Inpatient drug rehab refers to both hospital-based treatment as well as residential substance abuse therapy. In both cases, patients live in a 24-hour-a-day setting, completely removed from their regular lives and the temptation to continue to drink or use drugs. Inpatient rehab lets patients focus entirely on getting and staying sober without other distractions. Inpatient drug and alcohol treatment offers supervised detox from the substances, including medication assistance if needed, and a combination of group and individual therapies for the duration of treatment.
The length of inpatient rehab programs varies from 30 days to as long as one year, often with a “step-down” approach wherein the patient moves from a high-intensity treatment such as detox to a lower-intensity program such as a sober living house over the course of care. The length of time in treatment depends on many factors, including the severity of the addiction, the patient’s individual treatment plan, and outside issues such as work and family. SAMHSA, the Federal government substance abuse treatment agency, reports that medications used to assist detox and recovery are an effective way to support treatment, when used appropriately in a hospital, inpatient or residential setting. Medications used to treat co-occurring mental health issues are also vital to a successful recovery from addiction.
Any good treatment program considers recovery in relation to the patient’s overall environment, as well as the person’s psychological condition and social skills. Inpatient rehab emphasizes teaching patients to take personal accountability in their lives, as well as to address negative patterns of behavior, beliefs about themselves and others, and their overall lifestyle that may contribute to their ongoing substance use. Rehab therapy helps replace these behaviors with functional, constructive patterns of behavior that enhance a person’s ability to stay sober, maintain a job and rebuild their lives after treatment ends. Treatment also includes connecting the patient with life-long relapse prevention assistance, such as sobriety support groups in the community.
The National Institute on Drug Abuse (NIDA) research shows that people who maintain participation in outpatient treatment for relapse prevention as well as attending self-help sobriety support groups have the lowest relapse rates after inpatient or residential treatment. A study published in the Journal of the American Medical Association (JAMA) showed both short and long-term inpatient rehabilitation programs are successful in helping people establish and maintain addiction recovery. However, the same study also revealed that longer-term programs are more successful in some areas of substance abuse recovery. Overall, research shows that the longer a patient stays in an inpatient or residential treatment center, the better their chances for a lasting recovery from severe drug or alcohol addiction.
Inpatient and residential alcohol and drug rehabilitation are most appropriate for people with severe and persistent addiction problems, often those who have failed to maintain sobriety after trying other treatment approaches. Sometimes, people with serious substance addictions need hospital-supervised detoxification due to the risk of seizures, delirium tremens (DTs), coma or death as they withdraw from the effects of heavy substance use. Medications and other services are required to help them through this initial phase of recovery, and such care is simply not possible at home or in an outpatient setting.
Inpatient and hospital substance abuse treatment gives patients around-the-clock care and therapy on an individualized basis. Treatment is available from a variety of specialists, including doctors, psychologists, psychiatrists, specially trained nurses, social workers and addiction specialists. Inpatient and residential substance abuse treatment also helps prevent people from impulse drinking or using, thanks to the 24-hour supervision and staffing. For some people, this can be a life-saving difference from outpatient care. For the person with a long-standing addiction problem, severe co-occurring mental health issues or a history of chronic relapse after treatment, inpatient drug rehab is the treatment modality of choice.
Inpatient drug rehab is usually broken into three parts: detox, hospitalization or inpatient treatment, and residential treatment. Sometimes residential treatment is also called a “therapeutic community.”
A shorter, 30-day program gives patients time to finish detoxing, learn something about their addiction and start participating in therapy. Without follow-up to an intensive outpatient program and significant participation in community self-help groups, however, relapse rates for chronic, long-term addicts remain high. 60-day programs give chronic addicts and alcoholics more time to work through issues of their addiction and start to establish a pattern of living sober. A sobriety support network begins to evolve. However, the 90-day programs are the minimum recommended for severe addiction problems. These programs, as well as the longer therapeutic community programs, are the inpatient rehab programs, associated with the highest long-term rates of recovery.
Some people might see a long term stay at an inpatient rehab facility as a negative. However, if recovery and sobriety are the goals, these programs are the ones with the track record of success. The 24-hour supervised care and the teams of specialists dedicated to patient recovery make all the difference for patients with severe, long-standing addiction and alcoholism problems.
Patients in an inpatient or residential rehab setting will participate in intensive group and individual therapy throughout their stay in treatment. They will be able to focus on their treatment and on moving ahead with a healthier lifestyle because there are away from other commitments. People in inpatient rehab also get treatment for other mental health or medical conditions, so they are sure to take any needed medications daily, and they have their medical status checked regularly. Often, this is a big change from when they were using or drinking. Simply being compliant with medication often makes an enormous difference in a person’s ability to manage their addiction issues.
The types of therapy provided at inpatient rehab are the same as in outpatient, but often more intensive and focused. Patients receive individual, group and often family counseling along with psychiatric sessions. They may also participate in exercise groups, stress management or art therapy. Often, other therapy modalities like yoga, “ropes” courses and more are included, depending on the program. Education on life skills like nutrition, self-care, and vocational skills are often a part of long-term programs. Relapse prevention and ongoing sobriety support skills must be a part of any quality inpatient or residential program.
It can be difficult to choose the right inpatient rehab program, especially if financing is an issue or there is a crisis at hand. Often, there is a lack of options or people simply do not know what sort of questions to ask about treatment. Always try to get as much information about each program available, and weigh the options before making a decision. If needed, get the help of an addiction specialist to make the choice of a facility. Whenever possible, make decisions based on what is best for the patient and the need for lifetime health and sobriety rather than on what is easiest and fastest.
Is it based on a 12-step program or is it faith-based, for instance. Most importantly, is the program based on an evidence-based approach? Current scientific evidence indicates addiction changes the structures and chemical actions of the brain. This Medical Disease Model also takes into account how addiction is the result of other biological, psychological and sociological issues.
According to NIDA, successful treatment programs use evidence-based practices that have been developed through scientific data and measurement. These programs use all or some of these methods of treatment:
Scientific research shows the combination of medication with cognitive and behavioral therapies is the most successful approach to treating alcoholism and drug addiction.
A co-occurring disorder refers to the situation in which a person has both a substance abuse condition and a psychological diagnosis. This occurs in 50-75% of people with an alcohol or drug use problem. Even if a facility claims to treat both conditions, it is critical that they do so correctly, including the use of psychological medications if appropriate. Good programs have psychologists and psychiatrists available to diagnose and treat these conditions, as well as trained staff to help patients address both conditions. Sometimes co-occurring disorders are called “dual diagnosis” situations.
Good inpatient and residential rehab centers offer both, especially individual therapy where the deeper psychological issues underlying addiction can be addressed.
No therapy program is better than their staff, so make sure that any inpatient program has medical and psychiatric doctors available around-the-clock. Therapists must be credentialed as both addiction therapists and mental health therapists in the state where the facility is located. Usually, this means they have a minimum of a Master’s degree in Psychology or Social Work plus additional training and certification. Nursing staff and techs should also have additional training in addictions and mental health care. An inpatient treatment facility run solely by “sober addicts and alcoholics” is not a safe place for medical care. Staff licenses and credentials must be on display and in plain view of patients.
Any hospital or residential treatment facility should be accredited by one of the two major associations, either the Joint Commission on Accreditation of Healthcare (JCAHO) or the Commission on the Accreditation of Rehabilitation Facilities (CARF). The accreditation certificates must be on display in plain view of patients and must be up-to-date.
Most programs claim they do this, but if they do not have the options and services within their program to support the treatment plans, they cannot carry out the plan. Addictions are complex, made more complicated when co-occurring disorders are present. No two patients will need the same interventions. Plans need to include appropriate medical management of both medical and psychological concerns, addiction treatment and therapy, and reintegration into the community.
A program that only looks at a patient’s substance abuse is unlikely to have a good long-term success rate. Evidence-based practices dictate that people who are trying to recover from alcohol and drug addiction also need care for mental health and medical issues. They need to restructure their entire lives, and this includes learning to eat a healthy diet, exercise, socialize without using substances, have healthy relationships, manage stress and solve problems as part of a sober lifestyle.
A good inpatient or residential rehab will have a strong program of aftercare, including psychiatric care, for at least one year after the patient leaves active treatment. Aftercare should also include ensuring the patient is engaged in community self-help sobriety groups, medical care or mental health counseling if needed, or even a vocational program. Relapse rates after treatment can be over 50% within one year, so any successful treatment program must include a robust relapse prevention and aftercare program.
Some inpatient or residential treatment programs expect patients to detox from all chemicals before entry. In cases of severe and long-term use or acute overdose, this is not a safe option and withdrawal must be supervised in a medical facility. Some people with severe and persistent mental illness may have a sudden worsening of their psychiatric conditions during withdrawal, leading them to be a danger to themselves or other people. These people also need care in a hospital setting during detox. Carefully consider what sort of treatment is safe and appropriate given the individual situation at hand.
For instance, some inpatient and residential rehab centers only treat one gender or certain age groups of patients. Others are open only to people without a significant criminal background. Some programs have restrictions on visitors, or may limit a patient’s access to telephone, TV, internet, etc. as privileges for achieving particular program milestones. Some programs offer private rooms, while others are dormitory-style or offer only shared rooms. These may be important issues to think about before admission.
Many long-time alcoholics and addicts have lost their jobs and health insurance benefits, leaving them with few options to pay for treatment. Inpatient and residential care costs vary widely, depending on how they are funded. Even patients who still have insurance find their coverage varies greatly, based on the type and length of rehab. If a patient has health insurance, contact the insurance company to find out what they cover first. Discuss the options for treatment, including inpatient and residential care, copays, deductibles and out-of-pocket expenses. Talk with the treatment centers, to see if they have options for financing the remainder. Many programs offer payment plans. Patients without insurance may qualify for Medicaid or Medicare funding. Often, the rehab center can assist with this application. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA). They are an excellent source of information about various rehab programs as well as payment and finance options for recovery.
Almost every state has resources for inpatient and residential substance abuse rehab. Do an Internet search for your state + “inpatient substance abuse rehabilitation” or your state + “inpatient alcohol treatment” and find a link to the state’s network of treatment facilities. Look for the link ending with .gov rather than one of the sponsored links at the top of the search page. Other excellent resources to locate inpatient drug rehab centers include:
SAMHSA – the U.S. Substance Abuse and Mental Health Services Administration offers a comprehensive treatment locator service at https://findtreatment.samhsa.gov/
NIDA – the National Institute on Drug Abuse, provides a wealth of information, links and other information to help individuals and families locate services at https://www.drugabuse.gov/related-topics/treatment and https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/where-can-family-members-go-information
The American Society for Addiction Medicine (ASAM) supports Addiction Medicine Doctors who treat drug and alcohol addicts throughout recovery. Their webpage on treatment offers addicts, alcoholics and their families an array of resources regarding treatment options, questions to ask and information needed to move ahead in recovery.
Inpatient treatment for service Veteran’s is available through the V.A. Health Services.
Many treatment centers accept state Medicaid payments. A list of these programs is located at the Medicaid.gov site. You should also double check with both your state Medicaid and with any treatment center prior to entering care.
