A number of different factors help to determine whether inpatient or outpatient rehab is most appropriate, including a person’s individual treatment needs, preferences, and available resources. This article will walk through some of the main differences between inpatient and outpatient rehab, their costs, and other important factors to consider when determining the best treatment option.
What Is Inpatient Rehab?
Inpatient rehab refers to any inpatient treatment facility designed for those recovering from an addiction. Inpatient facilities are 24 hour facilities where patients stay overnight for a certain amount of time. A typical course of treatment ranges between 10-30 days, although some people might stay shorter periods just for detoxification, or longer durations for detox and treatment.
There are many different options for inpatient rehab, and some programs feature different types of therapy. For example, some rehab centers may advertise specialized forms of therapy like art therapy, equine therapy, or more holistic treatments like yoga and meditation, while others are much more clinically focused.
More clinical treatment programs might focus more on “Evidence-Based Practices” like Cognitive Behavioral Therapy or Medication-Assisted Treatment (MAT) that combine behavioral therapy and medications like methadone or suboxone.
There are also different “levels” of inpatient care, with higher-level facilities designed to treat those with more severe addictions. Higher levels of care tend to have more of a medical focus, including more doctors and nurses on staff, medically monitored detox services, and the ability to prescribe medication as a part of the treatment.5 These facilities may also be more restrictive, with locked doors and windows, security, and more safety features.
Lower levels of inpatient care tend to have fewer medical staff and services, employing more counselors and addiction specialists. These facilities tend to focus more on individual and group therapy rather than medically monitored treatments.5
Residential Treatment Centers
Residential treatment centers are technically also considered inpatient treatment centers, but they are often separately categorized because they offer less formal treatment setting and more of a structured sober living environment. Residential treatment programs tend to provide longer term treatment settings for people in recovery, often for 30 days and even up to 12 months, or sometimes longer. Some people may then transition on to a sober living environment for a smooth transition to daily life responsibilities while maintaining sobriety.
Individuals in sober living environments typically have already stopped using and have either completed or are still enrolled in other rehab programs. Maintaining sobriety is almost always a requirement of remaining in a sober living center. In many situations, residents also are required to hold jobs, pay rent, attend 12 step or other recovery meetings, and sometimes continue formal outpatient treatment.
Sober living centers are often regarded as supports to help people in recovery build a sober lifestyle, rather than as an inpatient treatment.
What Is Outpatient Treatment?
Outpatient rehab is treatment that is office-based, where a person comes 1-5 times per week for group, family, or individual therapy. These facilities tend to be staffed by trained addiction counselors and professionals. Again, different levels of outpatient care exist.
Partial Hospitalization Program
The highest level of outpatient treatment is a Partial Hospitalization Program (PHP). These are outpatient facilities that offer structured therapeutic day programs most days during a week, usually totaling around 20 or more hours per week of treatment.5
Generally, PHPs are used as a step-down for those who are coming out of inpatient settings. Individuals in PHP programs often complete a mix of group and individual therapy, sometimes in addition to meetings with medical professionals who help comprise their treatment team.
Intensive Outpatient Program
Intensive outpatient programs (IOP) are a type of rehab where a person usually comes 3-5 times a week for a few hours each time, usually for a total of more than 6 hours per week.5 IOPs usually offer a combination of group counseling sessions which are led by a trained facilitator and individual or family counseling sessions.
Often, random drug screenings are a part of the program, and clean screens are a requirement of the program. In IOP, individuals learn and practice skills that help them remain sober, while also relying on group members for support, encouragement, and accountability.
Some IOPs also provide periodic appointments with a psychiatrist or other medical professional that can prescribe medication as a part of treatment. Certain IOP programs specialize in MAT (Medication-Assisted Treatment). Examples include programs that specialize in treating Opioid Use Disorder, using a combination of behavior therapy and medications like suboxone or methadone. These medications are used to prevent withdrawals and cravings, and facilitate recovery. The cost of IOP programs varies, and is sometimes partially covered by insurance.
Regular outpatient rehab also exists. Typically, this is considered outpatient counseling. This type of rehab involves meeting in an office setting with a licensed therapist for one hour each week, or sometimes twice a week. In these sessions, a person will get support working towards goals they have for their recovery, while also learning new coping skills and addressing underlying issues.
Typically, outpatient counseling is covered by health insurance, and tends to be much more affordable than intensive outpatient programs.
Pros & Cons of Inpatient Rehab
Inpatient rehab is right for certain individuals, especially those who are in need of more intensive treatment or a more structured environment.
The following people might be best served in an inpatient program:5
- Those who have uncomfortable or dangerous withdrawal symptoms
- Those who have tried less intensive rehab in the past and did not have success
- Those unable to escape an environment where drugs and alcohol are accessible
- Those who have more severe addictions
- Those who need to get sober for health, mental health, social, legal, or vocational reasons
- Those who struggle with serious health or mental health issues that impact their recovery
- Those at risk of overdosing or with a history of overdoses
The following situations might make inpatient rehab an undesirable choice for some:
- Inability to afford treatment or have treatment costs covered by insurance
- Inability to take time off work or away from family for treatment
- Lack of inpatient treatment options close to where someone lives
- Less intense forms of addiction or fewer treatment needs
- Having previous success with outpatient rehab
- Already detoxed and looking for ongoing support to maintain progress
- Unwillingness to commit to complete sobriety
- Concerns about being in a highly structured environment
Pros & Cons of Outpatient Rehab
Outpatient rehab includes both intensive outpatient programs as well as traditional outpatient counseling.
Typically, intensive outpatient programs or partial hospitalization programs are recommended for people in the following situations:5
- Stepping down or discharging from inpatient care
- Needing more intensive treatment than provided in outpatient counseling
- Needing more structure and accountability than outpatient counseling provides
- Needing to complete treatment because it is mandated by the court or another authority
- Previous failed attempts to quit without help or with regular outpatient counseling
- Needing regular drug screenings
- Needing medication in addition to behavioral therapy treatment
- Preferring treatment that offers a mix of group and individual therapy
Intensive outpatient programs may not be suitable for those with:
- Severe forms of addiction
- High risk for relapse
- High risk for overdose
- Symptoms of withdrawal, especially from alcohol or Benzodiazepines
- Busy and demanding schedules
- High deductible insurance plans or lack of coverage for IOP or PHP
- An inability to afford treatment
- Concerns about confidentiality or privacy in group setting
- Concerns about backlash if their treatment is discovered by others
- Intense social anxiety that would prevent them from participating in a group
- Those unwilling to commit to sobriety
Traditional outpatient counseling that occurs once or twice a week is one of the lowest levels of treatment, but could be the right option for those with:5
- Less severe substance use problems
- A prolonged history of sobriety
- Less time and money to devote to treatment
- Previous success with outpatient counseling
- Minimal treatment needs
- A preference for non-medical interventions
- A preference for individual or family counseling
- A desire to address mental health issues as well as addiction issues
- A desire to moderate their drug or alcohol use, as opposed to quitting
- Strong motivation and confidence in one’s ability to stop using
- An active support system and previously developed coping skills
Traditional outpatient counseling might not be the right option for those with:
- A preference for group counseling
- A need for more structure or support than 1-2 hours per week provides
- A desire for medication and counseling at one facility
- More serious addictions or a need for more intensive treatment
- Active withdrawal symptoms
- Health or mental health conditions that complicate recovery
- A high risk of overdose or a history of overdose
Is Inpatient Rehab More Effective than Outpatient Rehab?
Different people benefit from different treatments. Previous research on whether inpatient rehab is more effective than outpatient rehab has failed to provide a concrete yes or no. The answer, it seems, is highly individualized.
Some research suggests that the severity of the addiction is a significant factor in determining what treatment will be more effective, with people who have more severe addictions benefiting more from inpatient treatment and vice versa.7 However, research also suggests that most people do not benefit more from inpatient treatment compared to outpatient, with one study finding detox in the inpatient setting was unnecessary 90% of the time, and that the financial resources allocated to this could be used to provide the necessary services including detox in a less intrusive setting.2
Research does support that outpatient rehab is more cost-effective than inpatient rehab, and also that there aren’t significant differences in the success rates between the two.3,6 Research on intensive outpatient programs found that, for most individuals, these programs were just as effective as inpatient programs.4 The affordability of these programs in comparison to the costs of inpatient treatment also make these treatments more accessible to people unable to afford the high costs of an inpatient stay.
One of the most significant factors in determining whether a given treatment will be effective is not the type of treatment itself, but what comes before and after it. Those who complete one episode of either inpatient or outpatient treatment with no follow up care are more vulnerable to relapse. Those who strive for a “continuity of care” and are diligent about follow up services like ongoing counseling and attendance at addiction support groups tend to have higher rates of sustained recovery.4,6
Cost of Inpatient & Outpatient Rehab
Treatment costs vary widely for both inpatient and outpatient treatment, and are dependent on a number of factors. The type and location of the facility, the variety of services offered on-site, and the qualifications and training of the staff all help determine the cost of treatment.
The cost of treatment is always a consideration when exploring options, but should not be the sole consideration. Cost and quality are not always associated, but there are some cases where less reputable facilities charge less in order to entice people to receive their treatment there.
Very little research has been conducted on current inpatient costs, but in the 1990’s, the average cost for an inpatient rehab stay was over $15,000.6 Adjusting for inflation, today this translates to around $30,000, assuming a person is paying out of pocket. This is likely on the higher end of treatments costs, according to many rehab sites and blogs, which cite costs between $5,000-$20,000 for a 30 day stay. Facilities marketing themselves as luxury treatment options can be much more expensive, even as high as $60,000.
Inpatient facilities that bill insurance are locked into set rates, which can vary slightly depending on the insurance company. A standardized federal rate exists to guide pricing for inpatient psychiatric care (including inpatient substance use treatment), and it is updated each year to reflect inflation and cost of living adjustments. In 2020, the standardized rate for inpatient care is $798.55 per day.1 Many insurance companies use this rate as a guideline when setting their rates, agreeing to pay this amount or a certain percentage over this amount.
Outpatient treatment is much more affordable, especially for those paying out of pocket for their treatment. Individual counseling sessions vary, but typically those paying out of pocket can find options for around $100 per session, unless they live in an expensive city like NYC, where the price ranges between $250-300 per session.8 Intensive outpatient treatment is usually more expensive, but still less than inpatient care. Rates vary, but $250 per day is a typical rate.9
Those using insurance to pay for their treatment (either inpatient or outpatient) should consult with their insurance company to get details about their coverage. The amount an insured individual pays would depend on their particular plan, and may be a set amount (copay), a percentage (coinsurance), or the full rate to a certain dollar amount (deductible). An advantage of using insurance is that the person would pay the amount set by the insurance company, rather than the rate set by the facility, which is often considerably less.
It is worth noting that many facilities (both inpatient and outpatient) offer options to help make their services more affordable. These might include offering payment plans, interest free financing options, or discounted rates for self-paying clients. Even when discounts are not advertised, it is worth asking about self-pay discounts or whether the agency offers sliding scale options for those unable to afford the full cost of treatment.
Length of Treatment
The length of treatment is variable, and often is adjusted based on individual treatment needs. Typically, inpatient rehab stays tend to be shorter in duration, anywhere between a few days to a month, with one month being the average.6 Some people who seek inpatient rehab only stay a few days while they are detoxing, and check out after their withdrawal symptoms subside. Certain residential programs offer longer term treatment, averaging 71 days in length.6
Intensive outpatient programs are generally offered for a period of 2-3 months, but sometimes longer. These programs often have a more structured treatment program, in which individuals progress through the program in stages. Traditional outpatient counseling is more adjustable, and often is continued long term for a year or even longer, depending on the person’s needs and preferences.
It is not uncommon for people in outpatient care to reduce the frequency of counseling sessions as they make progress, coming in once every other week or even once a month after they hit certain recovery milestones.
How To Determine the Right Treatment
Ultimately, most people are able to use what they know about themselves and their situation to determine which treatment is right for them. Inpatient and outpatient treatment options can both be effective, but certain factors might make one more appropriate than the other.
Some of the main factors to consider when making this decision are:
The Amount of Time and Money You Can Commit to Treatment
Inpatient and intensive outpatient treatment options will typically be more expensive, and will require more of a time commitment. Consider your home and work responsibilities, whether you can take time off, and what you can afford. Look into your insurance benefits to get more detailed information about the costs of different treatment options.
The Severity of the Addiction
Consider how long you have been using, how much you use, and how often. Will you experience withdrawal symptoms when you stop, and if so, could these be medically dangerous to do on your own? Those who have more severe addictions or who need medical detox often benefit from inpatient treatment.
Your Ultimate Goals for Recovery
Those who need to completely stop all drugs and alcohol might benefit from the structured sober environments provided in inpatient, residential, and intensive outpatient settings. Those unsure about their end goal for recovery or who are interested in moderating their use as opposed to stopping might find outpatient treatment is more aligned with these goals.
The Level of Support You Need
Those who have strong support networks and are able to count on these individuals may need less intensive treatment than those without these networks. Support tends to be built-in to inpatient, residential, and intensive outpatient programs in the form of professional support and support from others in the program. Those in individual outpatient care might benefit from supplementing treatment with a support group like AA or NA if natural supports are lacking.
Your Past Recovery Efforts
Another way to gauge the level of treatment that you may need is to reflect on your own past experiences. Have you tried to get clean or sober before? If so, how did it go? If you had problems doing so in the past in an outpatient setting, inpatient might be the way to go. If you have been able to stop on your own in the past and achieved long stretches of sobriety, you might be fine with outpatient treatment.
Resources for Those Struggling With Addiction
If you or a loved one is struggling with an addiction, consider reaching out for assistance. There are several free hotlines that will help you locate treatment options near you. Support groups like 12 step meetings are also available in most communities, and are free to attend. There are meetings both for people with an addiction as well as for loved ones struggling to support someone with an addiction.
Substance Abuse and Mental Health Service Administration: SAMHSA has a website and a 24/7 hotline to help connect people to mental health and addiction treatment.
12 Step Groups: These peer-led groups are available in most communities, free of charge.
Addictions and Recovery Website: Offers a comprehensive list of resources including self-help groups and websites, treatment locators, government agencies and recovery organizations with information and resources.