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Inpatient or Outpatient Addiction Treatment: Which Makes the Most Sense?

Alcohol and drug addiction is a highly complex disease, but the good news is that even people who have struggled with substance abuse and addiction for many years can recover and live healthy, productive lives. Although any attempt at treatment is a step in the right direction, the best solution is treatment that works the first time. Unfortunately, treatment is not a one-size-fits-all situation and there is no single solution that works for everybody. While outpatient treatment works for many people, others require intensive residential treatment for long-term recovery.

Treatment length is an important factor for both outpatient and residential treatment. Studies by the National Institutes of Health (NIH) indicate that long-term recovery is directly connected to adequate treatment length, and that outcomes for both outpatient and residential treatment are more successful when treatment lasts at least 90 days.

Unfortunately, financial considerations are a factor for many people, and money is often the deciding factor when people choose outpatient treatment. Even individuals with insurance are often surprised to learn that their insurance limits residential treatment to 28 days or less – often as few as five days. Studies have proven that in most cases, such short-term treatment is woefully inadequate for long-term recovery.

While money is an important consideration, there are other practical reasons why outpatient works best for some people. Outpatient treatment, which usually involves one to five sessions every week, is less disruptive for people who have family, work or academic responsibilities that don’t allow for a long absence. Many people opt for outpatient treatment because they prefer to keep treatment private for various reasons, including potential threats to employment.  

Outpatient treatment is most likely to work for people who have supportive friends and family that can provide some accountability. This can be difficult for some families who may strongly deny enabling, yet they may provide housing, food, phones, money, or transportation to a loved one with addiction. This person with addiction then has no real reason to change. A “bottom” is a moving target, and families often allow it to continue to get lower by their continued support of the addict. John Southworth of Southworth Associates, and a Godfather of interventionists in this country, is often heard to say “the first thing I do is fire the family!”

Statistically, outpatient treatment is more likely to result in relapse, and many people seek residential treatment after one or more failed attempts at recovery. A problem with this approach is that each attempt is preceded by increasing damage to the person’s health, relationships, career, finances, and life in general, and they may not live long enough to finally recover from this fatal disease.

Inpatient treatment is a more structured, highly supportive environment that allows individuals to focus strictly on recovery, away from the situations and temptations that helped to foster addiction in the first place. Around-the-clock care is often needed for people who have struggled with substance abuse and addiction for long periods of time, or those who come from unstable home environments where support is lacking or addiction is present. Regardless, addiction is a family disease, and inpatient treatment can include much needed education, counseling and teaching for a recovering family.

For many individuals, living in a group environment with other like-minded people relieves feelings of fear and isolation. There is no access to alcohol or drugs, and if cravings become unbearable, there is usually somebody available to talk through the rough moments.

Inpatient treatment centers also provide more specialized treatment, which is critical for people who require medically supervised detox, or those who need help with underlying issues such as depression, anxiety, pain or post-traumatic stress disorder (PTSD). According to the National Alliance on Mental Illness (NAMI), about 53 percent of people with drug addiction and 37 percent of people with alcoholism have at least one other serious mental illness.

In my experience, there are many situations where outpatient treatment simply does not work. A person with many years of experience with addiction or a history of other failed treatments is unlikely to be able to implement the needed lifestyle and thinking changes necessary. Those who use cocaine or methamphetamine, especially if intravenously, are very unlikely to succeed in outpatient treatment. It is medically dangerous to detox from alcohol or benzodiazepines as outpatients. Although commonly done, it is dangerous to give Librium or Ativan to an outpatient to help them stop drinking. More often than not, they end up continuing to drink in addition to taking the medication, which can be very dangerous.

There is a practice among insurance companies today to provide only inpatient detox for a few days, then require finishing treatment as an outpatient. A large amount of evidence exists showing that detox only will fall >90% of the time, and there is no real evidence that transitioning to outpatient after detox achieves better results. More often than not, the outpatient treatment is not even started before relapse occurs.

Insurance companies also often deny inpatient treatment for opiate addiction, claiming it can be safely detoxed and treated as an outpatient using buprenorphine (i.e. Suboxone). An inpatient stay, though, can result in being off of all opiates including buprenorphine. This can have tremendous success if followed by a strong aftercare program. The outpatient method of using buprenorphine takes several months to wean off, if it is ever done, and has a growing track record of failures that has resulted in widespread misuse and diversion of buprenorphine among addicts. In my experience of treating thousands of addicts/alcoholics either as inpatients or outpatients, residential treatment from a place with a real understanding of this disease has the highest success rate by far.

Ultimately, too many times the decision for length and kind of treatment is not made by medical or health professionals, but rather by insurance companies using very suspect data to support their decisions. Even governmental sources seem to lean toward inadequate modalities due to the huge financial strain of treating this disease epidemic. Those with addiction, families, friends, and physicians of addicts must become vocal advocates for appropriate treatment. Even with limited finances, good treatment of the kind that is needed can almost always be found if truly sought. Organizations such as Foundations Recovery Network and others have become rich sources of information and referrals to like-minded treatment centers that fit a person’s resources. Individuals should seek a program with strong involvement of a physician who is board-certified in addiction, along with other multidisciplinary professionals whose goals include no addictive substances upon discharge, well-rounded treatment of all other health issues, and a practice of implementing a strong aftercare plan.

MORE ABOUT DESTIN RECOVERY
Roland Reeves, MD is the founder of the treatment facilty for addiction, Destin Recovery located in Destin Florida.  He and his medical team use proven medicine and treat addiction as a chronic disease. They treat the disease of addiction and substance abuse with the same rigorous methodology as doctors treat diabetes, heart disease or depression. Treatment involves the latest science that combines medical therapy and private, one-on-one counseling. This complex disease involves changes in the structure and function of the brain. Treatment needs to involve the mind, body, and soul. This requires not only therapists and peer groups, but the ongoing involvement of a physician. For more about Destin Recovery go to www.DestinRecovery.com.

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