A common misconception among those struggling with addiction is that it is a purely psychological condition. And, when most people think about psychological treatment, they picture regular office visits with a therapist. Addiction, however, has an undeniable physical component that oftentimes cannot be safely managed in an outpatient setting. In addition, the behaviors associated with drug and alcohol use have often been ingrained over the span of years or even decades. Such deeply rooted patterns of thoughts, feelings, and actions are incredibly difficult to change without the constant and focused professional intervention that can only be administered in an inpatient program. Still, intensive outpatient programs and routine therapy can be effective for recovering addicts and alcoholics, when they are appropriate for that level of care. So, the critical questions are:
What are the advantages of inpatient treatment?
Who is likely to succeed in outpatient treatment?
Benefits of Inpatient
Safe & Comfortable Detox
As referenced above, drug and alcohol use over a prolonged period has profound physical consequences. In particular, alcohol, opioids, and benzodiazepines are likely to cause physical dependence with regular use. As a result, stopping cold turkey can cause extremely uncomfortable, and sometimes even dangerous withdrawal symptoms. The ongoing battle to stave off these withdrawal symptoms is often the driving force behind the development of addiction. When a recovering addict or alcoholic goes through withdrawal, they are at an extremely high risk for relapse. For this reason, an inpatient detox should almost always be the first stage in the treatment process for individuals who drink or use on a near-daily basis.
In addition to providing the safety of round-the-clock medical supervision, the accountability of a structured inpatient setting significantly reduces the likelihood of relapse during this high-risk period. Another advantage of being medically detoxed in a controlled setting (as opposed to getting a prescription for detox meds or being “weened off” by your prescribing physician) is that patients have immediate access to medical professionals who can give additional medications when severe or unexpected symptoms breakthrough.
It may be tempting for those who overestimate the physical component of addiction to opt for an outpatient suboxone doctor, methadone clinic, or a prescription for drugs like Antabuse or Vivitrol. Medication-assisted treatment (MAT) programs can be a good option for many, but only when they provide sufficiently comprehensive psychological treatment. Simply getting a Suboxone prescription is not a substitute for treatment, and is essentially trading one addiction for another (albeit, a far less dangerous one).
More Intensive & Focused Care
While there may be certain elements that are similar in the path of one addict to another, each individual has unique needs when it comes to treatment. While some may be able to identify traumatic events that ultimately led them toward addiction clearly, others may have no clue why they drink and drug the way they do. Still, others may suffer from co-occurring mental health conditions like depression, anxiety, eating disorders, and self-harm. In an inpatient setting, clients can see specialists who have experience treating substance use disorders and specific co-occurring issues. In an outpatient setting, it is much more difficult for multiple clinicians to effectively coordinate an individualized client treatment plan. Clinical Director Kate Greenwald, LPC, explains why she sees an inpatient setting as helpful for her clients below.
“I think it makes a huge difference that clients can see their therapists every single day. They have plenty of one-on-one sessions, but they also get to work with them in group settings. It really can alleviate the fear and anxiety that is common in early recovery to know that you are surrounded by people who know how to help. Trying to dig into deep underlying psychological processes for the first time can be really difficult in an outpatient setting when therapy is only a few hours per week and a client has to focus on work and family and other external factors.”
As mentioned above, addiction often develops over years of drug and alcohol use. The thoughts, behaviors, and emotions associated with drinking and drugging are firmly established and have been reinforced repeatedly. Even those who believe that they drank or used drugs “like a normal person” for a long time before sliding into addiction may realize with honest self-reflection that the warning signs were there far earlier than they thought. Changing these patterns is an uphill challenge that requires commitment and focus. Clients in an inpatient setting can avoid the distractions of the outside world and devote their time and effort to making meaningful personal progress. And, because they are shielded for several weeks from the temptation of relapse, they can build a more stable foundation in recovery. Studies indicate that it takes, on average, 66 days for new behaviors to become a habit. When you consider that this was for comparatively simple habits (like eating healthier), you get an idea of the importance of time and commitment when trying to break an addiction.
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Outpatient treatment, including intensive outpatient (IOP), is most effective as a “step-down” for clients who have completed inpatient treatment. At minimum, clients who wish to attend an outpatient rehab should have successfully detoxed from drugs and alcohol. Those with less “severe” addictions who have maintained a few weeks of sobriety (either on their own, as a result of incarceration, or by attending 12-step meetings) may also be appropriate for an outpatient level of care.