We’ve put together a guide covering the details of outpatient and inpatient rehabilitation to help you or a loved one decide which type of treatment is right for you. Inpatient rehabilitation services are more intensive than outpatient, although both require a lot of self-reflection and hard work.
Inpatient rehab stays can last from 28 days up to 90, with some programs lasting even longer if the addiction is severe. One of the benefits of inpatient rehabilitation is removing yourself from the triggers and situations in your life that cause you to drink or do drugs. You’ll be housed in a dormitory-like setting with staff trained in recovery supervision supporting you around the clock, along with others who struggle with drugs or alcohol.
During your stay at an inpatient rehab center, you’ll have group therapy sessions along with individual counseling sessions. Many inpatient rehab centers focus on the 12-step principles of sobriety, so you may be attending AA or NA meetings, as well. During the times when you aren’t in therapy sessions, you’ll probably be attending educational seminars about the nature of addiction as well as coping strategies to work through triggering situations.
Your days will be structured, typically rising early for breakfast. Many addicts suffer from malnutrition, so eating well is part of the healing process. Many facilities also have fitness centers, although you may have to be medically cleared to work out. The staff at the facility will typically monitor your pulse and blood pressure, as well as dispensing medications you may need, including drugs to ease withdrawal symptoms and to treat any underlying mental health issues.
Outpatient rehab facilities offer a few different levels of therapy and are best for slight to moderate addictions. There’s no medically supervised detox, although some facilities will provide a prescription for Suboxone or medication to ease alcohol withdrawals. If your addiction is severe, it’s important to consult with a doctor before you go into outpatient treatment, as you may need medical supervision to prevent seizures or other health issues.
Intensive Outpatient Therapy (IOT) involves daily counseling and educational seminars, similar to the kinds of therapy and informational tools that those who choose inpatient rehab are given. You’ll be encouraged to attend AA or NA meetings or other similar programs, such as Celebrate Recovery or SMART Recovery. After your daily therapy session or sessions, you’ll return home, so having a strong network of support at home and work is essential to helping you protect your sobriety.
Once the more intensive IOT phase is complete, patients step down to less intense treatment sessions, including meetings and weekly or bi-weekly individual therapy sessions. Most clients are recommended to stay in IOT for at least 90 days, with ongoing weekly therapy or meetings.
Both inpatient and outpatient rehab therapies include an initial intake evaluation. Be prepared to be honest about your drug or alcohol use, how often you use, and how much you use or drink each time. You’ll probably have a physical exam, evaluating the level of your dependence and establishing any health needs that need to be addressed. Medication for detoxing may be prescribed at this time.
Aside from establishing your physical condition, the intake will also include an interview with a counselor. Your support system at home will be included if you’re considering IOT, to help the facility match you with the best counselor for one-on-one therapy.
Once your initial intake evaluation is completed, you may go immediately to your rehab community, or you may be allowed to go home for the night and return the next day. If you don’t go immediately into rehab, you’ll be drug and alcohol tested when you check-in to determine if you’ll need to be supervised as you sober up. Most facilities have certain medications that help offset the withdrawal symptoms, and protect your body from possible seizures or worse. Benzodiazepine, opioid, or alcohol withdrawal can be dangerous to detox from if you aren’t medically supervised.
Many inpatient rehab facilities have a separate medical detox unit and nursing oversight. Once your detox is complete, you’ll “step down” into the inpatient rehab general population. This is where you’ll spend your days in therapy and counseling and learn tools to help you stop the reactive urges to drink or use drugs.
As you progress through your inpatient therapy, you’ll meet with your case manager to determine your responsiveness to treatment. Most inpatient therapies last about 30 days, but patients who have a more severe addiction may need more time living sober before they are ready to go back to their normal lives and routines.
As your time in inpatient ends, you’ll likely be set up with intensive outpatient therapy, to help ease you back into your life. You may have some family therapy sessions toward the end of rehab, to see what kind of support system is in your life. When you leave rehab, plan to find support meetings, like Celebrate Recovery, AA, or SMART recovery near you.
Some people, especially those whose addiction was severe, or those who were in a dangerous living situation prior to rehab, may opt for a sober living house, a community of people in early recovery, supervised by professional addiction counselors. In these communities, you may receive training on how to get and hold a job, money management skills, or parenting classes. This may help those who have relapsed in the past create healthy habits in real-life situations while living in an environment that has accountability for staying sober.
After your intake session for intensive outpatient therapy, you may have access to medication to help you with chemical withdrawal at home. When this is completed, you’ll move on to the rehabilitation process, addressing the underlying reasons that you choose to drink or use drugs. Some addicts have clinical depression or anxiety and self-medicate with drugs or alcohol, and medication or cognitive behavioral therapy may be part of your individual treatment program to address these underlying issues.
In intensive outpatient therapy, you’ll have group sessions, individual counseling, and education about the disease. May IOT patients look at their therapy as a job, as you’ll spend several hours a day doing the work of getting and staying sober. As you progress in your sobriety, you’ll have weekly evaluations, including drug testing. When you get stronger in your sobriety, you’ll gradually decrease the frequency of your counseling session.
Expect IOT to last about 90 days, but you’ll probably wish to continue with meetings and therapy, to keep you focused on sobriety.
Each substance abuse patient has a different story, and each individual responds differently to therapy. Some people work best when challenged and pushed, while others need comfort and a helping hand through the process. Recovery is difficult, and your emotions are raw, not only because of the physical discomfort but also because of the hard work involved in exploring the underlying reasons for addiction and the emotional vulnerability of opening up to a therapist and in a group.
Note: We want to remind each reader that our guide is intended to inform, but not advise a specific treatment for you. Your primary care doctor, as well as the medical professionals at whichever rehab facility you select, will guide you to the best course of treatment for you to give you the best chances of success.
Inpatient treatment is best for individuals who have moderate to severe addiction. Living in a safe, secure rehab community can help you form new relationships and remove many of the aspects of your life that trigger you to drink or use drugs. Patients that are in unsafe situations will probably benefit from the secure housing that inpatient rehab provides.
In addition to being physically safe, inpatient rehab allows you to focus on your sobriety versus balancing your work and life commitments with your counseling sessions. You’ll also have the chance to develop new relationships with others in similar situations to yours. Additionally, those addicts that have a severe addiction will have medical oversight around the clock.
Bear in mind, however, that inpatient therapy is a big commitment, and you’ll have to make arrangements to take time off work, arrange childcare, or the like. In addition, inpatient therapy can be pricey. Some insurance companies will cover the costs of the therapy but not room and board, while others may not cover the treatment at all. You’ll have to weigh your responsibilities in life with your own capability to achieve sobriety.
For people who aren’t severe addicts, outpatient therapy may be a better fit. If you have a trusted network of help in your life to support you through your treatment, then you may have more success with IOT. Also, if you can’t take time off work, or if you have family obligations, you may not be able to enter into inpatient rehab.
Outpatient is good for those in relatively good physical condition, who don’t require the medical attention severe addicts need. Others who enter into IOT may be stepping down from inpatient rehab, but still need the support, structure, and tools of sobriety from their inpatient stay.
The Substance Abuse and Mental Health Services Administration (SAMHSA) offers resources for those who need help finding a dual diagnosis center, a crisis hotline, and more information about the nature of drug and