In the Treatment of Alcohol Abuse there are No Clear Differences in Outcomes between Inpatient Treatment and Outpatient Programs

Alcohol use disorder has serious implications including increased risk of violence, motor vehicle collisions, and criminal activity. Treatment can be given in an inpatient/residential setting or in an outpatient/day-treatment setting. Given the significantly lower costs of the latter approach it is important to determine if there are differences in outcomes between these. However, one of the issues is that treatment programs vary greatly in many areas including duration, care setting, goal intensity, and amount of psycho-education. It is perhaps unsurprising, therefore, that research into differences between inpatient/residential and outpatient/day-treatment programs have produced conflicting results. Previous reviews have not determined a clear beneficial outcome for either approach, but have noted significant methodological issues which have limited the ability to potentially identify clear differences. Since there are significant cost differences between these approaches, and there has been a marked switch away from inpatient/residential programs for this reason, it is important to examine the recent literature to determine if these conclusions have changed. The primary finding from the current analysis is that there remains a marked lack of good outcome studies in this area. Issues include lack of details on many potential aspects that my affect outcome, such as the roles of age, gender, severity and nature of abuse, presence of co morbidity, and program details. From the limited literature available the only consistent finding is that, in general, longer-term programs are more successful than shorter-term programs for both inpatient/residential and outpatient/day-treatment settings. Future research is still needed to determine which program factors, such as goal intensity, care structure, psycho-education, therapeutic alliance, social and human capital, and the inclusion of an education program, actually affect outcomes. The rather dispiriting conclusion is that despite the huge impact of these conditions, the large sums being spent to address them, and recommendations for many years for the need for improved research regarding this issue, our knowledge regarding the most effective types of treatment for Alcohol use disorder remains limited. Perhaps the only conclusion possible at this time is that longer programs are likely to be more effective.