Is There a Difference Between Outpatient and Residential Inpatient Addiction Treatment Programs?

Is There a Difference Between Outpatient and Residential Inpatient Addiction Treatment Programs?

Individuals, who engage in substance abuse use, are often facing more than one issue. Research literature has shown, time and time again, that there is a stereotypical personality that accompanies the addict, rightly named, the ‘addictive personality’.

Some characteristics that accompany said individual are as follows:

  • Impulsivity
  • Difficulty in delaying gratification, sensation seeking
  • Nonconformity combined with a weak commitment to the goals for achievement valued by the society.
  • Social alienation and a general tolerance for deviance.
  • Poor tolerance for stress, increased sensation of distress

This is being outlined, to assist people into understanding why addicts cannot just stop using drugs. Substance use is not just an action but it is in fact a lifestyle. This implies that in order for an individual to stop utilizing drugs; he or she must not only stop using but must change aspects of his or her personality that may have lead him or her down this unhealthy road. Once he or she has agreed to change and start a new and healthy chapter in their life they must then decide on a plan of action. It is unadvisable for an individual to attempt to stop using drugs on his or her own. Breaking such habits is difficult for anyone with the assistance of others let alone as a solitary mission.

So, now the question comes, inpatient or outpatient?

Research conducted over the last few decades indicates that longer treatment periods are associated with more positive outcomes. On average, a treatment period of three months was correlated with more positive results. In the case of substance abuse treatment, this is to mean less incidence of relapse. Patients expressed more positive feelings towards more intense treatment plans. So, those individuals who were in residential treatment and received one on one consistent attention were more likely to indicate a better sense of overall satisfaction in regards to treatment. However, there is little statistically significant difference between outpatient and inpatient long term treatment recidivism. Meaning, long term effects of staying clean do not differ.

In order to understand the above findings, one must integrate the information previously presented. In order for substance use to cease permanently, an individual must totally change his or her behavior and surroundings. Going into a residential facility assists in removing one from his or her life. This cuts out locations and individuals that probably assisted in facilitating drug use. One is also in the presence of others with a similar goal. All of these factors are positive and if one can integrate them into his or her psyche, inpatient treatment can longitudinally provide the basis for healthy living. The one factor that proves to sabotage all this is properly presented in one question often asked by residents of treatment programs:

What Happens When I Get Out?

It is a valid question. In a controlled environment anything is possible. If temptation is outlawed, the individual does not have to utilize his or her decision making skills because in effect, the decisions are made for them. Substance users in this context can be thought of as a child. As children, our parents monitor our behaviors and our actions often giving us the proverbial slap on the wrist if we reach too close to the fire. As adults, we must utilize our decision making skills or else we have the potential to be severely burned. For this reason, substance abuse recovery must take place in small steps with much reinforcement utilized.

The main variable shown to influence whether treatment programs work or not is continued monitoring. One study that analyzed outcomes of parolees who participated in treatment communities (TC), either outpatient or inpatient, found that the outcome variable: return to prison, was correlated with longer participation in ‘aftercare’ treatment programs. Thus, those individuals who left prison and had some level of reinforcement, was more likely to stay clean and not return to incarceration.

McLellan (2004), a researcher out of the University of Pennsylvania, compares substance abuse treatment to treatment for any other chronic illness. Mclellan point out, that what will make treatment effective is the three following variables noted:

  • Making treatment options attractive
  • Offer options/alternatives
  • Constant and continued monitoring of the individual

It is no shocker that most people are more inclined to do something they view as positive or attractive. So, first treatment options should be something that in fact beckons to the individuals tastes. Varying options in the form of treatment (i.e group versus individual therapy for instance) keep treatment ‘entertaining’ if you will, thereby making continued treatment an option. Finally, when an individual leaves treatment he or she needs to continue with what we will call ‘stabilization’. Whether that means switching from residential to outpatient treatment or joining a group like alcoholics anonymous or narcotics anonymous after intense treatment depends on the individual and the program from which he or she graduated.

No one program will fit every individual as every person is different. Residential treatment may very well be the best option for some and not for others. It is up to the individual to decide what will suit him or her better. Having said that, when considering substance abuse treatment one must remember that treatment consists of a plan that must unfold longitudinally. Changing one’s behaviors and in effect, one’s personality is a long process which, with proper guidance and support can occur. Like any task worth undertaking it takes time, perseverance and most importantly assistance from those who can help to attain a life free of drug use.

Rachel Hayon MPH, RN

Nelson, B. The Addictive Personality: Common Traits are Found. New York Times: published January 18th, 1983. Retrieved online June 22nd, 2008.
Burdon, W., Dang, J., Prendergast, M.L., Messina, N.P. & Farabee, D. (2007). Differential effectiveness of residential versus outpatient aftercare for parolees from prison-based therapeutic community treatment programs. Substance Abuse Treatment Prevention Policy; 2: 16.
Burdon WM, Messina N, Prendergast ML. (2004). The California Treatment Expansion Initiative: Aftercare Participation, Recidivism, and Predictors of Outcomes. Prison Journal;84:61–80.
Condelli WS, Hubbard RL. (1994). Relationship between time spent in treatment and client outcomes from therapeutic communities. Journal of Substance Abuse Treatment.;11:25–33.
Hubbard RL, Craddock SG, Flynn PM, Anderson J, Etheridge RM. (1997). Overview of 1-year outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors. 11:261–278.
Hubbard RL, Craddock SG, Anderson J. (2003). Overview of 5-year follow-up outcomes in the drug abuse treatment outcome studies (DATOS). Journal of Substance Abuse Treatment; 25:125–134.
McLellan, Thomas (March, 2004) Have we evaluated addiction treatment correctly? Presentation at the American Psychological Association Conference.
Simpson DD, Joe GW, Brown BS. (1997). Treatment retention and follow-up outcomes in the drug abuse treatment outcome study (DATOS). Psychology of Addictive Behaviors.;11:294–307.

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