Intensive Outpatient Program

Intensive Outpatient Program

What is an Intensive Outpatient Program?

Intensive outpatient programs (IOP) are substance abuse rehabilitation programs where a person participates in daily substance abuse rehabilitation activities, yet returns home in the evening.1 This is a different option from residential or inpatient treatments.

Intensive outpatient therapy involves participating in at least nine hours of outpatient sessions per week. This is usually for about three hours for three days a week. However, some programs may offer longer or more frequent therapy sessions. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the minimum recommended amount of time to participate in an intensive outpatient program is 90 days.2 However, some people may find they need more time while others may transition to a less-intensive program more quickly. It is important that a person is aware that the longer they are treated, the better their outcomes are likely to be.

According to an article in the journal Psychiatric Services, intensive outpatient programs are the second-most common rehabilitation treatment option in the United States. The first is traditional outpatient treatment. In 2011, there were an estimated 6,089 intensive outpatient treatment programs in the United States. This number represents about 44 percent of all addiction treatment programs.

  • Intensive Outpatient Programs Make up 44% of All Addiction Treatment Programs 44% 44%

What Services Are Provided During an Intensive Outpatient Program?

Some of the services a facility might offer through intensive outpatient therapy include:

  • Drug and alcohol use monitoring

  • Educational programming

  • Family counseling

  • Group therapy

  • Individual counseling

  • Pharmacotherapy and medication management

  • Program intake and an orientation session

  • Treatment planning and review

What are the Two Phases of Mental Health Treatment During IOP?

Most experts divide intensive outpatient treatment into two phases. The first is treatment engagement and the second is early recovery.

During the treatment engagement phase, a person meets with a counselor to discuss their substance abuse. In addition to assessing the severity of one’s substance abuse, a counselor also asks questions about a person’s support network and daily abilities to function. The counselor will review with the person the overall goals for treatment and the expected duration of the therapy.

Some of the general services an intensive outpatient program provides include:

  • Building coping strategies to learn how to deal with strong cravings for substances or how to handle seeing people they used to drink or do drugs with

  • Educating a person on relapse and how to recognize the early stages of relapse

  • Helping a person identify and re-establish social supports to build a lifestyle free of substance abuse

  • Addressing a person’s overall well-being, including social, psychological, and emotional well-being

These treatment goals help a person work toward the early recovery stage. Once a person has achieved abstinence from substance abuse, the therapist will start to work with them to anticipate the transition to less-intensive treatments. Examples include participation in 12-step groups or continued individual therapy sessions.

How is Intensive Therapy Different from Other Levels of Care?

Intensive outpatient treatment is usually an alternative to inpatient or residential therapy. Doctors usually recommend inpatient treatment for patients who require medical detoxification treatments. This could include patients who abuse substances such as alcohol or benzodiazepines. Because these substances have the potential to cause adverse or life-threatening effects, doctors may also recommend residential therapy for those who may require 24-hour care and supervision. An example may include a person who is at risk of self-harm or who is having suicidal thoughts.

Addiction Treatment Has Five Levels of Care

The American Society of Addiction Medicine categorizes five levels of care for those seeking rehabilitation treatment. These levels range from 0.5 to IV and are as follows:

Level 0.5: Early Intervention Services

Level l: Outpatient Services

Level ll: Intensive Outpatient Services

Level lll: Residential and Inpatient Services

Level lV: Medically-Managed Intensive Inpatient Services

Using this structure, intensive outpatient services fall in the middle levels of care. For some people, intensive outpatient programs may be the first line of treatment while for others, they are a step-down option after residential treatment.

Other Differences Between Inpatient Programs and IOPs

In addition to differences in the place where a person receives care, there are a few other differences between intensive outpatient services and inpatient options. One example is that intensive outpatient treatment programs are usually longer in duration than residential programs. For example, many of the intensive outpatient programs are six weeks or more in duration while inpatient programs may be anywhere from five days to two weeks. Exceptions exist as to how long each of these approaches lasts.

Another difference is that a person in an intensive outpatient program has the opportunity to start practicing their new skills at home. They can start to anticipate problems and concerns they may have while being at home, and can address these in their therapy sessions.

Misconceptions and Factual Research About IOP Rehab

What Are Some Misconceptions About Intensive Outpatient Rehabilitation?

A common misconception about intensive outpatient programs is that they are only offered in rehabilitation facilities. In reality, a person can find intensive outpatient rehabilitation programs in a variety of settings. These include hospitals and community behavioral health centers.

Another misconception is that intensive outpatient programs cannot treat a person who suffers from substance addiction and mental health disorder.3 In fact, some intensive outpatient programs are specifically designed to help those who have mental health problems as well as addiction. Examples can include depression, anxiety, post-traumatic stress disorder, and obsessive-compulsive disorder. While intensive outpatient programs are not a good fit for those who have suicidal thoughts, they can be for those struggling with mental illness. Intensive outpatient programs may incorporate medication management for mental illnesses as part of their program’s component.

What Does Research Say About Intensive Outpatient Treatment?

Research review published in the journal Psychiatric Services studied the evidence surrounding intensive outpatient programs. They reviewed several randomized controlled studies, which researchers consider to be the gold standard in determining the level of evidence for effective care. Researchers concluded that “a wide range of service intensities can be effective for individuals with substance use disorders.” They identified a high level of evidence that intensive outpatient treatment programs can be just as effective as inpatient treatment programs, provided a person meets sufficient criteria for intensive outpatient treatment.

The study concluded that intensive outpatient programs demonstrated consistent effectiveness for reducing drug and alcohol use from admission to a program to follow-up. An estimated 50 to 70 percent of those who participated in intensive outpatient programs were sober upon follow-up.

  • Intensive Outpatient Program Participants that were Sober Upon Follow-Up 70% 70%

Researchers also concluded that, with some exceptions, there are few differences between intensive outpatient programs and inpatient programs. The study did find that some individuals experienced better results from inpatient programs than an intensive outpatient program. Examples include those who struggled with severe alcohol or drug problems and those who reported suicidal thoughts.

Is Intensive Outpatient Therapy a Good Fit for Me?

According to SAMHSA treatment protocols, there are several individuals for whom researchers have proven intensive outpatient treatment is beneficial.

These include the following special populations:

  • Those who are economically disadvantaged: Traditionally, intensive outpatient programs are not as costly as inpatient treatment options.

  • Women who are pregnant: Allowing a pregnant woman to remain in her home can provide greater stability and promote willingness to participate in treatment.

  • Individuals who are mandated by the court system or otherwise coerced into treatment: Those who do not enter drug rehabilitation programs of their own free will may find they are better able to stick with the program if they perform an outpatient treatment option instead of a residential treatment plan.

  • When a person can participate in an intensive outpatient treatment plan that is specific to their needs or culture: Examples include specialized treatment programs for Native Americans, Spanish-speaking individuals, or for adolescents.

Intake Assessment for an IOP Program

An intake counselor will conduct a full assessment of the drug abuse history, including if there has been previous rehabilitation and relapse. Counselors will also consider if there is a significant co-morbid medical condition or mental health concern that may make inpatient treatment a better option. They will also consider family and support at home. If a person does not have a stable home environment, intensive outpatient therapy may not be a good fit at this time.

Questions You Should Ask About an Outpatient Rehab Program

While not all people enter an intensive outpatient program of their own choosing or free will, many do. And those that do can often weigh their choices regarding services and the place where they can best see themselves succeeding. That is why it is important for a person to ask questions prior to choosing an intensive outpatient program or a residential one.4

Examples of these questions include:

  • How does the program incorporate research into best practices?

  • How does the program create individualized treatment recommendations? How often will my treatment plan be in review?

  • How long would you anticipate I would require treatment?

  • What are the next steps for me after I complete this level of treatment?

These questions can be a jumping-off point into deciding if intensive outpatient treatment is the right fit for them.

What is Detox Like in an Intensive Program?

A person should only detox in an intensive outpatient program if they do not have a history of abusing alcohol. Because alcohol abuse has the potential to cause severe symptoms during a withdrawal period, a person who is a heavy and long-term alcohol abuser should only detox at a medical facility. Also, if a person is wishing to detox from benzodiazepines by going “cold turkey” and not tapering their dosages, they should likely seek detox in a medical facility. This is because a person who suddenly stops taking benzodiazepines may be at greater risk of experiencing a seizure.

Most other people who are in good health can detox in an intensive outpatient program. In some instances, doctors in an intensive outpatient program may prescribe or monitor the results of pharmacotherapies. This could include if a person who is addicted to opiates such as painkillers or heroin opts to take medications such as methadone or Suboxone to reduce the severity of the detox and its side effects. A participant can receive their doses of these medicines in a treatment session.

Personal Impact of Intensive Outpatient Programs for Substance Abuse

How Might This Impact My Family?

SAMHSA recommends that a person’s family be involved in many aspects of intensive outpatient rehabilitation. Examples may include the monitoring of a person’s detox and immediately reporting any adverse or concerning symptoms to the program. The family also plays a vital role in encouraging the person to continue in their program.

Addiction and substance abuse can severely alter a family’s dynamic. Some family members may be in denial about their loved one’s problem. Others may feel disappointed, let down, and skeptical due to the person’s past behaviors. As a result, the family unit often needs time, education, and understanding. Some families may opt to participate in family group therapy sessions with their loved one or without. Sometimes, families may require additional education to gain a better understanding of addiction, the recovery process, and how the family can rebuild their relationships over time.

How Can I Make My Treatment a Success?

One of the most important factors in the success of intensive outpatient therapy is a smooth transition from intensive treatment to an outpatient one. Often, rehabilitation programs will recommend counseling sessions to follow intensive outpatient therapy at different durations so that a person is still actively participating in their recovery process. An example might be going from five intensive outpatient sessions a week to three for two weeks and then twice a week for another two weeks. Making efforts to bridge the gap between intensive programs and less-intensive options can help a person prevent relapse.

It is also important for a person to remember that recovery is a continued journey. Even if a person graduates from an intensive outpatient program, they will still benefit from continued participation in counseling and group therapies. For example, those who participate in a 12-step program (such as Alcoholics Anonymous) after treatment typically yield higher rates of sobriety than those who do not. As a result, most substance abuse experts encourage graduates of intensive outpatient programs to think of the process as a new beginning, not a complete end to their journey.

Beat Addiction with IOP

Intensive outpatient programs are an effective way to help a person achieve abstinence from substance abuse and learn how to rebuild their life and family relationships. With some exceptions, most research has found that intensive outpatient programs are an effective alternative to residential programs. Intensive outpatient programs can be more affordable to those in recovery and can also help a person remain in their home with their supportive loved ones.


Resources

  1. https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201300249
  2. https://www.ncbi.nlm.nih.gov/pubmed/22514853
  3. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states/types-treatment-programs
  4. https://www.drugabuse.gov/sites/default/files/treatmentbrochure_web.pdf

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