in-patient treatmentAccording to the National Council on Alcoholism and Drug Dependence (NCADD), one out of every 12 American adults suffers from an alcohol use disorder (AUD). Only a little less than 9 percent of those needing treatment for an AUD actually got the help they needed in a specialized facility in 2014, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) publishes. Alcohol is involved in close to 90,000 deaths each year, and it is the fifth highest cause of disability and premature death in the world, NIAAA further reports.

Alcohol dependence and addiction are treatable and alcohol-related deaths preventable. There are typically two levels of alcohol treatment available: inpatient and outpatient. In an outpatient program, individuals stay at home and attend sessions, meetings, and trainings at a facility according to their schedule, while in an inpatient program, individuals stay onsite in a specialized facility for a period of time. The National Institute on Drug Abuse (NIDA) recommends that a substance abuse treatment program be at least three months in duration, regardless of the type; however, individuals often start in one level of care and then progress to less intensive forms of care during those 90 days. Generally speaking, an inpatient, or residential, alcohol treatment program will be the most comprehensive option available and provide the highest level of care, amenities, and services.

Addiction and treatment are highly individual, and what works best for one person may not work as well for the next person. There are some generalizations that may indicate when inpatient alcohol treatment is the optimal course of action. For example, someone who is heavily dependent on alcohol and has been drinking large amounts for a long period of time may be best suited to an inpatient setting where their physical and emotional needs can be best addressed. Alcohol withdrawal can be potentially life-threatening, and inpatient care can use both pharmacological and supportive care methods while providing high levels of medical and mental health treatment.

The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes that 7.9 million Americans (who were at least 17 years old) suffered from co-occurring disorders in 2014. Co-occurring substance abuse and mental health disorders require specialized treatment that can be optimally provided in an integrated fashion during inpatient treatment. Individuals with a prior history of alcohol withdrawal, or who have attempted outpatient care or other forms of alcohol abuse treatment before, may benefit best from an inpatient program. Individuals who are at a high risk for being a danger to themselves or others may require inpatient care as may those who have limited support at home. In short, inpatient care can provide a safe and secure environment that allows the brain time to heal from long-term and excessive alcohol abuse.

Services Provided during Inpatient Treatment

Alcohol addiction is a complex disease with physical, behavioral, social, and emotional aspects that should all be tended to during a treatment program. Some of the typical services offered in an inpatient alcohol treatment program include the following:

  • Detox

Alcohol acts on some of the neurotransmitters in the brain, like dopamine, serotonin, and gamma-aminobutyric acid (GABA). GABA works as a central nervous system depressant, slowing heart rate, temperature, and blood pressure as well as reducing anxiety and stress levels. Alcohol artificially increases the amount of GABA in the brain. Dopamine and serotonin are involved in the reward processing and motivation circuitry of the brain; as alcohol stimulates their production, moods are elevated. Chronic alcohol abuse can cause levels of these pleasure-inducing and naturally tranquilizing chemicals to be significantly depleted, and individuals may then suffer withdrawal symptoms. Alcohol withdrawal can range from mild to severe and even become life-threatening about 3-5 percent of the time, the New England Journal of Medicine (NEJM) publishes.

Symptoms of withdrawal include fatigue, depression, anxiety, headache, nausea, vomiting, dizziness, muscle aches, tremors, sweating, restlessness, anxiety, irritability, alcohol cravings, and an irregular heart rate and blood pressure. In extreme cases, fever, hallucinations, significant confusion, and seizures may occur a few days after the last drink; this is called delirium tremens, and it is the most severe form of alcohol withdrawal. Withdrawal can start as soon as eight hours after the last drink, peaks around 2-3 days in, and generally lasts about a week, the National Library of Medicine (NLM) publishes. Detox, therefore is generally 5-7 days in duration, and inpatient detox, regularly called medical detox, is ideal in the case of alcohol withdrawal. Medical detox may use medications, such as long-acting benzodiazepines, to calm some of the overactive functions of the central and autonomic nervous system and help a person to become physically stable. Vital signs can also be closely monitored during medical detox, fluids can be introduced, and mental health support and supervision given.

  • Behavioral therapies

According to NIAAA, almost 90 percent of American adults reported drinking alcohol at some time in their lives as of 2014. Drinking alcohol in and of itself does not constitute a problem; it is when alcohol abuse becomes out of control and affects various areas of a person’s life that concerns arise. Individuals may abuse alcohol excessively for a variety of reasons, and behavioral therapies can help people to get to the root of what thoughts may have led to these self-destructive actions. Behavioral therapies, like Cognitive Behavioral Therapy (CBT) for example, help to positively influence thought and behavior patterns that may be unhealthy through both group and individual therapy sessions. Motivational Interviewing (MI) is another behavioral therapy technique that is nonconfrontational and nonjudgmental, and helps people to find the motivation within themselves to make positive changes. Self-acceptance and self-reliance are also taught through behavioral therapies.

  • Counseling

Counseling sessions are vital to inpatient alcohol treatment. Sessions may be done both in small groups of peers and also individually. Family and spouse or partner counseling may also be included in a treatment program, and can help to heal relationships and teach new, effective communication skills. Some programs may include an intensive Systemic Family Intervention program that is short-term, helping to improve the overall workings of the family unit as a whole.

  • Treatment for co-occurring disorders

Concurrent medical or mental health issues and substance use disorders can complicate treatment protocols, which is why an integrated treatment plan that uses a team of medical, substance abuse, and mental health providers all working together may be ideal. Professionals can ensure that treatments complement each other and that any medications used will be safe and effective for both disorders. Substance abuse can exacerbate symptoms of a mental health disorder, and vice versa. Treating both disorders together, simultaneously, during an inpatient treatment program can ensure that all of the client’s needs are met.

  • Pharmacological approaches

There are several medications that may be commonly used during alcohol treatment programs, as published by NIDA. These may include: disulfiram (Antabuse), topiramate (Topamax), acamprosate (Campral), and naltrexone (ReVia, Vivitrol). These medications can help individuals to remain abstinent and/or help to manage withdrawal symptoms and drug cravings. Supplements and other pharmacological tools may be helpful during alcohol treatment programs as well.

  • Educational programs

Individuals learn about addiction and substance abuse, and what they do to the brain and body, in recovery. Armed with this knowledge, people can better understand what to expect during treatment and ongoing recovery. Educational programs are also often offered to family members to help all loved ones have a better understanding of the disease and be on the same page for recovery.

  • Life-skills training

Individuals will learn new and effective ways to communicate and handle day-to-day life tasks. Group sessions may include working through things together. Often, homework is assigned. Individuals are encouraged to practice these new skills outside of sessions and then report back on what worked and what didn’t work.

  • Anger and stress management

Coping mechanisms and techniques for managing stress and controlling anger are important during treatment and recovery. Individuals may become hostile, aggressive, or even suicidal during alcohol withdrawal. Inpatient treatment programs can not only provide security for individuals and those around them, but also teach better ways to handle these difficult emotions. Stress can be a large culprit and predictor of substance abuse, and individuals who learn how to better handle it are better equipped to refrain from abusing alcohol again in the future. Individuals may explore what their personal triggers are that cause stress or anger to rise up, and how to recognize and prevent them from leading to relapse. Alcohol abuse can actually change the way a person’s stress response works, damaging the natural reaction to stress, the journal Alcoholism: Clinical & Experimental Research publishes. During inpatient alcohol treatment programs, these changes can be explored and positively modified, as individuals learn how to better regulate emotions and cope with stressful situations without the need for alcohol.

  • Nutrition planning

Alcohol can deplete some of the body’s essential nutrients, and a healthy and balanced diet can be important during recovery. Foods that are rich in vitamins and minerals, and low in saturated fats and sugars, can be beneficial in helping to restore healthy physical balance. Alcohol abuse and withdrawal can cause appetite changes that may lead to malnutrition. The balanced diet and structured mealtimes provided during inpatient alcohol abuse treatment programs can help to rectify this and promote good health.

  • Fitness programs

Exercise can naturally boost endorphin’s and raise self-esteem and confidence levels. Many inpatient alcohol treatment programs will offer fitness classes or exercise programs to clients. A healthy dose of exercise can help to combat stress and clear the mind while improving a person’s physical fitness level.

  • Complementary medical techniques

Things like yoga, acupuncture, chiropractic services, mindfulness meditation, massage therapy, and more may be helpful in regulating moods and creating a healthy mind-body connection and balance. These services may be offered at an inpatient treatment program as adjunct therapies, meaning that they are provided in addition to other therapeutic techniques. They may complement the healing process of both the brain and the body.

  • Alternative therapy programs

Art, music, adventure, or equine-assisted therapy are all considered alternative therapy techniques that may be useful during an inpatient treatment program. These programs provide a creative outlet that can distract the mind and help individuals to feel a sense of accomplishment and purpose. These therapies are often offered in conjunction with traditional methods as well.

  • Relapse prevention programs

NIDA reports that addiction has about a 40-60 percent relapse rate. This means that relapse is a common part of substance abuse recovery and should not be considered a failure. Instead, it should be seen as a setback that can be rectified. Relapse prevention programs teach individuals ways to minimize and reduce instances of relapse.

  • Peer support or 12-Step programs

These groups provide a safe sanctuary of likeminded individuals who can relate to and understand each other. Participants can provide a sympathetic ear and encouragement. Twelve-Step groups, like Alcoholics Anonymous or AA, offer a peer network and fellowship for individuals who wish to obtain and sustain sobriety on a long-term basis. These groups usually meet at least once a week for an hour or 90 minutes. Abstinence is the only requirement for membership in AA, which is free. Membership is confidential.

Inpatient vs. Outpatient Alcohol Treatment

Inpatient care programs may cost more than outpatient ones. Many insurance policies may require that an individual first attempt an outpatient program before they will cover a residential one. In the long run though, alcohol treatment programs are more cost-effective than continued alcohol abuse, regardless of the format. NIDA publishes that substance abuse treatment may provide a return on investment (ROI) at rates as high as $12 to every $1 spent when healthcare costs, drug-related crime, legal expenses, and criminal justice costs are taken into account.

Family, work, school, or other life obligations may make it difficult for people to stay in an inpatient facility for a significant length of time. Outpatient programs are more flexible with existing schedules and activities. Inpatient programs can provide the opportunity to completely reset one’s life, however, offering necessary structure, support, and a safe and secure environment in which to recover. By sticking to a regimented sleeping, waking, and eating schedule, a person may be more alert, well-rested, and better emotionally equipped to work through a treatment program. An inpatient program removes the stressors of daily life and many of the potential triggers to relapse.

Additionally, excessive and long-term alcohol abuse damages many of the brain pathways and functions, and a stay in an inpatient facility may allow enough time for it to heal and function properly again. Brain imaging and studies published by Psychology Today indicate that the brain can heal itself over time and with the introduction of new and healthy habits. An inpatient alcohol treatment program can provide tools for developing new habits and the time for these habits to become ingrained, thus helping the brain to heal. It can take at least two months for a habit to become fixed, Psych Central publishes, and some habits may take even longer before they are routine. Inpatient treatment programs provide support, encouragement, and the opportunity to practice new skills that are learned during sessions in order to firmly establish these improved positive habits and methods for coping with stress and daily life events.

Generally speaking, inpatient alcohol abuse and addiction treatment programs may be the most effective method for enhancing a long and sustained recovery. These programs provide a safe and supportive environment as well as the time needed to heal and the tools necessary to move forward in a life free from alcohol.

inpatient vs outpatient