For those based in the UK and looking for treatment for drug and/or alcohol addiction, there are two main options available: inpatient (residential) and outpatient treatment.
Both inpatient and outpatient treatment have a high success rate for treating addiction.
Although both are similar and offer, relatively, the same drug and alcohol services, they differ in various ways.
These differences are worth consideration for anyone seeking treatment for drugs and/or alcohol.
Therefore, this article will discuss both inpatient and outpatient treatment, highlighting some of their differences, pros and cons, price ranges, and what to expect.
What Is Inpatient Rehab Treatment?
Inpatient treatment, commonly known as residential treatment, refers to a facility (usually private) that provides a drug and alcohol treatment program that requires people to stay at the facility for the duration of their treatment.
On average, people stay at residential facilities for between 28 to 90 days. However, this can vary and will be covered in more detail below.
People are provided with a bed, food, utilities, and access to professional staff and facilities.
Access to inpatient treatment and then the treatment process usually follows several stages:
- Referral
- Pre-treatment assessment
- A medical examination
- Detoxification
- Therapy
- Relapse prevention
- Aftercare
There are several ways to access inpatient treatment: through the NHS, self-referral, or a referral from a medical professional, such as a GP or social worker.
Although the NHS does not run inpatient treatment facilities, it is possible to access funding through the NHS.
This requires a referral from a key worker and an application to be made to a local council for consideration.
It should be noted, however, that NHS funding is not easy to come by and requires people to meet strict criteria, such as attending local drug and alcohol services and showing a willingness to change.
Because most inpatient programs are run by private facilities, people can self-refer. This simply requires the person to find a suitable rehab facility and contact them.
Finally, most medical professionals and key workers will help people access an inpatient treatment program.
Once the person has found a suitable facility, they will be required to attend a pre-treatment assessment.
This is usually a phone call with one of the facility’s staff. People will be asked questions about their reasons for entering treatment, what they hope to get out of it, and if they have any other medical conditions or needs.
This assessment is done to help staff provide the best treatment plan.
Upon entering rehab, people will undergo a medical examination – both psychological and physiological.
This looks for any other medical conditions, such as mental disorders, and will help determine if a specific medication is needed or specialised therapy.
Following this, people will begin the detoxification stage; this is the process of the body and brain expelling the substance.
During the detox process, people are likely to experience unpleasant withdrawal symptoms. Fortunately, during inpatient treatment, people will have access to 24/7 medical support.
People will then begin attending therapy. This can be wide-ranging and will depend upon the therapy that the facility provides.
However, some common types include Cognitive Behavioural Therapy (CBT) and group therapy. Therapy types will be covered in more detail later.
An important part of inpatient treatment is relapse prevention. As the name might suggest, this is aimed at helping people maintain sobriety upon leaving treatment.
In most cases, this involves working alongside a medical professional to create a relapse prevention plan – usually, a written document containing information about sobriety, therapy, coping mechanisms, and potential triggers.
Finally, upon leaving inpatient treatment, most people will be offered aftercare. This is post-treatment support, often in the form of continued support, therapy, help accessing local drug and alcohol services, and 1-to-1 check-ins. (1)
What Is Outpatient Rehab Treatment?
An outpatient treatment program, as mentioned, is like inpatient treatment. The reason for this is that it follows a similar process.
People will make a referral and undergo a pre-treatment assessment. Upon starting an outpatient program, people will have a medical examination, followed by detox, therapy, relapse prevention, and aftercare.
However, outpatient treatment differs in various ways.
The most evident way in which outpatient treatment is different from inpatient treatment is that it is not residential; that is, people do not stay overnight at a facility whilst receiving treatment.
Instead, people will be expected to attend weekly appointments. On average, people attend 12 to 14 hours of treatment per week.
Treatment can take place at a variety of different locations, such as a doctor’s surgery, local drug and alcohol service, or hospital.
These weekly appointments will follow a similar stage process as inpatient treatment.
First, people will undergo a medical assessment. This is the same as an inpatient assessment but most likely be done by a medical professional, such as a GP.
Following the medical examination, people will begin the detoxification stage. Unlike inpatient treatment, people will not have 24/7 medical assistance and will be expected to, relatively speaking, detox at home.
However, people can still expect some medical and emotional support. Medical professionals will be able to provide medicine and people will undergo therapy during outpatient treatment.
Like inpatient treatment, people can also expect to create a relapse prevention plan and receive aftercare.
There are several different types of outpatient treatment, however: traditional outpatient treatment, partial hospitalisation, and intensive outpatient treatment.
A traditional outpatient program is as mentioned above. People will attend weekly appointments and return home afterwards.
Partial hospitalisation programs require people to attend a facility 7 days a week but allow people to go home at the end of the day.
Intensive outpatient treatment (Intensive Outpatient Program or IOP) requires people to attend more regular sessions during the week, sometimes as much as 30 hours per week.
Pros and Cons of Inpatient Treatment
As can be seen, both inpatient and outpatient treatment share some similarities and differences. However, both have several pros and cons.
Some of the pros of inpatient treatment include:
- Assisted detox
- Shorter duration of treatment
- Intensive 24-hour care
Whilst detoxing during inpatient treatment, people will receive a higher degree of treatment.
There will be 24/7 medical assistance, with people having quick access to medication if needed.
Inpatient treatment is more intense than outpatient treatment. However, this means that treatment tends to last for a shorter duration.
As previously mentioned, this is usually between 28 to 9 days. However, people are free to choose how long they would like to stay.
Most inpatient facilities offer 7-day, 14-day, 28-day, 90-day, and 90-day-plus programs.
Inpatient treatment also offers specialised care. Expert professionals will be on-hand to provide medication, counselling, and therapy.
This makes inpatient treatment particularly useful for people that suffer from severe addiction, such as heroin or alcohol addiction.
Some of the cons of inpatient include:
- Need for commitment
- Expensive
The main downside to inpatient treatment is that it can be very expensive. On average, in the UK, private residential treatment costs between £300 to £500 per day.
In addition, because inpatient treatment requires people to stay overnight, people will have to leave behind any other commitments.
For parents or those that have jobs, for example, this is not ideal.
Pros and Cons of Outpatient Treatment
Some pros of outpatient treatment include:
- Flexible treatment
- The cost
- Community building
- Family and friends support
Those that opt for outpatient treatment will benefit from its flexibility. For example, people that have other engagements – work or childcare – or do not want to stay overnight at a facility
Some private facilities do provide outpatient treatment for a cost – usually between £150 to £250 per day. However, many outpatient programs can be accessed for free through the NHS and local UK-based drug and alcohol services.
Those that undergo outpatient treatment will also be encouraged to engage with local drug and alcohol services, such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and SMART Recovery.
By doing so, people will meet like-minded individuals and be able to build a support network.
Finally, people will have friends and family close by to offer support.
Some of the cons of outpatient treatment include:
- Less medical support
- Longer duration of treatment
- Surrounded by potential triggers
As noted earlier, because outpatient treatment requires people to attend weekly appointments, this means that people will not have access to 24/7 medical assistance.
Further, weekly appointments also mean that outpatient treatment can last a lot longer than outpatient treatment.
On average, in the UK, outpatient treatment last between 6 months to a year.
Finally, as people are not removed from their usual environment, relapse is a possibility.
People might be in environments that have potential triggers, such as relationships or social situations. (2)
Different Types of Therapy in Inpatient and Outpatient Rehab Programs
Whilst attending either inpatient or outpatient treatment, there is a wide range of different types of therapy that people might encounter.
The type of therapy that people will undergo will depend upon what is offered by the treatment program.
However, there are several common therapy types in the UK, such as:
- 1-to-1 Therapy: 1-to-1 therapy involves people sitting with a trained professional, such as a psychologist, and discussing issues related to addiction. The goal of the medical professional is to uncover the root cause of the addiction. In part, this might involve discussing relationships, current social environments, past traumas, and current triggers.
- Cognitive Behavioural Therapy (CBT): CBT focuses on how thoughts lead to actions. Concerning addiction, studies have found that people tend to have a series of negative thoughts before engaging in negative behaviours. During CBT, people learn about their thought processes and how to change negative thoughts into positive ones. In turn, this should lead people to engage in positive behaviour changes.
- Motivational Interviewing (MI): Motivational Interviewing involves people attending a series of sessions (interviews) with a trained professional. People will discuss their motivations, such as their motivations to use a substance. During these sessions, people develop new, healthy motivations.
- Group Therapy: One of the most widely used therapies is group therapy. Group therapy has been found to have a high success rate in encouraging people to maintain sobriety. During group therapy sessions, people will meet with peers and discuss issues relating to addiction, such as current struggles and personal experiences. (3)
References
(1) Pettinati, Helen M., Kathleen Meyers, Jacqueline M. Jensen, Frances Kaplan, and Bradley D. Evans. “Inpatient vs outpatient treatment for substance dependence revisited.” Psychiatric Quarterly 64, no. 2 (1993): 173-182.
(2) Christian, Nicholaus, Richard Bottner, Amber Baysinger, Alanna Boulton, Blair Walker, Victoria Valencia, and Christopher Moriates. “Hospital buprenorphine program for opioid use disorder is associated with increased inpatient and outpatient addiction treatment.” Journal of Hospital Medicine 16, no. 6 (2021): 345-348.
(3) Lo Coco, Gianluca, Francesco Melchiori, Veronica Oieni, Maria Rita Infurna, Bernhard Strauss, Dominique Schwartze, Jenny Rosendahl, and Salvatore Gullo. “Group treatment for substance use disorder in adults: a systematic review and meta-analysis of randomized controlled trials.” Journal of Substance Abuse Treatment 99, no. February (2019): 104-116.
