When a person enters a treatment programme for an alcohol or substance misuse problem, they will either receive inpatient care, or an outpatient treatment programme.
You may be weighing up what the best choice for you would be out of inpatient or outpatient rehab.
With an inpatient treatment programme, you’ll stay at the facility for period of time while you undergo medical and psychological interventions to help you recover.
Outpatient care involves living at home, but travelling to a rehab facility for daily or weekly sessions.
Whatever choice you make between outpatient or inpatient programmes, you’ll be under the care of medical professionals who will give you the right treatment for you.
There are many pros and cons to different rehabilitation services. Let’s explore the question of inpatient vs outpatient rehab a little further…
Defining inpatient vs outpatient rehab
Being an inpatient predominantly refers to people who follow a therapeutic programme as residents at treatments centres specialising in addiction recovery, the programmes tend to last between 4 – 6 weeks.
At inpatient rehab, you will:
- Be under a high level of care by medical professionals
- Eat, sleep, and live at the treatment centre for the duration of your programme
- Engage in a range of educational, psychological and social activities to equip them with the tools and knowledge to enhance your recovery
They may also receive detoxification treatment to help eradicate their physical dependence.
They will more than likely have follow up support care for a period of time after their inpatient treatment programme is over, but this will be at a lesser intensity.
An outpatient treatment service refers to people who receive a range of treatments to aid them with their recovery while living at home in their usual surroundings. They may well engage in treatment activities for a period of weeks or months but always return to their own home.
This could include people who are day patients, where they would receive treatment for most of the day, or half day and then return to their home to be with their family.
Measuring success outcomes of inpatient vs outpatient rehab
When considering the question of inpatient vs outpatient rehab treatment to determine which is better, it is perhaps worth defining how we measure “better”. What information are we looking for to assess which is better?
Because using different methods will probably produce conflicting results.
To ensure any consistency in research findings it is important for all researchers to use the same measurement when they are conducting research.
What impacts inpatient vs outpatient success rates?
There are several factors that need to be taken into account when assessing whether inpatient or outpatient services are more effective.
It is difficult however, to ensure that when comparing inpatient care with outpatient services that all patients in both groups are equally comparable.
Not all substance misuse patients are alike
When we compare inpatient vs outpatient rehab services, there can be a huge disparity in the patients that are being measured, as everyone is unique.
This disparity makes it harder to assess which service is better. Individual differences may appear in:
Type of addiction – Some inpatient services contain people with different addictions, whereas others may cater specifically for certain addictions only.
If a treatment centre specialises in treating particular substances it could have a higher success rate than those that treat multiple types of addiction. (4)
The severity and duration of the addiction- i.e. how much of the substance they have consumed and how long they have been dependent on the substance for.
This means some patients will have more severe forms of addiction than others.
Whether the person is male or female
Men and women have different treatments needs and so may respond differently to the way a programme is structured and / or delivered. (3)
Can you go to rehab if you have a mental health disorder?
Yes, rehabs often treat mental health diagnosis coexisting alongside a substance misuse diagnosis.
Whether you’d be better off at inpatient vs outpatient rehab is a tricky comparison, because we need to take into account the other struggles a person may be dealing with.
Someone with a dual diagnosis would find the challenge of recovery more challenging than someone diagnosed with a substance misuse disorder alone. (4a)
What else impacts impatient vs outpatient success rates?
Inpatient vs outpatient rehab treatment providers will differ in terms of the therapeutic content of their programmes, whether it be:
- Quality
- Intensity
- Range of treatments
- Duration of treatment
They may also differ in the experience and skill set of the staff and also the ratio of staff to patients at the treatment centre, which has been identified as a key factor in the success of a programme.
Inpatient treatment centres that have a higher staff to patient ratios have been found to have more successful outcomes. (5)
Does it matter if I go to a specialised inpatient or outpatient rehab?
Treatment programmes may also differ as some programmes treat several types of substance misuse whereas others may target particular addictions (e.g. alcohol) and specialise in treating that.
There is also the option of stepping down from inpatient care and becoming a day patient.
You’ll receive support as you continue your recovery after inpatient treatment has finished. This will also vary depending on your individual circumstances (8)
How long does it take to get sober at inpatient vs outpatient rehab?
A common approach to measuring success is to examine whether people have still remained abstinent for a certain period of time after receiving treatment, this could involve assessing patients at 6 month intervals after treatment.
At OK Rehab, we offer free advice from a team of non-judgemental professionals, many of whom are in recovery and understand how hard it can be to change your relationship with addiction.
To find out more about inpatient vs outpatient rehab, simply reach out to our 24/7, confidential hotline on 0800 326 5559.
Inpatient vs outpatient rehab – research findings
It has been found that individuals who had been assessed using the Addiction Severity Index as having a more severe addiction showed a more significant improvement.
This is in comparison to those who had taken part in a more intense treatment programme in an inpatient residential setting instead of following an outpatient treatment schedule. (9)
Conversely, it has been found that those individuals who were assessed as having a less severe addiction when entering treatment showed greater improvement from participating in an outpatient treatment plan. (9)
Substance and success in inpatient vs outpatient rehab
Whether inpatient or outpatient is more effective can depend on the type of substance that a person is being treated for.
For example research has found that long term abstinence rates for people with an alcohol dependence who have participated in inpatient detox programmes were equal to those that had engaged in a detox programmed as an outpatient.
For drugs however, it has been found that 78% of patients attempting detox from an opioid drug in an inpatient setting were able to complete the withdrawal successfully. In the same study however in the outpatient group only 24% were able to achieve that goal. (5)
The researchers found that the main reason for their inability to successfully complete the programme was because of the influence of other drug users and the social pressure they were able to exert over the people who were striving for recovery.
This may be a different sort of pressure that drug users regularly encounter, which people dependent on alcohol do not.
When inpatient services maybe a better option
A woman in a therapy session at an inpatient rehab, sitting on a sofa
Previous attempts have failed
Another factor to consider in the battle between inpatient vs outpatient rehab is whether or not a person has already tried to give up.
If a patient has already received rehabilitation for their substance misuse before when receiving treatment as an outpatient and failed, then it might be an idea for them to reflect on the reasons why that was.
It maybe that an inpatient setting was more suitable for their individual circumstances.
This includes people who have previously attempted detox treatment as an outpatient and not managed to complete it successfully.
At OK Rehab, we offer free advice from a team of non-judgemental professionals, many of whom are in recovery and understand how hard it can be to change your relationship with addiction.
To find out more about inpatient vs outpatient rehab, simply reach out to our 24/7, confidential hotline on 0800 326 5559.
Severe withdrawal symptoms
A woman in a crouched, defensive pose with her arms around herself, considering inpatient or outpatient rehab
If a person has severe withdrawal symptoms that need to be carefully managed, then an inpatient setting would definitely be advised as the best treatment option for them.
As previously mentioned, those with a more severe substance misuse problem have tended to benefit most from an inpatient treatment programme.
Some people have more severe symptoms of dependence, as they may have been taking substances for several years. Such people may find an inpatient service would be more beneficial for them.
The withdrawal symptoms from alcohol can be extremely dangerous and life threatening, so anyone vulnerable to severe alcohol withdrawal symptoms would be strongly advised to receive treatment as an inpatient.
Here, they will be regularly monitored and have quicker access to any medical assistance if their condition deteriorated.
Those vulnerable to environmental triggers and influences
City nightlife bars, clubs and shops
An inpatient setting removes many potential relapse triggers, it means all the potential temptations are eradicated from a person’s environment so they are in a stronger place to focus on building their psychological resilience.
Familiar environments could be full of triggers because of the associations the mind of the patient has made between the substance use and the surroundings in which the substance misuse occurred in over the years.
It only takes a slight moment of weakness to be tempted to relapse when you live permanently in your own home and this is less likely to be the case at an inpatient setting.
Highly trained staff will be on hand to provide the best support for you.
If patients feel that there are too many influences, temptations and triggers around them in their social and domestic life then it maybe good idea for them to receive inpatient treatment.
It has been apparent that being an outpatient may make someone more vulnerable to being coerced back into taking substances by fellow misusers. (5)
At OK Rehab, we offer free advice from a team of non-judgemental professionals, many of whom are in recovery and understand how hard it can be to change your relationship with addiction.
To find out more about inpatient vs outpatient rehab, simply reach out to our 24/7, confidential hotline on 0800 326 5559.
What happens during a stay in an inpatient rehab?
During your stay at a residential rehab, you’ll receive:
- Addiction counselling – CBT, DBT and brief interventions are common
- A relapse prevention plan – you’ll learn coping mechanisms to dodge relapse triggers
- Aftercare – once you leave, you’ll receive regular check-ins to help you stay sober
Why do people relapse?
It has been acknowledged by many addiction researchers that people with certain diagnosis struggle in their quest for abstinence with several relapse attempts behind them. (4a)
Patients diagnosed with Anti Social Personality Disorder (ASPD) for example make up a significant proportion of places at treatment centres and tend not to be successful in their pursuit for recovery. (4)
Those patients with a dual diagnosis are also advised to follow an inpatient treatment programme because their circumstances provide more of a challenge for their recovery than those diagnosed with a substance misuse disorder alone. (4a)
Inpatient services offer round the clock care and risk monitoring for patients that are most vulnerable, such as those with severe addictions and a dual diagnosis. (8)
If inpatient treatments do not appear to have a high success rates it could be because a large proportion of the patients in this group were the most vulnerable clients with more complicated circumstances than those who join outpatient treatment programmes.
Lack of a Support Structure
Another important consideration is the domestic living arrangements of each person.
If someone lives in a healthy, supportive environment with people that love and care about them then they have a solid foundation to begin their recovery and an outpatient treatment programme may work for them.
It is essential for people close to the person attempting recovery to show patience and understanding.
If there is likely to be any conflict and disharmony in a person’s domestic life then this potentially could hamper their chances of a successful outcome.
If a person is isolated and not in close contact with family members and lacks social support then it would be more beneficial for them to attend an inpatient setting where they would get the support and encouragement they need.
Recovering from a substance misuse disorder is not something that should be attempted alone, as indicated in the main guiding principle of AA. (1)
At OK Rehab, we offer free advice from a team of non-judgemental professionals, many of whom are in recovery and understand how hard it can be to change your relationship with addiction.
To find out more about inpatient vs outpatient rehab, simply reach out to our 24/7, confidential hotline on 0800 326 5559.
Inpatient services offer regular, structured activities
Inpatient rehab services offers people highly structured daily activities throughout the duration of their time there. This will include: morning groups, educational sessions, one to one meetings with key workers.
This is following individual programmes of activities written reflection exercises, counselling and therapy, and group therapy. (8)
There should also be a 12 step programme to follow, which will be the cornerstone of their recovery. Being present in a residential setting allows someone to fully concentrate and think deeply about these 12 steps. (8)
There are key workers to turn to if there is anything causing patients stress and anxiety and they can also issue reminders of daily schedules and provide motivation if needed.
Having all these activities and resources readily available is hugely advantageous for people in an inpatient setting, and it saves them travelling time which could potentially increase stress.
Some people need structure with a strict regime and clear boundaries to help them on the road to recovery.
How can relapse be prevented after inpatient or outpatient rehab?
You’ll receive coping mechanisms and aftercare to keep you in recovery even after you leave.
How does outpatient drug and alcohol rehab work?
If you want to give yourself the best chance of recovering an inpatient setting will probably be the best option, a person needs to carefully think about their own level of motivation.
If you are someone that needs to be motivated and responds well to motivation then an inpatient setting would probably be better. (5)
Highly self-motivated people will be able to attend daily workshops, have regular therapy, attend relevant meetings and set up activities that they find engaging and fulfilling.
Such motivated people know how to structure their days and what activities and appointments they require and so would benefit from an outpatient arrangement.
If someone is unsure about how to structure their days with relevant activities to enhance their recovery then trained staff at an inpatient setting can work with them to set short, medium and long term goals for them to aim for.
At OK Rehab, we offer free advice from a team of non-judgemental professionals, many of whom are in recovery and understand how hard it can be to change your relationship with addiction.
To find out more about inpatient vs outpatient rehab, simply reach out to our 24/7, confidential hotline on 0800 326 5559.
The intensity of outpatient treatment
A significant factor to take into account when determining which is more effective in inpatient vs outpatient rehab, is the different forms of outpatient treatments available.
Each person will have their own personalised programme to follow.
Research has indicated though that if outpatient treatment can match the same intensity of treatment activities that feature in an inpatient setting, then they can be just as effective.
The longer an outpatient receives a more intense level of treatment that is comparable to an inpatient setting the greater chance of a more successful outcome for them. (3,6)
This may involve spending more time as an outpatient, possibly several hours a day to engage in various psychosocial interventions, but the important point is they return to their own home after their work is done.
Benefits of outpatient programmes
Inpatient programmes do have their time constraints and when patients complete their treatment programme they leave the intense and supportive nature of the environment that they experienced while completing their treatment.
Inpatient treatment providers need to ensure the follow up service they provide matches the intensity that each person requires so that they can avoid relapsing.
Outpatient programmes on the other hand can be specially designed to go on for longer with an intensity that matches inpatient settings.
There will be no break from the arrangement they provide, it can last for longer than an inpatient facility stay, because it is a cheaper option and less disruptive for patients.
At OK Rehab, we offer free advice from a team of non-judgemental professionals, many of whom are in recovery and understand how hard it can be to change your relationship with addiction.
To find out more about inpatient vs outpatient rehab, simply reach out to our 24/7, confidential hotline on 0800 326 5559.
A thorough assessment of each patient is vital
A comprehensive assessment of each person looking to access treatment for addiction is key to selecting the most suitable treatment option for them.
Of course, each person should have a voice in contributing to their treatment plan, but there are circumstances when they may find that their preferred option is not the most suitable for them.
A comprehensive assessment will help to find out if they have a dual diagnosis, whether they have relapsed before or whether they have sufficient social support, all of which would indicate a requirement to follow an inpatient programme.
It is more important to bear in mind which setting is more suitable for each individual person.
A person who relapsed while receiving treatment as an outpatient would have been better having treatment at an inpatient setting where they could be monitored more closely.
A thorough assessment should also check for the motivation levels of each person to find out if they have the right mindset to adhere to a recovery programme as an outpatient.
If a person is lacks motivation for their recovery and keeps relapsing when having treatment as an outpatient then it might be a good idea for them to seriously consider an inpatient treatment service.
Inpatient vs outpatient rehab – conclusion
There is no reason to assume that outpatient treatment is inferior to inpatient treatment.
There has been evidence of high quality, intensive outpatient treatment undertaken by patients over a long period of time that have proven to have been just as effective as inpatient services.
However, anyone seeking to follow a treatment programme for their substance misuse should undergo a comprehensive assessment to ascertain which treatment path they should follow.
Being an outpatient requires a lot of determination, motivation and the psychological skills to resist any triggers.
If someone is missing these key traits then attending a specialist treatment centre as an inpatient would be a better option.
Its extremely difficult to assess when treatment stops for anyone because one could argue it is always ongoing.
Many people in recovery continue to have some type of therapy for a long period of time afterwards, whether it is personal therapy or attending regular AA meetings, all of which are vital in maintaining abstinence.
At OK Rehab, we offer free advice from a team of non-judgemental professionals, many of whom are in recovery and understand how hard it can be to change your relationship with addiction.
To find out more about inpatient vs outpatient rehab, simply reach out to our 24/7, confidential hotline on 0800 326 5559.
Inpatient vs outpatient rehab – references
(1) Alcoholics Anonymous (2021) What is AA? Available @What is AA? | Alcoholics Anonymous – Great Britain (alcoholics-anonymous.org.uk)
(2) Covington, S. (2002) Helping Women Recover. Creating Gender Responsive Treatment in Ashenberg-Straussner, S. and Brown, S. (ed) The Handbook of Addiction Treatment for Women. Jossey Bass. San Francisco
(3) Finney, J., Hahn, A., Moos, R. (1996) The Effectiveness of Inpatient and outpatient treatment for alcohol abuse: The need to focus on mediators and moderators of setting effects
Addiction Dec 91(12) 1773-1796
(4) Fisher, G.L. (2011) Understanding Why Addicts are Not Alike: Recognising the Types and How Their Differences Affect Intervention and Treatment. Praeger. Oxford, England
(4a) Gossop, J. (2005) Multiple Substance Misuse and Multiple Dependencies in (ed) Dual Diagnosis and Psychiatric Treatment: Substance Misuse and Cormorbid Disorders. Marcel Dekker. New York
(5) Lewis, J., Williams, S (2003) Home Detoxification Peterson, T. & McBride, A. (ed) Working with Substance Misusers: A Guide to Theory and Practice London. Routledge.
(6) McCarty, D., Braude, L., Lyman, D.R., Dougherty, R., Daniels, A., Ghose, S., Delphin-Rittmon. M. (2014) Substance Abuse Intensive Outpatient Programmes: Assessing the Evidence. Psychiatric Services June 1: 65(6) 718-726
available online@Substance Abuse Intensive Outpatient Programs: Assessing the Evidence (nih.gov)
(7) Moss, A, Dyer, K (2010) The Psychology of Addictive Behaviour. Palgrave McMillan. New York
(8) Nightingale Hospital (2021) Addiction Treatment and Rehabilitation
available online@Addiction treatment and rehabilitation | Nightingale Hospital London
(9) Wild, T.C., Wolfe, J. (2009) The Clinical Course of Addiction Treatment: The Role of Non-Specific Therapeutic Factors in Miller, P. (ed) Evidence Based Addiction Treatment. Academic Press. London
