Intensive Outpatient vs Inpatient?

[Jabberwocky]

I'm curious to hear whether folks have had more successful experiences in IOP type environments versus inpatient ones?

I certainly was much more successful at remaining abstinent while on an a MMT outpatient program. Shit got me sober. And once I got off methadone I found another IOP program. I did that abstinence based (though very enlightened) program for 90 days to make sure my head way screwed on right and give me a little extra help in making the transition from methadone to a healthier lifestyle that didn't include eating massive amounts of exogenous endorphins every facking day.

And that outpatient program was equally wonderful, providing a helpful (though far from perfect) experience I was able to learn and benefit a lot from. Because I had taken the time to do my own research both when I went looking for a MMT provider and later the more abstinence focused treatment provider, I was able to find treatment models that actually directly and addressed by individual needs.

My more recent experiences, once I'd learned or thing or two about how manipulative and exploitive the recovery industry can be, my more recent experiences (finally) getting sober have been like night and day compared to those I had when I first tried, back when I could distinguish the efficacious from the exploitative and arbitrary when it comes to treatment.

I guess what I'm asking is this:

• Do you find IOP or inpatient programs to help you create more stability for you, in life and recovery?

 

[cj]

I think outpatient is a more realistic approach to changing your life. Inpatient is this little cocoon where everything is controlled and the stressors that drove your addiction are more or less eliminated. I am not sure how helpful that is once you leave and all your problems smash you in the face especially if you left a lot of wreckage behind when you checked in. If I ever have to do it again ill do a inpatient detox followed by an IOP program.

 

[aihfl]

I would definitely say so, even though my only IOP experience to date was far from ideal (12 step indoctrination). I did manage to rack up several months during and after the IOP compared to relapsing in pretty short order after both of my residential treatment discharges. For me, I think not having your life completely disrupted and put on hold is more effective in the long term since it allows you to keep your routines (work, hobbies, etc.) which in turn provides more opportunities to stay sober. I know after both of my residential discharges, after being in a bubble for 28 days, my reaction was "now what?" and it can be challenging to get back into your routines and the longer you stay out of your routines, I know in my case, the larger the possibilities for relapse. I'll start another IOP next week based on SAMHSA's evidence based "Matrix Model," so I'll keep adding to this thread as it plays out.

 

[simco]

I've only experienced IOP, not inpatient (for substance use). But I did do a lot of research on inpatient rehabs, trying to decide if I should admit myself to one. My research led me to two beliefs:
* The rates of success in inpatient do not appear much (if any) greater than success rates in IOPs. But the cost of inpatient is astronomical compared to outpatient.
* Like cj said, by design, inpatient rehab wraps patients in a cocoon, which certainly has something to be said for it. But it strikes me that this makes re-entry into the outside world pretty tricky.

I will admit, though, that the sealed-off nature of inpatient might be just the ticket in some cases. If someone can't abstain from drugs, the merits of inpatient become obvious.

 

[2dark2see]

I've done both residential inpatient treatment and intensive outpatient treatment programs. However each of these programs was done for anorexia and not opiate addiction. But for what it's worth, I've had success with both treatment models. The times I did residential treatment were when my weight was extremely low and there was no way I'd be able to regain much weight in an IOP program (and they wouldn't take me anyway bc my weight was too low). My longest stay in residential was 4 months and that was my most successful stay. Many feel that the longer the program the greater the chances are of success, and I happen to agree with that based on my own experiences (I'm not saying 28 days won't work, I'm only saying that for me 4 months was way more effective than the 60 days I had done before).

And as far leaving the bubble of residential treatment and re-entering the real world, yes it was hard... BUT I challenge you to find an inpatient/residential program that doesn't recommend a stepping down process upon discharge. They recommend patients go from inpatient to some kind of IOP, and then usually to go on to regular outpatient treatment such as weekly therapy, support group mtgs, etc. So when you leave residential treatment you are not going out into the world with no structure regarding treatment/recovery, you are just stepping down to less structure (by attending an IOP) than you received while inpatient.

Obviously it's up to the patient as to what they choose to do once leaving inpatient treatment.... and my first residential treatment stay (it was 60 days) I left and ignored those recommendations, didn't do any kind of follow up treatment as an outpatient and promptly fell flat on my ass. I ended up back in residential treatment in less than a year for the same thing, anorexia, only this time I was a bit wiser as to how hard the transition would be (they told me it would be hard that first time around but of course I thought I knew better and thought I was "different" from those who relapsed) and I actually listened to the step down treatment recommendations being made and I was much more successful that time.

I really think the choice of residential, inpatient or IOP is very specific to each person and their situation and what is going on in their life at that particular time. Just like we all have different reactions/side effects from meds, we all respond differently to each type of treatment option.

 

[cj]

I've done both residential inpatient treatment and intensive outpatient treatment programs. However each of these programs was done for anorexia and not opiate addiction. But for what it's worth, I've had success with both treatment models. The times I did residential treatment were when my weight was extremely low and there was no way I'd be able to regain much weight in an IOP program (and they wouldn't take me anyway bc my weight was too low). My longest stay in residential was 4 months and that was my most successful stay. Many feel that the longer the program the greater the chances are of success, and I happen to agree with that based on my own experiences (I'm not saying 28 days won't work, I'm only saying that for me 4 months was way more effective than the 60 days I had done before).

And as far leaving the bubble of residential treatment and re-entering the real world, yes it was hard... BUT I challenge you to find an inpatient/residential program that doesn't recommend a stepping down process upon discharge. They recommend patients go from inpatient to some kind of IOP, and then usually to go on to regular outpatient treatment such as weekly therapy, support group mtgs, etc. So when you leave residential treatment you are not going out into the world with no structure regarding treatment/recovery, you are just stepping down to less structure (by attending an IOP) than you received while inpatient.

Obviously it's up to the patient as to what they choose to do once leaving inpatient treatment.... and my first residential treatment stay (it was 60 days) I left and ignored those recommendations, didn't do any kind of follow up treatment as an outpatient and promptly fell flat on my ass. I ended up back in residential treatment in less than a year for the same thing, anorexia, only this time I was a bit wiser as to how hard the transition would be (they told me it would be hard that first time around but of course I thought I knew better and thought I was "different" from those who relapsed) and I actually listened to the step down treatment recommendations being made and I was much more successful that time.

I really think the choice of residential, inpatient or IOP is very specific to each person and their situation and what is going on in their life at that particular time. Just like we all have different reactions/side effects from meds, we all respond differently to each type of treatment option.

Great points about listening to advice. I never could overcome the innate desire to use when I was in treatment. I very much had a fuck you I wont do what you tell me attitude toward the whole thing. I cant honestly say I ever wanted total abstinence I just wanted the pain to stop. So recognizing where your mind is on the subject of abstinence is important before picking.

 

[2dark2see]

lol cj I was pretty similar to you my first time around in residential... well maybe I didn't exactly have a fuck this attitude, I was more like "I've learned all I can here (CBT, DBT, mindfulness, etc) so I won't need any more help on the outside when I leave bc now I know everything and all I've got to do is put this knowledge into practice". Hmm... as I typed that out I think I did have a combo of fuck your recommendations and I know everything kind of attitude lol! I actually remember thinking "how hard can this really be, why do people relapse?!". Omg was I naive at that point! That was when I left and didn't follow any step down treatment recommendations and I failed miserably! And then went crawling back into residential treatment less than a year later in worse shape than I was the first time around.

Back in 2010 I worked with domestic violence victims and I remember this one statistic they taught us - that it takes an average of 7 times for a person to leave their abuser before they actually leave for good. That was 7 years ago and I'm not sure if that stat is still accurate but it reminds me of addiction treatment.... relapse is almost par for the course (I know some don't relapse but many of us have been they this a few times), but what's important is that we keep trying.

One of my favorite quotes goes something like "Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, 'I will try again tomorrow"...,.

 

[dopemaster]

I would say outpatient.

Inpatient feels like a combination of jail, a psych ward, and jesus camp if you are lucky enough for religion to not be offensive. I dunno it its just paying someone to lock you up and make you wake up and do stupid shit like coloring and at least here they are anti-aa/na and personally the aa and na people coming by was the highlight of my day as far as what they had planned. The food was worse than jail and you are treated like an inmate. The food is worse than jail too and I find there is less freedom so I would rather go to jail twice as long if it was a court thing.

I get the medication I need to not die of a siezure in jail but inpatient hell no, they kept having to take me to the hosptital till eventually I didn't qualify for inpatient. I feel like they are not equipped to deal with heavy duty drug addiction. Also if you have a criminal record, you get treated like extra shit and are less likely to get your medication and they always ask if you really need it. I don't see why they want to take people of non narcotic medications or medications that are medically required and replace it all with psych meds, they hope for the best and make it your fault if they can't help you.

That is just my experience and I live in a state with the worst healthcare in the country.

Outpatient you are treated more as a peer, a fellow person in recovery. There are more honest and open converstations. The goals are more realistic. The motto of one place was "progress, not perfection" and that is realistic. I see drugs smuggled into inpatient, at least in outpatient people will talk about if they used and why and they don't tell your PO if it is a court thing but I personally never admitted to using and I knew exactly when the drug screens were but really other people would piss in a cup for me at times.

Outpatient has actually worked for me and it takes time and long terms support. The idea you can have someone locked up and just because you paid 20-50k for it does not make it the best gift ever, its actually a cruel and selfish act to place a family member in drug treatment against their will because guess what, if they don't want to stop using they won't.

I actually met a doctor who sent his brother to rehab and he told me how it went down. He called the cops on him and basically got it so his charges would go away if he went to inpatient drug treatment which dude did. It put a rift between them and within a month of being out his brother died. I suppose the doctor knew I was a drug addict and my family and just wanted to say inpatient isn't the best idea. I really don't want to say how I know this doctor or what type of doctor he is other than an ethical and good one. He knew my mother had pulled an involuntary and I was assesed sane and not drug addicted so he just wanted her not to do it again because they probably would put me in for 3-12 months.

I really don't feel like linking to articles about people dying in drug treatment but it happens quite often and there are close calls pretty much on the daily. Their mantra is heads on beds and that is what they care about at the end of the day. I would imagine it is a highly lucrative business. The outsides and waiting rooms look so nice but the inside is like a jail.

I am pretty jaded on inpatient and have almost died in there several times. At this point I would smuggle drugs in my damn self. I wouldn't be too keen on counting on someone who isn't good at that time of thing or paying premium for something I actually need and I am fucking glad I don't qualify for inpatient.

Anyways I am coming up on a year of outpatient. I graduated after 4 months but still go and I don't go as often but it keeps me in check. It took longer than graudating to stop abusing drugs and of course I am a liar and always will be with the system.

 

[Captain.Heroin]

I've never done either. From what I've witnessed in others, in-patient tends to work better than IOP. That doesn't mean that can be generalized to everyone, however.

 

[cj]

I would say outpatient.

Inpatient feels like a combination of jail, a psych ward, and jesus camp if you are lucky enough for religion to not be offensive. I dunno it its just paying someone to lock you up and make you wake up and do stupid shit like coloring and at least here they are anti-aa/na and personally the aa and na people coming by was the highlight of my day as far as what they had planned. The food was worse than jail and you are treated like an inmate. The food is worse than jail too and I find there is less freedom so I would rather go to jail twice as long if it was a court thing.

I get the medication I need to not die of a siezure in jail but inpatient hell no, they kept having to take me to the hosptital till eventually I didn't qualify for inpatient. I feel like they are not equipped to deal with heavy duty drug addiction. Also if you have a criminal record, you get treated like extra shit and are less likely to get your medication and they always ask if you really need it. I don't see why they want to take people of non narcotic medications or medications that are medically required and replace it all with psych meds, they hope for the best and make it your fault if they can't help you.

That is just my experience and I live in a state with the worst healthcare in the country.

Outpatient you are treated more as a peer, a fellow person in recovery. There are more honest and open converstations. The goals are more realistic. The motto of one place was "progress, not perfection" and that is realistic. I see drugs smuggled into inpatient, at least in outpatient people will talk about if they used and why and they don't tell your PO if it is a court thing but I personally never admitted to using and I knew exactly when the drug screens were but really other people would piss in a cup for me at times.

Outpatient has actually worked for me and it takes time and long terms support. The idea you can have someone locked up and just because you paid 20-50k for it does not make it the best gift ever, its actually a cruel and selfish act to place a family member in drug treatment against their will because guess what, if they don't want to stop using they won't.

I actually met a doctor who sent his brother to rehab and he told me how it went down. He called the cops on him and basically got it so his charges would go away if he went to inpatient drug treatment which dude did. It put a rift between them and within a month of being out his brother died. I suppose the doctor knew I was a drug addict and my family and just wanted to say inpatient isn't the best idea. I really don't want to say how I know this doctor or what type of doctor he is other than an ethical and good one. He knew my mother had pulled an involuntary and I was assesed sane and not drug addicted so he just wanted her not to do it again because they probably would put me in for 3-12 months.

I really don't feel like linking to articles about people dying in drug treatment but it happens quite often and there are close calls pretty much on the daily. Their mantra is heads on beds and that is what they care about at the end of the day. I would imagine it is a highly lucrative business. The outsides and waiting rooms look so nice but the inside is like a jail.

I am pretty jaded on inpatient and have almost died in there several times. At this point I would smuggle drugs in my damn self. I wouldn't be too keen on counting on someone who isn't good at that time of thing or paying premium for something I actually need and I am fucking glad I don't qualify for inpatient.

Anyways I am coming up on a year of outpatient. I graduated after 4 months but still go and I don't go as often but it keeps me in check. It took longer than graudating to stop abusing drugs and of course I am a liar and always will be with the system.

Your right about many inpatient places not being equipped to deal with a real serious detox from benzos or alcohol. Any idiot RN can get someone off opiates fairly safely but it takes knowledge and patience that most places lack to safely bring someone off long term gaba drugs. I saw a girl seizure bad during my first inpatient stay and the nurses where running like they had no clue wtf to do. It was at night so no doctor. They ended up having to call an ambulance and the girl didn't come back and was never spoken about again. Hopefully she was ok but looking back that's some scary shit.

 

[aihfl]

Even in top flight facilities worst case scenario can happen. My first medical detox was at Shands Hospital (University of Florida Hospital) in Gainesville and an attorney from Tampa who drank the better part of a handle of vodka daily had a seizure and went into cardiac arrest and died, all within full view of the rest of us.

I like the point dopemaster brought up. The place I've been detoxed the last two times looks great on paper (pool, gym etc.) but we hardly ever went. They have a 28 day program but since it is a psych hospital and not a rehab, it is a locked facility. I was going stircrazy after a week; I can't imagine spending four weeks there. The recovery wing was allowed limited time outside (one of the therapists would take us outside to do yoga if the weather was nice), but limited is the operative word. I don't know if the food was intentionally prepared to bind you up, but I don't think my colon could have tolerated four weeks of it. The best thing about the place, and the reason I'm returning to IOP there is that it's NOT Jesus camp. I mentioned earlier in this thread they use an evidence based treatment model developed by the Substance Abuse and Mental Health Services Administration. Plus, they don't have an issue with me continuing to take the Ativan I'm prescribed for panic attacks.

I was taken to a county-run detox facility about two years ago by the cops rather than being charged with public intox and the first thing I saw was a brawl over the telephone. I asked a guy if it was always like this and he said, "Yeah, pretty much." I asked him how this compared to "33rd St." (Orange Co. Jail) and he said he'd much rather be in medical at 33rd St.

 

[cj]

Even in top flight facilities worst case scenario can happen. My first medical detox was at Shands Hospital (University of Florida Hospital) in Gainesville and an attorney from Tampa who drank the better part of a handle of vodka daily had a seizure and went into cardiac arrest and died, all within full view of the rest of us.

.

Yeah that's fucking scary. A definite case of he would have been better off drinking or in an outpatient setting where there wasn't a huge rush to get him tapered to zero. That's the problems with hospital detoxs the beds are so coveted and expensive that the doctors are pushed to keep the detox right on the razor edge of what is safe. Every once in a while the razor tilts and bam that happens. Outpatient programs are the future of drug treatment for many good reasons and a few not so good ones but inpatient has basically priced itself out of the market. Plus the more studies that come out showing better or the same outcomes for patients inpt vs outpt the more insurance companies are going to balk at paying for inpatient care. They will become a niche market for those with cash and cater even farther to the individualized luxury care plan which is ironic because if they would create truely individualized treatment plans now they might get there relapse rates down far enough to justify there existence. Its the chicken and the egg I suppose.

 

[aihfl]

Your right about many inpatient places not being equipped to deal with a real serious detox from benzos or alcohol. Any idiot RN can get someone off opiates fairly safely but it takes knowledge and patience that most places lack to safely bring someone off long term gaba drugs.

I'm glad to hear you say this. During my last stay in detox the place was full of people coming off heroin/opiates and they scoffed at the relative severity of alcohol and benzo withdrawals. Dumb asses.

 

[neversickanymore]

^alcohol is the hardest drug on the planet imho

Most of the time people do iop right after ip. If a person has already done an ip or two they may try just jumping in at iop.

 

[cj]

I'm glad to hear you say this. During my last stay in detox the place was full of people coming off heroin/opiates and they scoffed at the relative severity of alcohol and benzo withdrawals. Dumb asses.

Having been through both I can safely assure you that benzo withdrawal makes opiate wd feel like a childrens drug.

 

[aihfl]

Having been through both I can safely assure you that benzo withdrawal makes opiate wd feel like a childrens drug.

I came off opiates and alcohol at the same time in 2014 so I can't speak as to how bad opiate WD alone is.

 

[neversickanymore]

I did methadone, oxy and benzos at pretty much the same time. I can honestly say that there is a limit to how bad a person can feel.

 

[cj]

I did methadone, oxy and benzos at pretty much the same time. I can honestly say that there is a limit to how bad a person can feel.

Yeah but that's cold comfort for someone facing it. You guys are tough I don't know if I could handle that.

 

[Jabberwocky]

lol cj I was pretty similar to you my first time around in residential... well maybe I didn't exactly have a fuck this attitude, I was more like "I've learned all I can here (CBT, DBT, mindfulness, etc) so I won't need any more help on the outside when I leave bc now I know everything and all I've got to do is put this knowledge into practice". Hmm... as I typed that out I think I did have a combo of fuck your recommendations and I know everything kind of attitude lol! I actually remember thinking "how hard can this really be, why do people relapse?!". Omg was I naive at that point! That was when I left and didn't follow any step down treatment recommendations and I failed miserably! And then went crawling back into residential treatment less than a year later in worse shape than I was the first time around.

Back in 2010 I worked with domestic violence victims and I remember this one statistic they taught us - that it takes an average of 7 times for a person to leave their abuser before they actually leave for good. That was 7 years ago and I'm not sure if that stat is still accurate but it reminds me of addiction treatment.... relapse is almost par for the course (I know some don't relapse but many of us have been they this a few times), but what's important is that we keep trying.

One of my favorite quotes goes something like "Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, 'I will try again tomorrow"...,.

Thank you for this post

 

[dopemaster]

I forgot who brought it up but my biggest problem with drug treatment is that I have panic disorder and take klonopin. I need it and you shouldn't taper someone off a mg a day or at all.

I dunno what type of quack thinks they can take you off a medication you have been on over a decade and take you off in less than a week when you have seizures if you don't take it.

Also they had problems with every non-narcotic medication that is schedule IV now but I really had some bad injuries but basically they wouldn't even let you take allergy medicine if you were allergic to cats and they had cats for example.

They did all this holistic stuff. I remember the psychologist calling the higher ups saying there was no way it was going to work and then she whispered to me "you should leave, you might die here" and shit got real.

I started phoning friends and family because I was already having pretty bad muscle spasms and if I checked in officially I was fucked and even though it was free I would be charged 1000 dollars a day for each day I wasn't there, so I imagine that is how they keep people there. I had just handed them my money for I guess their version of commisery so there I am in the middle of no where with no phone reception and them refusing to give me my money.

As far as the people I phoned for rides someone did come to get me but they told me a few lies. Your mother doesn't want you to call her until you finish and go to a halfway house, your girlfriend broke up with you, your friend said he won't speak to you until you finish our program. My girlfriend picked me up, my mother called and demanded to speak with me, and my friend had told them he could pick me up the next day at noon or later that night if need be.

I hadn't seen that friend in a while but he was a close friend and the only one near there and I was losing my shit quick. I had already gone through detox and was considered clean by AA/NA standards and I didn't see why I couldn't take muscle relaxers if my whole back spasms. It isn't like I haven't had some really bad injuries. They gave me some shit like they had someone addicted to muscle relaxers and I laughed and they told me it wasn't funny and I said yeah it is.

I wasn't about the buy this whole accupuncture which is 69.95 a session is all I need not to have pain for a week shit and to drink decaffinated imported tea for 4 bucks a pop shit.

So I was really surprised at the degree they isolate you from family. If I had gone through the whole check in process, you can't use the phone or see anyone for several months. I get it might work if you are not actually addicted to anything. I suppose the main problem was I needed to stay on klonopin and they let me keep it in jail at this point which is rare but the guys in county have seen me have a few seizures.

I thought I was fucked for sure when I left and my PO was going to put me in jail but she said if the place didn't suit my needs I could just do outpatient and that worked out pretty well for me. I think I was the only person to actually finish their program and most people just stay in it so they can piss dirty and still finish probation.

I still was disgusted they told me lies about my treatment plan because I wouldn't have gone there if I had none they would say one thing on the phone and did another the second my ride was gone. So when I was calling for a ride I started with my mother and the nurse was like no she doesn't want to talk to you and hung up the phone while I was talking and my mother freaked out and demanded to speak with me so I already knew they were lying because she said she was going to come up there if she couldn't speak with me.

I decided halfway through the paperwork when they told me about their no-benzo policy and I was out. I am on the anxiety medication for a reason. I don't know where they get off saying my gf left me or that my friend didn't want to speak to me. The whole time I was waiting for my ride they kept saying shit like "she ain't coming" or "I told you she left you" but there is a two hour deadzone and they knew it and I knew it so yeah she actually drove 4 hours to pick me up. I dunno why they tried to fuck up my friendship cuz when I talked to my friend his dog had just died and he ended up having to bury it that day so he was willing to come that night or in the morning.

Of course they don't make any money and they signed me up for six weeks to they really wanted to bill me for 40k dollars as I had a free ride because I wrote them a letter. It would have been one thing if I had known and they had not lied on the telephone.

I really do think they would have let me die of a seizure before taking me to a hospital. It is kinda too late if it takes 20 minutes to get to a hopsital and yeah a seizure can kill you and you can have worse from benzo wd so even with a month of clean time they insisted benzos had something to do with my heroin addiction.

I haven't used heroin just a week shy of a year now and I really don't think benzos are part of my past drug habit because I still take them and outpatient let me take them and didn't even bring them up but then again you could be on oxy and morphine and they wouldn't care. I have had the staff tell me they didn't think the most the people on heavy duty pain meds actually needed them and I know because half them were selling them and I of course didn't say anything, I kept my head down to anything like that as well as any corruption.

I don't think you can beat drugs or alcohol problems in a set amount of days and being forced into a rehab facility is never good. They are pretty good at selling their services and they are willing to lie and they don't care if you die. I get some people on a low dose of benzos probably don't need them but at 6 mgs you are looking at serious complications and some tea is not going to fix the issue because it goes far past relaxing a bit and an inevitable medical problem that they really shouldn't even try to ride out but would most likely just give me some antipsychotics and say it was suicide if it came down to it and I didn't pull through.

Anyways they were kinda obligated to keep me on benzos until I either checked out or got a ride and I was expected to be out by 6am in the morning and left at 2am and they gave me a load of shit and for some reason kept all my drawing pencils and mailed them to me. I am not a big fan of television and asked if I could bring a few sketch pads and pens. I suppose they wanted to check it very well for drugs because they were pissed they didn't get paid.

I think the problem is privatizing medicine. This place is not really any different than a state facility, it might have a nice couch but you have a roomate. You also for some reason are not allowed to talk to the opposite sex even though you might be sitting right next to them if you choose to sit in the commons room you can't say a word without being locked in your room for a day. I didn't even get through the rules before I started calling people and they still kept reading them to me like I was going to stay.

It really annoyed me that I told them I was leaving and they were like "what are you going to do walk" and I said if it comes down to it. They laughed but I actually have hitchhiked from alcohol detox about 250 miles so yeah I would have. When I left they wouldn't give me the money I just gave them, my wallet, and some of my stuff. I don't get it. I am an adult who signed in willingly and they did call my probation officer and I didn't give them the number. My PO was cool about it and said its like a suit and if it doesn't fit right its not the one you want. I was just glad I didn't wind up in jail.

I really feel like these people did everything they could think of to keep me there when it clearly was putting my life in danger.