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Alcohol Abuse Treatment: Out-Patient or Residential? II

Aug 18, 2007
It is difficult to make a decision to seek treatment for alcohol abuse, dependency, or addiction. But having made that choice it becomes even more confusing when seeking an appropriate type of program. Essentially the first decision comes down to opting for either Inpatient or Out-Patient.

First consider In-Patient, commonly referred to as "Residential." Generally these programs run from 30 to 90 days at an average cost of $1000/day, though some may run three or four times that amount. Usually the client is confined to a facility, shielded from outside pressures, assessed, counseled, and released to aftercare which usually consists of weekly groups at a hospital, clinic, or other local facility and the mandate "don't drink, attend AA, work your program."

The benefits are fairly straightforward: removel from immediate stressers; isolation from temptation; appeasement of family and employers; time to regroup and collect one's thoughts; and a period away from the usual alcoholic fog.

The drawbacks are equally apparent: expense; disconnection from reality; labeling; depression; and re-entry shock which generally leads to relapse within a month or two and a return to old behaviors which will now necessitate out-patient services if you can can afford them either financially or emotionally.

Out-patient, on the otherhand, allows the client to gradually modify behaviors within the ongoing context of their daily life. It also provides assessment and counseling and followup, but with continuity of program, staff, and facility.

The drawback is that the client isn't isolated or protected from their usual stresses and temptations. But is this really a negative point?

Nearly anyone can modify a behavior in a controlled environment for a short period of time. People do lose weight at spas; they get into shape at camps; they quit drinking in rehab. But they almost always return to their old patterns when they return to their usual lives and problems, people and jobs, neighborhoods and families. All that has changed is that they've had a very expensive vacation.

The harsh reality is that change takes place within the individual in their usual surroundings, or it doesn't last for long. That said, Out-Patient treatment is more effective because it works with all of the day-to-day problems that must be coped with. It's cheaper, but you can always stay at a hotel for awhile if you need to escape long enough to clear your head and develop some plans. It's more inclusive, again because it is done within the context of your real life. It's also less prone to labeling you with a permanent diagnosis which may or may not be accurate and is usually demeaning.

Finally, modifying behaviors over time is more apt to result in lasting change. It takes time to alter behavior, usually about thirty days to break a habit and a year or more to replace the activity. If you want to succeed, expect to give yourself the time you deserve in the most efficient ways available.
About the Author
Dr. Edward Wilson has been developing and providing alternative alcohol counseling, including moderation, sincve 1990. He is the co-founder and Clinical Director of Your Empowering Solutions, Inc, located in S. California. http://www.non12step.com
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