatment that can make it more affordable. This includes Medicare, Medicaid, and plans available under the Affordable Care Act. Private plans also often cover certain aspects of treatment.

Care must be used, however, not to select outpatient treatment based on cost alone. If inpatient treatment is warranted, choosing outpatient services instead can result in a decreased likelihood of recovery, resulting in a lost investment.

The pros and cons of each level of care in addiction treatment are based more on the individual’s needs than on a direct analysis of services and cost. As described by NIDA, the best treatment type for an individual is based on that individual’s particular degree of substance abuse and other needs. For this reason, the individual and treatment specialist together can determine what the pros and cons are for that individual based on treatment types, helping to place the person in the level of care that is most likely to result in recovery and long-term abstinence from drugs or alcohol.