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Inpatient vs Outpatient Rehab: Steps to Making the Right Substance Misuse Recovery Decision


Decisions regarding the right treatment for someone suffering from addiction are not always clear-cut. The person and his or her family members may have certain preferences, and insurance plays a role as well. It’s important to consider the various factors involved in figuring out the right treatment for someone ready to enter recovery.

The Case for Inpatient Treatment

When a person with substance misuse issues is ready for treatment, Mary Marcuccio, a Family Consultant at My Bottom Line in Connecticut, believes in inpatient care. “When I work with a family, I am always going to recommend inpatient detox and inpatient rehab, for a number of reasons.” When it comes to recovery, she wants to take people completely out of their element. “We want to make sure we’re changing people, places and things. When we have our loved ones at home, the family members aren’t therapists. They’re not prison guards, and our homes become prisons, for those in treatment. None of that is healthy.” In an inpatient treatment center, the patient is out of the home environment, in a structured setting and with professionals. “There’s no emotions that will cloud the process. Professionals can keep the emotional distance that is necessary.”

Insurance companies may push for outpatient treatment as a first step, since it’s typically less expensive. “Insurance companies think they’re saving money by putting outpatient programs first. It should start with inpatient right off the bat,” states Marcuccio. That includes entering detox if necessary.

Marcuccio uses the analogy of a person breaking his leg. Instead of putting on a soft cast and wearing sandals to repair the injury, the person goes to the hospital and gets the entire leg set in a hard cast to set the fracture. Most of the repair and healing happens on the front end, and when the leg is further along in the healing process, the doctor can downgrade the leg to a soft cast to finish the healing.

In recommending inpatient vs outpatient treatment options, Marcuccio doesn’t differentiate between the drug of choice or the person’s age. “If I’m drinking too much or taking pills, I’m doing it because I’m not okay, whether I’m 18 or 48. Something is wrong, and you need to figure out what it is,” she states.

Marcuccio finds that inpatient programs benefit the family as well. She requires her clients to get counseling with a therapist, do some type of spiritual work and attend a support group. If the patient completes detox and treatment and develops new coping skills, but comes back to the same broken, toxic, angry and resentful family members, that’s a relapse waiting to happen. “The best gift you’re going to give your loved one is to make yourself healthy,” she says of the family.

The Case for Outpatient Treatment

Not everyone agrees that outpatient treatment should be dismissed. Outpatient programs can benefit some in recovery, says Andrew R, Moss, LPCC-S, LICDC-CS, Director of Stabilization Services at Maryhaven, a treatment center in Ohio. “If it’s a safe place to be, with enough support, outpatient may be the best option for them,” he says.

Residential care is helpful for someone who doesn’t have the coping skills and doesn’t have a stable home situation. Clinicians working in detox assess a person’s readiness for residential or outpatient care when it’s time for the next treatment step. Some patients prefer residential treatment because they’re scared of returning to the community and don’t feel they have those coping skills.

If a person relapsed but has a lot of skills, said Moss, they may do well in intensive outpatient counseling. “It’s more effective for people with some previous experience in recovery,” Moss said. Those who are going to treatment for the first time and younger people with less life experience and fewer life skills are often better suited for inpatient treatment, he states. “They are more vulnerable in outpatient treatment. They need to build up their skills sets and support.”

Marcuccio does not believe that a person’s prior rehab experience matters in determining whether to go to inpatient vs outpatient rehab. She recommends inpatient treatment for each relapse, but may consider changing the program type if needed.

Comparing Inpatient and Outpatient Programs

In terms of actual treatment, there’s not a lot of differences in inpatient vs outpatient rehab therapy programming, says Marcuccio. The primary difference is the amount of time spent in therapy.

While programs vary, this is a general idea of what different programs might offer for group and counseling therapy:

  • Inpatient: Seven days of programming per week, four to five hours per day.
  • Intensive outpatient: Three to five days a week, with three to five hours a day of therapy.
  • Outpatient: One to three days a week, with two to three hours a day of therapy.

Families often ask Marcuccio why they should send their loved one back to rehab when they may just abuse the substance again. “You never know at what point the person will be sitting in group and someone says something and it clicks,” she says. That’s when your loved one may decide they are ready to change. In terms of going to rehab, “the benefit to doing so outweighs not doing so — there’s only benefit, no downside.”

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