Inpatient vs. Outpatient Alcohol Treatment
Inpatient treatment for alcohol addiction takes place in either a hospital or residential (non-hospital) addiction rehab center. Patients stay at the facility around the clock for alcohol use disorder treatment that’s monitored by physicians, nurses and mental health professionals. Inpatient treatment is also referred to as residential treatment. Inpatient treatment offers a more intensive and immersive approach to the recovery process where individuals wholly focus on their recovery.1,2
Outpatient treatment varies in intensity. Intensive outpatient programs allow for sessions of at least 9 hour per week, usually delivered in three 3-hour sessions of structured programming, which could include individual, group, and/or family therapy, as well as education about alcohol use and mental health disorders.1,2
When Is Inpatient Alcohol Treatment Needed?
Alcoholism is a leading cause of preventable death in the United States. According to the Centers for Disease Control and Prevention, from 2011–2015, excessive alcohol use led to approximately 95,000 deaths, shortening the lives of those who died by an average of 29 years each year.3
Excessive alcohol use is often indicative of an alcohol use disorder, a chronic medical condition that can be treated effectively in both inpatient and outpatient settings.1,4
Studies have long shown that any kind of treatment—inpatient or outpatient—will benefit those seeking treatment for AUD, and that the intensity associated with treatment setting is less indicative of a positive outcome than the duration of treatment.1,4,5 Experts in the field of addiction treatment contend that an individual may benefit from both types of care and the important question is which type of care will benefit the specific individual during this specific moment in the progression of their alcohol use disorder.2
Treatment setting and intensity of treatment is therefore determined by a number of factors. These factors sometimes change during the course of treatment, as progress is made and treatment goals evolve.1,2
In general, however, some of the factors that contribute to determining whether or not a person would benefit from inpatient care include:2,5,6
- Greater severity of alcohol dependence.
- Previous unsuccessful attempts at detoxification or treatment.
- The presence of a severe mental illness (or multiple mental health disorders) that co-occurs with alcohol use disorder.
- Lack of social support or high level of relapse risk in their current living environment.
- Co-occurring drug addictions and their severity.
- Medical conditions warranting a higher level of physician oversight or medical care (e.g., diabetes, hypertension, or pregnancy).
What Does Inpatient Alcohol Treatment Entail?
In general, a course of inpatient alcohol treatment starts with patient assessment followed by withdrawal management and finally, addiction treatment. It ends with an aftercare plan that’s intended to help the patient avoid relapse by maintaining sobriety.5,6
Alcohol Addiction & Mental Health Assessment
A thorough assessment will help clinicians to determine the severity of a patient’s alcohol use disorder as well as the presence of any medical issues or mental health disorders. This initial assessment will help to structure the initial care and treatment plan.6
Detox for Alcohol Abuse
Those entering inpatient rehab for alcohol use disorder likely have developed a physical dependence to alcohol that could manifest mild, moderate or severe—even dangerous—withdrawal symptoms. Alcoholism can affect multiple organs including the liver, pancreas, central nervous system, cardiovascular system, and endocrine system. Medications, such as benzodiazepines, may be required to prevent seizures or alleviate other withdrawal symptoms. Monitoring and supportive care is provided to the patient 24/7. Preexisting medical needs, such as treatment for hypertension or diabetes, will also be managed and monitored. Nutritional deficits may be identified and corrected or managed as well.6
Alcohol Treatment Therapy
Treatment therapy sometimes overlaps with detoxification, with clinicians supporting and motivating the patient so that they are primed for success during this highly structured, yet individualized, treatment phase.6
Patients can expect to participate in talk and behavioral therapies, such as cognitive behavioral therapy (CBT). CBT explores the connection between a person’s thoughts and behaviors, helping to identify and address the underlying issues that led to unhealthy alcohol use in the first place.1,7 By changing the thought patterns related to alcohol, drinking behavior can then be modified and replaced with alternative coping mechanisms. CBT will likely be used in group therapy, where several clients meet simultaneously with a therapist (or sometimes multiple therapists), as well as individual, one-to-one therapy.7 In group sessions, patients learn from each other’s experiences as well as their own. Family therapy and mutual support meetings (e.g, 12-step or Alcoholics Anonymous) may also be a part included in an inpatient rehab treatment plan.7 Meeting may take place onsite, or patients may travel together to regular or occasional off-site meetings.1,7
Medications may be used to supplement behavioral treatment approaches. These may include aversive medications (e.g., disulfiram), which help deter the patient from drinking, and anti-craving medications (e.g., naltrexone, acamprosate) which reduce the patient’s desire to drink.8
Alternative therapies such as equine-assisted therapy, adventure therapy, art therapy, music therapy, yoga, and exercise therapy may also be included in an inpatient treatment plan.1 Other activities may include substance abuse education, skill-building workshops, fitness activities, meditation, or journaling.1
How Long Does Inpatient Alcohol Rehab Take?
The specific length of stay at an inpatient alcohol treatment program will vary according to the particular individual, the severity of the addiction, as well as financial factors. Other factors, such as co-occurring mental health disorders, polysubstance abuse, and medical issues, may affect the treatment length. Ideally, a patient’s duration of stay will be based upon outcomes and adjusted as needed as progress is made.1,8
Although people often associate inpatient rehab stays with the timeline of 28 or 30 days, studies consistently support extending treatment duration at an appropriate level of care as determined by the patient’s treatment progress and disease progression.1,8
In many instances, patients begin with an initial inpatient stay of a month and then transition to outpatient care. This type of flexibility can help to reduce costs while still maintaining the appropriate level of care for the patient at any given point in their treatment.1,8
What Happens After Inpatient Alcohol Rehab?
Aftercare is a critical component in the long-term recovery from alcohol use disorder and will be a part of any patient’s inpatient—or outpatient—rehab experience. Aftercare helps to extend treatment after a patient leaves rehab and comes in many forms. Whether aftercare involves biweekly therapy sessions, regular attendance at 12-step mutual support meetings (e.g., Alcoholics Anonymous), residence in a sober living home, or daily meditation sessions, the primary goals of aftercare are to reinforce healthy coping strategies learned in rehab and preventing relapse.1,7,8
- Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
- Substance Abuse and Mental Health Services Administration. (2018). TIP 47: Substance Abuse: Clinical Issues in Intensive Outpatient Treatment.
- Centers for Disease Control and Prevention. (2020). Alcohol Use and Your Health.
- National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol Use Disorder.
- McCarty, D., Braude, L., Lyman, D. R., Dougherty, R. H., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014). Substance abuse intensive outpatient programs: Assessing the evidence. Psychiatric Services (Washington, D.C.), 65(6), 718–726.
- Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
- McKay, J. R., & Hiller-Sturmhofel, S. (2011). Treating alcoholism as a chronic disease: Approaches to long-term continuing care. Alcohol Research & Health, 33(4), 356–370.
- Fuller, R. K., & Hiller-Sturmhöfel, S. (1999). Alcoholism treatment in the United States. An overview. Alcohol Research & Health, 23(2), 69–77.