Outpatient treatment allows clients to live at home, continue to work or attend school and fulfill other personal obligations. Recovering individuals attend group and individual therapy sessions each week. They meet regularly with a psychiatrist for medications to manage withdrawal, cravings and any existing mental health issues. The treatment is similar to that provided in a residential facility, although it is less expensive and somewhat less intense. Outpatient treatment can accommodate those with mild to moderate coexisting medical or mental health conditions by increasing the number and length of therapeutic visits each week. One important major difference in outpatient treatment is individuals are subjected to external triggers that can easily sabotage recovery efforts. On the other hand, proponents of outpatient rehab say it more accurately tests the efficacy of ongoing treatment and the client’s coping mechanisms because they face outside triggers.1,2
Many people seeking addiction treatment choose an inpatient rehab program, which involves residing at the facility for the duration of treatment. Most residential treatment programs are 28 to 90 days, depending on the client’s specific needs and preferences. In some cases, inpatient treatment is highly recommended due to the severe nature of drug-specific withdrawal symptoms, which need to be closely monitored. Many individuals who opt for residential treatment need 24/7 medically supervised detox at the onset, which must be delivered on an inpatient basis. Client stabilization is crucial to prevent serious repercussions, including death.1
Inpatient Versus Outpatient Efficacy Studies
To assess the effectiveness of inpatient and outpatient treatment, a number of studies have been conducted, most of which are drug-specific and applicable to hospitals rather than self-standing addiction treatment facilities. A 1989 clinical trial involving 164 clients compared inpatient to outpatient rehab for alcohol, although both groups were assigned to structured substance abuse treatment, which is not part of standard protocol for most hospital units. The 30-day same cause readmission rate for the inpatient group was 12.1%, compared to 8% for the outpatient group, despite an average of 9.2 days spent in inpatient alcoholism rehab. While more clients completed detox in the inpatient group (95% vs 72%), neither group experienced adverse events, including seizures or delirium tremens (DTs).3
Outpatient detox is not safe for alcoholics at risk of potentially life-threatening complications of withdrawal (e.g. DTs), or for individuals with associated medical conditions such as pancreatitis, gastrointestinal bleeding or cirrhosis. Moreover, outpatient detox is not appropriate for suicidal individuals, those with severe or medically complicated alcohol withdrawal syndrome, negative or disruptive family or job situations or transportation issues inhibiting the ability to travel daily to the treatment facility.4
Relapse rates after opioid detox range from 32% to 88%. In outpatient detox programs, interpersonal factors, drug-related triggers (e.g. drug-using friends) and persistent negative mood states were associated with opioid relapse. Abstinence was linked significantly with completion of a six-week inpatient treatment program and attendance at outpatient aftercare, and was negatively impacted by a family history of substance misuse.5
Key Contributing Treatment Factors
Although a specific treatment setting may be more appropriate for some clients, studies show other factors have more influence on outcome. Seven psychosocial factors appear to be important contributing factors in drug rehab outcome.6
- Client readiness to commit to treatment (e.g. ability to realize they have an addiction and taking steps toward changing)
- Trust in overcoming difficult situations and challenges (self-efficacy)
- Expectation of treatment results and respective satisfaction gained from results during and at the end of therapy
- The social supports perceived and experienced by the client
- Client clinical profile (e.g. coexisting psychiatric disorders, polysubstance abuse, negative or positive emotions)
- The manner in which clients undergoing treatment realize the meaning of life and search for it
A Greek study on a total of 157 participants analyzed the influence of the seven aforementioned factors on addiction treatment at a counseling center, residential facility and in the last phase of social reintegration. Recognizing addiction and taking the necessary steps to recover appeared to be extremely crucial for clients in the early stages of treatment (counseling center and third month of residential phase). Clients experiencing doubts about their lives’ meaning during the counseling center phase were less likely to move on to residential treatment. Clients with higher expectations of a positive therapeutic outcome from counseling felt less stress in the beginning and less satisfied by the residential therapy phase. They were more likely to successfully complete the residential phase and move on to social reintegration.6
Ultimately, the decision whether to undergo treatment on an outpatient or inpatient basis should be made based on the individual’s unique circumstances.
- Choosing Inpatient or Outpatient Addiction Rehab. Rehabs website. http://www.rehabs.com/about/inpatient-vs-outpatient-rehabs/ Accessed May 22, 2017.
- Outpatient Treatment Center. Drug Abuse website. http://drugabuse.com/library/outpatient-treatment/ Accessed May 22, 2017.
- Stephens JR, Liles EA, Dancel R, Gilchrist M, Kirsch J, DeWalt DA. Who Needs Inpatient Detox? Development and Implementation of a Hospitalist Protocol for the Evaluation of Patients for Alcohol Detoxification. J Gen Intern Med. 2014;29(4):587-593. doi:10.1007/s11606-013-2751-3.
- Hayashida, M. An Overview of Outpatient and Inpatient Detoxification. National Institute on Alcohol Abuse and Alcoholism. Alcohol Health Res World. 1998:22(1). doi: http://pubs.niaaa.nih.gov/publications/arh22-1/44-46.pdf.
- Chalana H, Kundal T, Gupta V, Malhari AS. Predictors of Relapse after Inpatient Opioid Detoxification during 1-Year Follow-Up. J Addict. 2016;2016:7620860. doi:10.1155/2016/7620860.
- Flora K, Stalikas A. Factors affecting substance abuse treatment across different treatment phases. IJPR. 2013:17(1):89-104. doi: http://www.psychosocial.com/IJPR_17/Factors_affecting_substance_misuse_Flora.html