Inpatient Versus Outpatient Rehab: What’s the Difference?

When it comes to addiction treatment, inpatient versus outpatient rehab both have their pros and cons when it comes to treating addiction and alcoholism. Certain categories of client do better in inpatient and outpatient is more appropriate for others.

This is blog number 16 in the series 20 things you should know about rehabilitative treatment: What works. This list was compiled by the European Association for the Treatment of Addiction, according to the latest evidence.

Inpatient versus outpatient rehab

What is the difference between inpatient and outpatient rehab?

Addiction treatment usually falls into two categories: Inpatient and outpatient programmes. They both have their unique place when it comes to helping addicts and alcoholics recover from addiction.

Inpatient programmes consist of intensive and residential treatment that is designed to treat severe addictions. Outpatient programmes are part time and allow the addict or alcoholic to continue to perform their responsibilities like going to work, university or school.

Deciding which option is best for you or your loved one can be difficult but it is an important choice that could affect the likelihood of an individual achieving long-term sobriety.

Inpatient treatment programmes vary in duration from 21 days to three or more months. There are primary (short-term), secondary (long-term) and tertiary (halfway house or sober living) inpatient treatment options. In an inpatient programme, individuals reside in a facility and have access to 24-hour support.

Outpatient programmes are designed to allow clients to continue working or studying and usually consist of a couple of hours of daily therapy over the course of a few weeks or months.

Intensive outpatient programmes have been found to produce similar results to those of inpatient programmes. Research has shown that 50 – 70% of people who completed intensive outpatient programmes were abstinent when followed-up by researchers which is similar to the success rates of inpatient treatment. Intensive outpatient programmes include a minimum of nine hours of commitments per week in at least three different sessions. These programmes often become less intensive over time with reductions in time commitments.

However, each programme has its unique benefits that apply differently to different types of client.

Board Of Healthcare Funders in South Africa
Hospital Association Of South Africa
Department of Social Development in South Africa
Department of Health South Africa
National Hospital Network South Africa

Who is best for outpatient?

Individuals with less severe addictions are usually good candidates for outpatient treatment.

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Some addicts and alcoholics are considered high-functioning and have managed to keep up with family, work or school commitments. This does not mean that their addiction is not affecting their lives but it does mean they haven’t (yet) progressed in the severity of their addiction. These addicts and alcoholics are encouraged to seek help and treatment before they lose all functionality and outpatient programmes are a good first option for this category of client.

Clients who are treatment-naïve, in other words those who have never been in treatment before, could consider attending an outpatient programme (depending, of course, on the severity of their addiction and other factors mentioned below).

Outpatient programmes are also appropriate for people who have not yet crossed the line from problematic substance abusers to full-blown chemical dependency.

Read – The 4 stages of addiction: When does drinking or drug use turn into addiction?

Research has shown that better results are achieved with 90 days or more of inpatient treatment, but many people may not have the time or money to attend more than the initial 21 – 42 days of inpatient primary treatment. Outpatient programmes are an important option for people who have completed primary treatment and have been found to greatly reduce the risk of relapse for these patients. Continuity of care over a longer duration has been found to be incredibly important as compared to shorter interventions, no-matter how intensive.

People who do not require detox are also good candidates for outpatient programmes.

Additionally, people with a stable and supportive home environment could consider outpatient addiction treatment options.

Who is best for inpatient?

Any person who has the time and resources would benefit from long-term inpatient treatment. However, there are specific categories of client for whom inpatient treatment is particularly appropriate.

People with severe and long-standing addictions should consider inpatient treatment for as long a duration as is possible.

Those who are likely to experience severe and dangerous withdrawal symptoms need to be admitted to an inpatient programme that provides a proper medically-assisted detox. People at high risk of dangerous withdrawal include those who are heavy users of alcohol, benzodiazepines and GHB.

If a person has attended treatment before (whether it was an inpatient or outpatient programme) and has subsequently relapsed, they are recommended to attend an inpatient programme for a period of three months or longer.

Inpatient care is recommended for people who reside in unstable and unsupportive, including abusive, home environments. Residential programmes are also recommended for people who are socially isolated, people who are medically unwell, homeless persons and those with severe co-occurring psychiatric problems.

Are you looking for a quality and evidence-based inpatient or outpatient treatment programme? Contact us today.

Otsile Ramarumo is a Recovery Assistant at Changes Rehab in JHB

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Clients Questions

When is inpatient care non‑negotiable for safety rather than just convenience?

Be blunt: inpatient care is about medical and environmental safety, not prestige. If your withdrawals are likely to be severe (alcohol, benzodiazepines, or mixed opioid/alcohol dependence), if there’s acute suicidality, unmanaged psychosis, severe medical comorbidity, or active IV use with infection risk, inpatient is the appropriate match to your needs. In Johannesburg that also means access to 24/7 nursing, monitored detox, and rapid referral to public hospitals if complications arise — things outpatient services can’t reliably provide. If your home environment is enabling violence, ongoing substance access, or coercion, inpatient removes those immediate risks so clinicians can stabilise you and build a realistic outpatient plan afterwards. Ask for a clinical risk assessment; it’s the only defensible way to choose level of care.

Can outpatient really work if I live in a high‑risk neighbourhood or a house full of using friends?

Short answer: sometimes, but only when the outpatient plan accounts for real-world risk. Outpatient is not just “attend sessions and go home.” For people living in unstable or gang‑affected areas of Johannesburg, outpatient must include concrete harm‑reduction measures — safe daytime spaces, transport solutions, supervised dosing if you’re on substitution therapy, or transitional housing if the home situation is toxic. If those supports can’t be put in place, outpatient becomes a revolving door back to dependence. Clinicians will look at your exposure to triggers, availability of sober contacts, and practical safety steps before recommending outpatient over residential care.

I’m the primary caregiver for my children and can’t be away for weeks — how do I choose treatment without losing custody or my job?

Nobody wants to choose between treatment and your kids or breadwinning. The right match balances clinical need with responsibilities. If your dependence is moderate and withdrawals are medically manageable, intensive outpatient or evening programmes can provide robust therapy without relocation, but only if you have reliable childcare and a stable home. If inpatient is clinically necessary, there are short admissions, phased residential placements, or step‑down options that preserve parental access and employment while prioritising safety — but you must plan this with clinicians, social workers, and sometimes your employer’s occupational health. Be transparent with your treatment team about childcare and work obligations so they can design a realistic, legally informed plan that protects your family and your recovery.

My GP has started me on methadone/buprenorphine — does that push me toward outpatient care or still require inpatient support?

Medication‑assisted treatment changes the calculus but doesn’t remove the need for personalised care. Opioid substitution can often be initiated and maintained safely in outpatient settings if there’s clinical monitoring, supervised dosing where needed, and psychosocial supports. However, if you have unstable mental health, polysubstance use, poor adherence history, or risk of diversion, starting medication in an inpatient or residential setting for stabilisation and dosing supervision is safer. In South Africa, access to regulated dosing sites and trained prescribers can be uneven, so the decision should factor in local availability, your HIV/TB status and medications, and plans for continuity of care — medication plus therapy is the match that reduces relapse risk, not meds alone.

What does a clinically sound step‑down from inpatient to outpatient look like so I don’t collapse back at home?

A step‑down needs to be a staged, concrete plan — not an optimistic discharge note. Clinically sound transition includes a handover meeting, scheduled outpatient therapy and psychiatry appointments within 48–72 hours of discharge, medication continuity (with clear prescriptions and dosing arrangements), and a safety plan identifying triggers and immediate contacts. It should also address housing stability, employment or schooling arrangements, and family or peer support structures in Johannesburg. Effective step‑downs often use intensive outpatient programmes for the first 2–6 weeks, weekly case management, and linkage to community support groups and medical services for at least 90 days when relapse risk is highest. If any of those pieces are missing, push your team to fill them before you leave inpatient care — that’s where most plans fail.

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Content on this website is for general information only and is not a substitute for professional medical advice, diagnosis, or treatment. Always speak to a qualified health professional about any medical concerns.
Changes Addiction Rehab PTY LTD (‎2013/152102/07) is licensed by the South African Department of Social Development (Practice No. 0470000537861) and the Department of Health, and is a registered detox facility and practice with the Board of Healthcare Funders. Our treatment programme is led by counsellors registered with the HPCSA, working alongside a multidisciplinary team of medical professionals under a unified practice. We are proud, standing members of the International Certification & Reciprocity Consortium (IC&RC), the Occupational Therapy Association of South Africa, the South African Council for Social Service Professions, the South African Medical Association, the South African Nursing Council and the South African Society of Psychiatrists. Changes Addiction Rehab has been in continuous professional operation since 2007, when it was founded by Sheryl Rahme, who has worked in the addiction treatment field since 1984. Our core clinical team brings over 100 years of combined professional addiction recovery experience.