It’s a fair question: Inpatient or outpatient treatment for alcoholism?
Obviously both are valid choices and taking any action is certainly better than doing nothing at all.
However, I am going to take a stand here and argue that inpatient treatment is vastly superior to outpatient rehab, and that everyone who is considering either of them should really take a look at just biting the bullet and checking into an inpatient facility.
The difference here (in case you are not aware) is that inpatient rehab has the alcoholic staying overnight in the facility, just like checking into a hospital. Outpatient rehab has the alcoholic going home each day and then coming back tomorrow for more therapy, counseling, and groups. Outpatient treatment generally costs less, though not necessarily by as much as you would think, because the therapy and the counseling are where most of the cost is.
The advantages of inpatient treatment over outpatient rehab
If you can convince yourself to go to inpatient rehab then you enjoy a number of advantages:
1) You stay in a protected environment where there are no temptations.
2) You get around the clock support from your peers. I used to stay up late at night (because it was difficult to sleep in early recovery anyway) and talk with my peers about recovery. I can remember doing this in inpatient rehab when I had only one week sober.
3) You get access to more resources because your visit to rehab is much more thorough. You have more time to explore the support systems that can help you to stay sober. You are living and breathing recovery 24/7 rather than for a few hours each day (as with outpatient rehab).
4) Outpatient treatment is like trying to put a patch on a problem. Inpatient treatment is fully immersing yourself in the solution.
5) If you get overwhelmed during inpatient rehab you have a safety net and you are in a protected environment. If you get overwhelmed during outpatient treatment it is likely that you will relapse because you are not protected.
6) During inpatient treatment you are never alone. There are always people with you. During outpatient treatment you will likely have points during your day when you are completely alone.
7) The success rates for inpatient treatment are generally higher than that of outpatient rehab (though it depends on which data you are looking at a bit).
There are probably some other advantages of inpatient treatment as well but they can be difficult to put into words. When you check into an inpatient facility you get a certain feeling….security, strength, rebirth, things like that. None of these feelings seem to come through if you are just showing up each day for a few hours of outpatient treatment.
The environmental factor in very early recovery
One of the great paradoxes of addiction recovery is the environmental factor. It goes like this:
1) People realize that they have built an entire life around drinking alcohol, so they go to rehab in order to escape this toxic environment and get help. Removing themselves from the bar and from friends who drink is an important step in their recovery.
2) People in recovery always claim that running away and changing your environment is not a recovery solution, and will only result in relapse.
So which is it? Are these two concepts not compatible with each other?
My opinion is that your environment is definitely a factor, and you should take it into consideration. But the problem comes in when people depend on this environmental change to cure their addiction entirely. Therefore they will run away from a toxic environment, expect that to fix their addiction, then they will not do any other work in order to recover. This is the problem.
Yes, your environment is a factor. If you live with other alcoholics then that is a real factor that can hold you back in your recovery. If you work at a bar then that is a real factor that can hold you back. These are things that you might need to change in order to recover. But they are not, by themselves, the entire solution to recovery. It takes more than that.
In very early recovery, environment is extremely important to consider. You cannot get over your drinking problem if you are surrounded by alcohol (or practicing alcoholics). This is really the number one argument for inpatient rehab. When you check into rehab you remove all temptation. There is no alcohol available. You are protected. This is probably the most important point of going and staying at rehab for 28 days. You insure that you do not drink. Simple and effective.
My own experience with inpatient rehab
I went to inpatient rehab 3 times. The last time that I went was my final trip and I have been clean and sober ever since then.
During this journey I also tried some counseling. I did not actually do outpatient treatment but I did talk to a counselor once each week.
This counseling session was completely useless because at the time I was still drinking every day. I had no real intention of stopping and no one could convince me of doing so. The counselor tried to convince me to go to inpatient rehab, and I was basically afraid of doing so.
Later on I got miserable enough that I decided to give inpatient rehab a chance. I did this 3 different times, but the first two times I was doing it for the sake of my friends and family. The last time that I did it I was doing it for myself, because I was truly sick and tired of drinking and I did not want to die. This is a very important point and really defines whether or not you will be successful in your own recovery journey or not. If you have reached a point of true surrender then you will likely be successful. If you have not surrendered fully yet then any form of treatment (inpatient or outpatient) is likely to fail for you.
When I first attended rehab I was not ready for it. I was willing to check into rehab but I was not willing to take action in my life. They were saying that I had to go to meetings every day when I left treatment and I was not willing to do that. I just wasn’t ready to change my life. I was not miserable enough with my drinking yet.
The same situation existed the second time I went to rehab. I still was not done drinking yet. I had not had enough pain in my life yet. At this point I knew that I was an alcoholic, but I also knew (or thought that I knew) that recovery could never work out for me. I was in denial of the solution. But I fully admitted that I was alcoholic. I just did not want to do anything about it, because I was afraid of sobriety, I was afraid of AA meetings, I was afraid of recovery. In fact I was also afraid of inpatient rehab, but I also realized that once you were checked in some where it was never that bad. But getting up the guts to go check in was obviously a big deal to me at the time.
Being honest with yourself about how much help you really need
I suppose there are cases where an alcoholic does not need as much help as I needed. When I finally got serious about recovery, I not only went to inpatient rehab, but I followed this up by living in a long term treatment center for almost two full years! I needed a lot of help.
Other alcoholics might be different. Part of my really doubts the truth of this, though. I believe all alcoholics are basically the same, at least in how they are driven to drink and to self medicate the way that I did. So maybe it is possible that other alcoholics can do just fine with outpatient counseling, whereas I needed to be at inpatient treatment for 20 months.
Just look at the difference between a 28 day inpatient program versus going to outpatient counseling. The outpatient counseling is usually something like 5 hours per day, maybe 3 to 5 days per week. Compare this to inpatient rehab which is 24/7! It is a vast difference in the amount of time and the level of immersion into recovery.
So one thing that you have to do is to get really honest with yourself about how much help you need in recovery.
There was a time when I was in steep denial, and I could not bring myself to admit just how much help I really needed. For example, the second time I was in rehab the therapists and counselors suggested that I follow up by living in long term treatment. At the time I had never even considered doing something like that and it sounded like a death sentence to me. The idea of living in rehab felt like prison (mind you, I had never been to prison either). So I lashed out at the idea of long term treatment and I got angry. In fact this was my excuse when I left rehab that time and relapsed immediately. How dare they suggest I live in rehab! I will show them, I’ll go get drunk right now! That was my exact thought process at the time, yet I could not see the depth of my problem.
But obviously if you leave a 28 day inpatient program and you relapse immediately then you probably could have used more treatment and more help. The problem is that the thing that killed it for you was not the lack of more treatment, but it was the fact that you were not willing to go to more treatment. In other words, would I have stayed sober if I would have forced myself to check into long term rehab at that time? No I would not have. I lacked surrender. I was not ready to be sober, period. I just wasn’t ready. No amount of treatment or therapy could have made me ready.
The only way to “get ready” to be sober is to surrender. And the only way to surrender is to get really sick and tired of the pain and the misery. And if you are not quite there yet then your only choice is to go back out and get some more pain and misery. This may sound like a really negative viewpoint but it is simply the truth that I had to discover for myself. I was in rehab and I wanted to want to get sober, but I just couldn’t do it. I had to learn the hard way how to want it. I had to live through more chaos and misery in order to become willing. This is how surrender works. You cannot force it. You can’t just pretend to surrender. If you try to fake it then you will only last for a day or two, maybe a week. But you can’t fake it for the rest of your life if you really want to drink deep down.
Making a decision for recovery to go to any length
A lot of people who hear about a 28 day inpatient program recoil from the idea in horror. They cannot even conceive of doing something like that because it is so incredibly disruptive to their everyday life.
People will therefore make excuses as to why they cannot attend inpatient rehab. They can squeeze outpatient into their schedule, but going to inpatient rehab is just like going to the hospital for 4 weeks. It is completely disruptive.
And so they make excuses. My excuse was that I was working at a job and I argued that I could not leave the job. Therefore I argued that I could not just up and go to rehab. It would be too disruptive, I could lose my job.
This is part of denial. The alcoholic is in denial of the solution. It won’t work because….. They have an excuse for everything.
The truth is that if they just surrender completely and go check into rehab then all of those problems that they are talking about will take care of themselves. Things will get sorted out. The world will keep turning while you are in rehab, believe it or not. Yet we try to convince ourselves that we cannot be missed for 28 days because it would just disrupt too many things.
Think for a moment of the alternative. Many alcoholics drink themselves to death. It happens. Had they gone to treatment they would be alive still. Yet they argued that they could not just “up and leave and go to rehab for 28 days” and so they made all sorts of excuses.
Well, now they are dead. Their alcoholism killed them. What good are their excuses now? How much sense do their excuses make in light of their death? I have one friend in particular who is gone forever. He died drinking. What good are his excuses about why he could not (or should not) check into a 28 day program? Death is the ultimate disputer of these lame excuses. Death mocks these excuses, really. There is no good reason to avoid going to treatment when the stakes are this high. This is your very existence we are talking about. This is your life!
In order to be successful in sobriety you need to be willing to go to any length. This is famously quoted at the beginning of every single AA meeting around the world, how we must be willing to go to any length in order to get recovery.
When you choose a lessor form of treatment over a more intense form, are you really willing to go to any length? In most cases the answer is probably “no.” Of course it will depend on what options are actually available to you. In some cases your insurance may not cover inpatient treatment, and will only cover outpatient services. This is a possible trend in the future as the costs of health care in general continue to spiral further out of control.
There is a scale of intensity when it comes to various forms of alcoholism treatment. It might go something like this:
1) Going to an AA meeting.
2) Going to see a therapist or counselor.
3) Going to outpatient treatment.
4) Doing all of the above.
5) Going to inpatient treatment.
6) Going to inpatient treatment, then following it up with all of the above.
7) Going to long term treatment.
8) Living in a recovery house long term.
As you move down the scale the treatment gets more and more intensive. Outcomes will generally be better the more intensive the treatment is. But this is also a scale about willingness. What are you willing to do in order to recover? Are you willing to go to meetings every day? Are you willing to live in rehab for several months if that is what it takes? Your level of willingness says a lot about your prognosis for long term sobriety.
I had to be willing to go to any length. I had to become willing to attend long term rehab in order to recover. Your situation may be different and not everyone will need to go to the extremes. What is important is that you are honest with yourself. If you go to a certain level of treatment and it fails for you then you need to be honest with yourself. Obviously you need more help than what you received. When I left a 28 day program and relapsed, I made a mental note to myself: “Obviously in the future I need to realize that I probably do, in fact, need long term rehab as the therapists are suggesting.” At the time I was not willing to attend long term, but at least I realized that it was probably necessary for me.
So what does it feel like to commit to recovery? You must abandon everything. You must crush your ego entirely and get out of your own way. You must throw up your hands and say “Please show me how to live, I do not know what I am doing any more.” If you are not at this level of surrender then I do not think it matters what form of treatment you go to. If you are not ready to be sober then nothing will work. Unfortunately none of the treatment options that we have available to us are able to alter your level of willingness.
The willingness must come from within. You have to have the drive to be sober. You cannot rely on treatment or therapy to somehow instill this motivation in you. It doesn’t work that way.
The alcoholic will resist change because the journey to sobriety is scary. It is fear that holds the alcoholic back from taking action. Though most alcoholics will not admit that they are afraid. But make no mistake, it is fear that holds them back.
The alcoholic is then motivated by pain. It is misery from alcoholism that motivates them to take action and to change their life. But this is balanced against the fear of change.
What has to happen is this:
The alcoholic must get so sick and tired and miserable from their drinking that they no longer care about the fear that is holding them back. This is the moment of surrender. When their pain and misery exceeds their fear. This is how you break through denial.
It is only then that successful treatment becomes possible.
What about you, what is your experience with inpatient and outpatient rehab? Which one worked for you, and why? Let us know in the discussion forums. It only takes a second to register!