Outpatient treatment sounds good, right? Outpatient rehab settings require recovering addicts to spend several hours per week in an outpatient addiction program. But, for some people, traditional outpatient treatment for addiction might not be enough.
This is when you want to look at a more intense treatment. That would be Intensive Outpatient Treatment (IOP). But, what is it, what does it treat, and is it the right prescription for your situation?
What is an Intensive Outpatient Program (IOP)?
When a longer stay in residential treatment is not possible or necessary, IOPs have long been a way to continue addiction treatment. IOPs also serve as a step-down from a more intensive treatment such as inpatient or residential treatment as people transition back into their community.
As a part of a continuing care program, IOPs have proved to be immensely beneficial. They are direct services for people with substance use disorders or co-occurring conditions who don’t require medical detoxification or 24-hour supervision.
IOPs are designed to provide behavioral, psychological, and social support therapies to patients while they continue to live at home. This allows patients to continue to participate in educational, work, and family activities while still attending treatment at a facility in the morning or at the end of the day.
What is Treated in an IOP?
IOPs are mainly used to treat these disorders:
- Bipolar disorder (including mania)
- Unipolar depression
- Eating disorders
- Substance use disorder that doesn’t require detox
- Transitional treatment for patients just released from psychiatric or residential treatment
What is the Purpose of an IOP?
IOP treatment operates on a small scale and doesn’t use intensive residential or partial day services. Programs are ambulatory services for people with substance use disorders (SUDs) who don’t meet the diagnostic standards for residential or inpatient treatment.
Intensive outpatient treatment is also appropriate for people who have been discharged from 24-hour care in a residential facility. These people still need more support than the weekly or bi-weekly sessions typical of traditional outpatient programs.
A psychiatric intensive outpatient program is aimed at patients who have primary mental health issues. A dual diagnosis intensive outpatient program is for patients who have difficulties with drug and/or alcohol dependence along with mental health issues.
Participants in IOPs have the chance to use the therapy groups to be able to recognize and understand problematic patterns in their lives. This helps them restore life role functions and supportive connections in their community.
How Long Does IOP Treatment Last?
IOPs typically offer a minimum of nine hours of service per week, in three, three-hour sessions. Some programs offer more sessions per week or sessions with longer durations, and some become less intensive over time of treatment. Since services are provided in an outpatient setting, that may cause the duration to be longer than that required for inpatient services. Patients remain in their homes and learn to recover in their community.
The length of treatment in IOP is usually three to four months. Lengthier programs may be needed for patients with more serious addictions. When a person completes an intensive outpatient addiction program, they will continue to addend outpatient therapy sessions for several more months and up to a year after.
What Services Does an IOP Offer?
There is a set of core services essential to all intensive outpatient programs. These are standard services offered to every patient. Enhanced services such as child care or arranging transportation may be offered at some facilities based on individual needs. These core services are:
Group Counseling and Therapy
Groups form the most important part of most intensive outpatient programs. Recent studies have shown that for relapse prevention training, the group therapy method is as effective as one-to-one therapy. Group counseling allows programs to reduce the cost compared to the more expensive individual counseling.
Group therapy supports patients by:
- It provides a chance for clients to develop better communication skills and socialization experience. This is particularly useful for patients whose socializing has typically revolved around using drugs or alcohol.
- The group experience creates an environment where patients help, support, and confront one another when necessary.
- Group therapy helps introduce structure and discipline into the lives of patients whose lives are often chaotic and undisciplined.
- It provides norms that bolster healthy ways of interacting in a supportive and safe, healing environment that is necessary for recovery.
- Personal recovery can be enhanced for group members who are further along in their recovery, who can then help other members.
- Group members can exchange new information, teach new skills, and guide other members as they practice new behaviors.
- It offers different types of groups throughout treatment to address different skills.
Types of groups are:
- Psychoeducational—These provide a supportive place where patients can learn about SUDs and the consequences. They typically occur early in treatment and are low-key instead of emotionally intense. Relapse training is also provided.
- Skills development—These groups provide the opportunity to practice behaviors within the safety net of the treatment setting. Skills development includes:
- Drug or alcohol refusal training during which patients act out situations of refusing the offer.
- Relapse prevention techniques. Patients analyze the triggers and high-risk situations for substance use and ways to avoid them.
- Assertiveness training. This teaches patients the differences between aggressive, assertive, or passive behavior. Patients are encouraged to practice being assertive.
- Stress management helps patients recognize situations that might cause stress and learn techniques to respond to stress.
- Support groups combine patients in the same recovery stage and who are working on similar issues. They practice changing negative thinking, tolerance, conflict resolution, and examining how one person’s actions affect the group.
- Interpersonal process groups—These groups either focus on a single issue of personal importance such as gender, sexual orientation, or sexual abuse. They may also be families or couples groups that assist patients in learning about the effects of substance use on family members and significant others.
In IOP, individual counseling is an important complement to group therapy, not the main form of treatment. However, psychiatric interventions and addiction counseling are suitable for patients with co-occurring substance abuse and mental health disorders. This is called a dual diagnosis.
Generally speaking, counseling in IOPs addresses the current problems created by the patient’s substance use disorder and their present efforts to achieve and maintain sobriety. A 30- to 50- minute counseling session is typically scheduled at least weekly during the initial treatment stage. A primary counselor is assigned to the patient to build a collaborative relationship.
An individual counseling session usually consists of the counselor bringing out the patient’s reactions to group meetings. He might also explore how the patient spent his time since the last session. He will ask how the patient is feeling, inquire about drugs or alcohol use and ask if there are any pressing issues.
The therapist helps the patient analyze his reactions to group topics. They will discuss treatment plans and coping strategies. Issues that might be too personal to discuss in group therapy will be examined. Therapists also help patients access services they need that are outside the program’s capacity and plan the transition to another level of care or discharge.
Psychoeducational groups are oriented more towards teaching and involve a straight-forward communication of facts. Counselors who implement these services need to be uncommonly knowledgeable about the subject matter. These sessions, like recovery groups, need to elicit discussion that helps the patients relate the topic to personal experiences and encourage emotional and behavioral change.
Some of the typical topics discussed in psychoeducational groups are:
- Understanding motivation and committing to treatment
- Determining the seriousness of the problem
- Conduction self-assessment and setting goals
- Overcoming barriers
- Understanding the effects of drugs and alcohol on the brain and body
- Learning about withdrawal symptoms
- Learning about the stages of recovery
- Recognizing high-risk situations and triggers
- Learning strategies for quitting and finding the motivation to stop
- Understanding cravings and urges
- Understanding abstinence and the use of prescription and over-the-counter medications
- Learning daily living skills, parenting, and educational skills
- Understanding relapse and developing relapse plans
- Rebuilding personal relationships
Pharmacotherapy and Medication Management
Pharmacotherapy is the treatment of a disease (SUD) with drugs. These are crucial components of effective substance use treatment. Pharmacotherapy itself does not change lifestyles or restore normal functioning, but medications do target the specific and limited aspects of substance use disorders.
The programs that require attendance 3 to 5 days a week are perfect for identifying patients that need medication and monitoring compliance.
Pharmacotherapy and medication management services help in several ways:
- Provides detoxification and relief of withdrawal symptoms
- Reduces craving and prevent relapse
- Reduces the medical and public health risks from the use or injection of illicit drugs
- Relieves the original disorder that may be contributing to a substance use disorder
- Observes the treatment of some medical conditions associated with substance use disorders
Despite extensive laboratory research and clinical trials, there is no convincing evidence of effective medications for treating dependence on cocaine and other stimulants, marijuana, inhalants, or hallucinogens. However, research does support the effectiveness of medication-assisted treatment for alcohol and opioid dependence.
Many patients who enter IOP treatment have co-occurring mental disorders. Those patients with moderate-severity disorders may be treated in programs that are primarily designed for patients with substance abuse disorders. These programs will work in coordination with mental health services. Moderate-severity co-occurring disorders include stable mood and anxiety disorders with psychotic features and borderline personality disorder.
Monitoring Drug and Alcohol use
IOPs include routine monitoring of patient’s illicit drug and alcohol consumption to decide if the therapy selected has the desired effect. Occasionally, programs rely on the patient’s self-reporting, but most use the objective method of testing specimens.
Monitoring helps clinicians decide the need for treatment adjustments, help families regain trust and helps patients avoid lapses, and discourages them from substituting a different drug or alcohol for their drug of choice.
Individuals who abuse substances are likely to have other interrelated problems in addition to their substance use. Services to concentrate on these issues may be split up across several agencies.
It might be difficult to access help without the assistance of a case manager who is knowledgeable about service providers and who is able to help patients contact these services. Case managers help patients prioritize needs that can’t be handled by the IOP.
Case management services include:
- Provide a core set of social services that include assessment, monitoring, and advocacy
- Provide the patient with a single contact person who is responsible for finding necessary resources
- Respond to the patient’s needs for personal assistance
- Speak with providers on behalf of the patient
- Focus on immediate ways to meet needs (e.g. clothing, shelter)
Twelve-step fellowships are the most common and widely attended groups for recovery support. Participating in a 12-step group such as AA, NA, or CA is positively associated with both retention in treatment and abstinence. Step groups provide principles of conduct and support for as long as the individual wants to attend.
Who Benefits from an IOP?
An intensive outpatient program for drug or alcohol addiction can be very successful, especially if the person is a willing participant. IOPs are an important part of the continuum of care for substance use disorders. They are considered as effective as inpatient treatment for most people.
Since you are inquiring about treatment programs, make the next step, and contact Harmony Ridge Recovery Center. We have a detox program that will prepare you, or someone close to you, for one of our treatment programs.
Our clinicians will develop a treatment plan that is right for you to get life back on track. A substance use dependence doesn’t have to define you or derail your life.