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Inpatient or Outpatient Rehab? How to Make the Right Choice



Large numbers of death by overdose prompting trend towards holistic pain relief

Let your mind start a journey through a strange new world. Leave all thoughts of the world you knew before. Close your eyes, let your spirit start to soar, and you’ll live as you’ve never lived before.”

–  Erich Fromm, German social psychologist

It may not feel like it at the time, but certain decisions that we make as we journey our way through life, sometimes running, sometimes stumbling, carry much more significance than we may realize.

Many times, choices are down to simple chance, fate, or even destiny, if you believe that those things exist. Turning a particular corner, for example, and then bumping into someone who will go on to change your life, sometimes for the better, sometimes for the worse. You chose to turn that corner, didn’t you?

However, occasionally, when events are more in our own hands, we have to make a decision that, little do we know, will have a huge bearing on where we go from here, and what direction our lives will now take because of it.

And, in those instances, even if we know our eventual choice is kind of important, we never know the outcome, for sure. We hope. Hope is really all we can do. It’s only when we look back do we know that it was the best decision for us.

There was a time during my crazy college years I had a choice to make, a decision that would ultimately shape who I became – who I am now. That choice, that decision, centered around whether I wanted to be packed off to another state, away from family and friends, from all that I knew, or whether I would stay – continue my college studies, and stay living at home.

An out-of-state residential addiction rehab center, recommended by Dad’s boss at work on the basis it had worked for his wayward daughter, or as our family physician had recommended, an intensive outpatient treatment program (an IOP, if you’re in the “know,” like me) about 30-minutes drive away.

I knew the option my parents preferred. The first one. Take me away and only let me back when I was all better, all cured, and no longer the coke-sniffing alcoholic their little boy had inadvertently grown up into. I can’t say I blame them, even now.

I can’t tell you why, having the final decision completely up to me, I chose the second option. I probably hated our doctor at that point anyway. Also, I didn’t really care much for college or for studying. Then again, I didn’t care much for a lot of things back then – except little baggies of white powder, and full bottles of bourbon or vodka. Bourbon, if I had the choice.

So, the IOP route it was. It had occurred to me that having to suffer 30 minutes every weekday (and the odd Saturday) of my father’s incessant lectures about exactly where I had “gone wrong” was manageable, certainly if those who ran the program could manage my addiction, manage my treatment, and manage to get me on the road to recovery.

*Spoiler Alert: They did.

That was 4 years ago last February. I have been clean and sober (and fiercely proud of it) since the day I began an 8-day medically-assisted detox, arranged through the addiction treatment facility (a wonderful, spirituality-centered rehab in Santa Barbara, here in California) where I was to attend as an outpatient for the next 3 months, and every day that followed.

Believe me, it was hard at first. Some days, it’s still hard. Then again, it does get easier every day. As long as I’m grounded, and working my recovery like it was Day One.

Inpatient or outpatient? That was the choice. Maybe you have that choice to make now, or you know someone who has to decide. Or maybe you know someone whose parents are going to decide for them. Here’s some important information that will help in that decision. Knowing what follows, then it really will be, and feel like, a choice.

Inpatient or Outpatient Addiction Treatment? Your Choice

If there is one thing that determines whether inpatient or outpatient addiction treatment is the best option for you, it’s this: your own personal situation. Your particular circumstances, whatever they may be, and how they either open up or restrict your choices in life, are the best measure of where your decision ultimately lies. Even if you address everything personal to you, in the end, your decision may well be simply the best compromise between these options.

However, to have first reached this stage, this possibly pivotal point in your life, is something to be commended. Choosing to seek help because you are no longer in control of your use of substances is the best decision you have ever made up to this point. Let me be one of the first to say, “Well done. That’s the attitude you need throughout your recovery, so good on you (whoever you are).”

There are many types of substance use treatments and therapies, with different methodologies and ideas about the best way to find recovery – and stay there. The very best of these should involve the main elements of evidence-based addiction treatment, which are substance detoxification (more commonly known simply as detox), group therapy, relapse prevention, and individual counseling.

Primarily, these fit into 2 categories: inpatient and outpatient treatment. Both options can include those main elements mentioned above, both can stop you using substances, and both can significantly reduce the risk that you will one day use these substances again.

Either can be successful. The best option for you is reflected by your own personal situation. Let’s now look at the pros and cons of each:

Inpatient or Residential Treatment Program (IP)

An inpatient rehab program, abbreviated to IP, as in Inpatient Program (and also called residential rehab because you live at the rehab facility – 24/7) is usually recommended for those with severe problems with drugs or alcohol, and those who also suffer from a mental health condition, such as depression, PTSD or bipolar disorder. Being a resident within an addiction treatment facility that can offer care around the clock helps substantially in avoiding the influences and triggers of your previous “normal” (addicted) life.

Inpatient rehab programs usually offer 3 incorporated phases of recovery: detox, reflection, and growth. Residential programs such as these can either be short or long-term (anywhere between 28 days to a whole year) and often provide other programs, like an outpatient plan, after the residency has finished ensuring the patient continues in treatment.

Advantages of Inpatient Programs

Inpatient rehab programs offer a number of significant benefits to people whose current lifestyle has the flexibility to deal with the stringent restrictions and the higher level of commitment for residency:

  • Both short-term and long-term inpatient rehab programs are designed to prepare you for an abstinent life after treatment.
  • Inpatient rehab treatment is highly structured and focuses on all aspects of a patient’s addiction, including one-to-one therapy where relationships, lifestyle, and psychological factors (related to personal history and situation) are discussed.
  • Residential facilities provide 24/7 care, usually in non-hospital settings. This can be exceptionally important for those also dealing with mental health issues and past trauma.
  • You basically live with other drug addicts and alcoholics, encouraging a “sense of belonging” and fraternity.

Please bear in mind the following advice when deciding whether an inpatient (residential) rehab program is best for you and your situation:

  • Attending an inpatient program for your addiction treatment is a major commitment, especially if you have children or other dependents, and/or are currently employed or in education.
  • Treatment can be challenging for many patients. Your time is basically no longer your own (although you will get periods of free time) during your highly structured, and staff-governed schedule.
  • Cost: As with any medical treatment in the U.S., the financial cost can sometimes prevent people from receiving the treatment they need. The majority of rehab facilities (inpatient or outpatient) will offer advice regarding your health insurance cover. That said, inpatient programs are far more costly than their outpatient counterparts. However, it is worth remembering that the cost of treatment is always less than the cost of addiction.

Outpatient Treatment Program (OP)

Intensive outpatient programs (IOP) and other outpatient rehab programs (OP) involve a daily treatment schedule, such as particular therapies, counseling, or group sessions at a medical clinic or a rehab facility. However, and very importantly, they are not residential – meaning patients attending these programs can continue to live in their own home, can continue with caring for children or dependents, and can continue their employment or education.

Furthermore, outpatient care typically costs significantly less than an inpatient rehab program, but the level of support may be less intensive. Much of the structure of an inpatient program is adhered to, including group therapy, relapse prevention, and individual counseling. If required, detox can also take place, usually at another facility, before the patient begins their outpatient program.

Advantages of Outpatient Programs

So, in summary:

  • You can continue to live at home.
  • You can continue to work or study.
  • If you’re a young adolescent, you have your family to support you.
  • Treatment costs are significantly less than an inpatient program. In fact, many healthcare insurance plans actually cover the cost of an outpatient program in full.
  • Appointments can be made for evenings and weekends.
  • There are usually 3 levels of programs available, distinguished by their intensity and how many hours per week need to be completed:
    • Part Hospitalization Program (PHP)
    • Intensive Outpatient Program (IOP), and
    • Outpatient Program (OP)
  • Some facilities can also treat outpatients who are also suffering from a mental health condition.

However, you must remember that outpatient treatment is not suitable for those who:

  • Constantly have the urge to use, as centers are not 24/7
  • You require medical attention or you suffer from multiple disorders
  • You are unreliable when it comes to keeping appointments

Whether you choose the inpatient path or the outpatient one, both will set you on your way to addiction recovery. Be under no illusions – this is no walk in the park. Work hard, open your mind to change, and become the person you truly are. May I wish you well.

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