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Updated on September 27, 2022

Inpatient Substance Abuse Treatment

What is Inpatient Substance Abuse Treatment?

When people enter inpatient treatment, they become full-time facility residents. Support staff is available 24/7 to provide care and supervision to residents. 

Inpatient treatment is among the five levels of care defined by the American Society of Addiction Medicine (ASAM): 1, 2

  • Early intervention
  • Outpatient treatment
  • Intensive outpatient treatment (IOP) 
  • Partial hospitalization programs (PHPs)
  • Inpatient treatment
  • Medically managed intensive inpatient treatment

Inpatient treatment has additional sublevels that differ in intensity. 

Regardless of their intensity levels, though, all inpatient services share these features:  

  • Structured, residential setting
  • 24/7 available staff
  • Clinical management from non-physician addiction specialists

Treatment for certain addictive substances is not always necessary in inpatient rehab centers. For example, behavioral therapies in outpatient settings are typically enough to treat caffeine and nicotine addictions.

Addictive substances that might require inpatient treatment include:

  • Alcohol: Some people with alcohol addiction drink to avoid withdrawal symptoms. These symptoms can be uncomfortable and sometimes life-threatening. 
  • Opioids: A group of highly addictive drugs that includes misused prescription opioids (like oxycodone or hydrocodone) and illicit street drugs (like heroin). 
  • Marijuana: Some people use this psychoactive drug to get high.  
  • Methamphetamine: A potent central nervous system (CNS) stimulant. Meth addiction is one of the most challenging addictions to overcome. 
  • Cocaine: Another stimulant that rewires the brain with continued use. Cocaine addiction commonly affects people of various age groups.

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Do You Need Inpatient Rehab for Substance Abuse?

Inpatient rehab might be right for you if you have one or more of these conditions or issues:3, 4

  • Severe addiction
  • Addiction to more than one substance
  • Addiction with co-occurring mental health disorders, such as depression, anxiety, or post-traumatic stress disorder (PTSD)
  • High risk of withdrawal symptoms; particularly alcohol and delirium tremens (DTs)
  • Previous history of relapse
  • No healthy or supportive environment for recovery

Doctors or addiction specialists will conduct a thorough health evaluation to help you find the most appropriate addiction treatment for your needs. They will assess your:3, 4

  • Physical and mental health history
  • Presence of co-occurring medical or mental health conditions, if any
  • Personal situation (like work, school, or family obligations)
  • Outlook and attitude (like motivation to change)
  • Living situation (like exposure to relapse triggers at home or non-support from family members)

What to Expect at Inpatient Rehab

Here are some things to expect in an inpatient rehab program: 

Detoxification

Detoxification (detox) is the first stage of inpatient treatment. In medical detox, medications help the body flush out drugs and alcohol. Some normal body functions are regained without experiencing withdrawal symptoms. 

These medications include:5, 6, 7

  • Benzodiazepine, acamprosate, and disulfiram for alcohol detox
  • Naltrexone for alcohol and opioid detox
  • Methadone, buprenorphine, and lofexidine for opioid detox

People typically experience withdrawal symptoms during the detox process. Staff members are present to ensure the process proceeds safely and comfortably.5

Structured Setting

Some people enter residential treatment after detox. This stage is less intensive, but the setting is still structured:5, 7, 8

  • Full-time residency is required
  • Staff members monitor, supervise, and provide medical care to residents
  • Residents follow a strict schedule
  • Counseling, group therapy, and other behavioral treatments are a part of treatment routines

Because people live in these facilities 24/7, they often need to make difficult decisions. They may need to find someone to look after their family. Or, they may have to leave their jobs or school.

Treatment Duration

A resident’s length of stay varies depending on their residential program type:3, 5, 7

  • Therapeutic communities: Residents live in the treatment center for 6 to 12 months. Both residents and staff members help improve the residents’ attitudes, thinking, and behaviors.  
  • Shorter-term residential treatment: This program has a shorter duration but is more intensive. It starts with 3 to 6 weeks of detox followed by a modified 12-step program.
  • Recovery housing: This involves supervised, short-term housing that usually follows up with other residential programs. Residents learn valuable skills like seeking employment or managing their finances. 
  • Halfway housing: Safe, substance-free environments that help people adjust to life outside of treatment.

High Cost of Treatment

Inpatient rehab programs are more expensive than outpatient and other less intensive programs. They provide more comprehensive treatment and residential care, food, and clothing.

Some insurance providers cover inpatient rehab, but it’s always important to check first. There are also options for those without insurance, like Medicare and Medicaid, private financing, and state-funded rehab programs. 

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Difference Between Inpatient and Outpatient Substance Abuse Treatment

Those who don’t meet the criteria for inpatient treatment may opt for outpatient treatment.1, 5

Compared to inpatient programs, outpatient programs are: 

  • Less structured: Can occur in an office or a clinic. This option is more suitable for those with jobs or extensive social support.
  • Less intensive: Fewer sessions per week, often a maximum of 9 hours/week.
  • Lower cost: Cheaper than inpatient treatment.

Examples of outpatient treatment services include:

  • Individual and group counseling
  • Motivational enhancement
  • Family therapy
  • Educational groups
  • Occupational and recreational therapy
  • Psychotherapy
  • Medication assisted treatment (MAT)
  • Other skilled treatment services

How to Find the Right Rehab Program 

Call your insurance provider to help you find a rehab facility. 

You can also check the directory of Substance Abuse and Mental Health Services Administration (SAMHSA).9

When checking out a rehab facility, consider asking these questions: 

  • How much does treatment cost? 
  • Does insurance cover rehab? If not, are there other payment options? 
  • What are the policies for residents? For example, do they allow cellphone use or family visits? 
  • What types of addictions do medical professionals treat in this facility? 
  • What types of therapy do they offer? 
  • Do they treat co-occurring disorders (dual-diagnosis)?
  • Do they provide aftercare and sober living options?
  • What professionals are involved in inpatient treatment? 
  • Is the facility licensed and accredited? 

If inpatient treatment is restrictive or expensive, consider intensive outpatient programs (IOPs) or partial hospitalization.1, 2

  • Intensive outpatient programs: Includes 9 to 19 hours of treatment sessions per week. They can be done during the day or evening, on weekends, or after school.
  • Partial hospitalization programs: Includes at least 20 hours of weekly sessions. They are suited for people with unstable medical and psychiatric conditions. 

These services are one step below inpatient treatment in ASAM’s levels of care. They’re more intensive than outpatient treatment. However, in terms of effectiveness, they’re comparable to inpatient treatment.

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Resources

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  1. Overview of Substance Use Disorder (SUD) Care Clinical Guidelines: A Resource for States Developing SUD Delivery System Reforms.Medicaid Innovation Accelerator Program (IAP). April 2017. 
  2. What Types of Alcohol Treatment are Available?National Institute on Alcohol Abuse and Alcoholism (NIAAA). Accessed February 9, 2022.
  3. Treatment Settings.” National Institute on Drug Abuse (NIDA). January 2014.
  4. Comorbidity: Substance Use Disorders and Other Mental Illnesses.” National Institute on Drug Abuse (NIDA). August 2018.
  5. Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).National Institute on Drug Abuse (NIDA). January 2018. 
  6. Hayashida, Motoi. “An overview of outpatient and inpatient detoxification.Alcohol health and research world vol. 22,1 : 44-6.
  7. Treatment Approaches for Drug Addiction.National Institute on Drug Abuse (NIDA). January 2019.
  8. Types of Treatment Programs.” National Institute on Drug Abuse (NIDA). January 2018.
  9. Find Treatment.” Substance Abuse and Mental Health Services Administration (SAMHSA). January 18, 2022.

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