One of the most common problems following residential treatment for any type of addiction is what to do next, and that’s where IOP, or intensive outpatient program, fills the void. Most patients seek out a form of residential or inpatient treatment as their first step to recovery. Inpatient rehabilitation occurs in a designated facility and usually lasts 30 to 45 days. After completing inpatient recovery, patients transition to IOP where they engage in individual and group therapy along with a range of support meetings.
While undeniably effective, relapse is still a risk. In fact, the rate of relapse for addiction is similar to that of other chronic diseases. This is where an IOP can be helpful. Attending this type of program can mean the difference between successful recovery and relapse. IOP is a valuable cog of the continuum of care.
What Is IOP and Who Are These Programs For?
The intensive outpatient program is often recommended for two core purposes:
- Patients with an addiction mild enough that medically supervised detox is not required
- Patients who want to continue their recovery journey after successfully detoxing in a residential setting and completing inpatient treatment
IOP is suitable for anyone suffering from alcohol dependence or drug addiction, but is recommended after a residential program.
According to SAMHSA (Substance Abuse and Mental Health Services Administration), around eight million Americans suffer from co-occurring disorders. IOP is able to provide simultaneous treatment for both addiction and mental health issues.
While not residential in nature, a decent intensive outpatient program will provide crisis services and there’s often a 24-hour hotline available. With family members involved in these programs and encouraged to provide a supportive home environment, patients are able to reap many of the advantages of an inpatient program without the restrictions of remaining at a facility overnight.
Goals of These Programs
Although an inpatient program can often be the safest and most effective approach for withdrawal and detox from severe addiction, leaving the cocooned environment of a treatment center without proper follow-up in place is risky. An outpatient program allows those addicted to drugs or alcohol to start rebuilding a solid foundation for continued recovery in a familiar environment but with all necessary support in place.
The full list of goals for intensive outpatient programs according to SAMHSA can be found here.
Some of these include:
- Continuing to abstain from drinking alcohol or using drugs
- Implementing behavioral changes
- Enhancing problem-solving skills
- Ensuring that a dependable support network is in place
- Dealing with housing, employment, and probation issues as appropriate
- Attending 12-step groups or other programs like SMART Recovery
How Long Does IOP Usually Last?
The National Institute on Drug Abuse (NIDA) recommends that outpatient programs should last approximately 90 days. However, some programs operate on a session-based schedule. For instance, Landmark Recovery conducts its IOP program over 30 sessions, typically scheduling three sessions each week. When treating methadone maintenance, providers usually consider 12 months as the minimum treatment duration, which can significantly extend the program.
Typical Schedule of IOP
A pre-admission assessment personalizes treatment, eliminating a catch-all schedule. However, we expect all patients to conform to the established schedule. Addiction treatment typically requires anywhere from 6 to 30 hours a week.
We design the nature of IOP to provide flexibility, allowing those in recovery to start normalizing their situation. The hours and timing of sessions fluctuate based on patient needs and schedules. Treatment blocks usually last from 3 to 4 hours on 4 or 5 days of the week. Individual sessions usually take 90 minutes and sometimes occur consecutively.
Most programs run on weekdays, offering both daytime and evening sessions to accommodate patient schedules. By default, groups consist of patients at similar stages in their treatment.
Core Components of IOP
As mentioned, IOP can be a first line form of treatment, a step down from a residential program or a step up from a more loosely structured outpatient program. Regardless of where the patient enters IOP on the continuum of care, there’s a range of common core services offered in line with the SAMHSA Treatment Improvement Protocols.
- Close monitoring of alcohol use and/or drug use
- Group counseling sessions
- Individual counseling sessions
- Medical treatment
- Mental health treatment
- Behavioral therapy
- Training in various core life skills
- Support group meetings
- Exposure to educational opportunities
- Case management
- Pharmacological tools
- 24-hour crisis management
Many other pastoral and vocational elements can be offered. From fitness and nutritional programs to childcare and family programs, there are many ways IOP helps patients to systematically rebuild and normalize a life that might have spiraled out of control.
Therapists also use counseling sessions, group sessions, and individual therapy extensively to teach patients new life skills and improve their communication methods. One of the benefits of IOP is that patients can take the lessons that they learn from their counseling sessions and put them into action immediately as they live life.
What Types of Therapies Do Therapists Use?
While research doesn’t conclusively favor one type of therapy over others, therapists use many theoretical approaches in intensive outpatient program therapy.
The Most Common Styles of Therapy Used in IOP
- CBT (Cognitive Behavioral Therapy): Therapists base CBT on the premise that all thoughts and behaviors, including destructive ones like excessive drinking or drug abuse, are learned. They guide patients to recognize what triggers these harmful behaviors and develop new skills to manage them effectively.
- 12-Step Programs: In many IOPs, therapists teach the fundamental principles of 12-step programs. They assist patients in beginning to work through these steps and encourage them to attend local 12-step meetings outside the intensive outpatient facility. When an IOP provides this treatment model, groups such as AA and NA often hold meetings on-site for easy attendance.
- Motivational Interviewing: A therapist may assist a patient in overcoming previous reluctance to treatment using this approach. It depends on the patients assuming responsibility for their actions and analyzing how alcohol or drug abuse has affected their lives. This process aids in the progression towards healthier and more productive behaviors.
- Matrix Model: The Matrix Model encompasses the three approaches mentioned above. Therapists find this approach most effective for patients addicted to stimulants like cocaine. Building a strong, patient-therapist relationship enhances its effectiveness. The focus of this model is time management, relapse prevention, and engagement in community support groups to secure lasting sobriety.
- Therapeutic Community: In this type of therapy, therapists consider the broader community as a therapeutic agent. The basic belief is that recovery is a developmental journey. Therapists promote mindfulness and total honesty in all situations. The guiding principle of this approach is that change is the only constant.
Many other types of therapy can be used with or without these styles of counseling.
Do These Programs Conduct Drug Tests?
The majority of intensive outpatient programs conduct drug tests daily, weekly or entirely at random to ensure the consistency of the program and the patients participating. A positive test is often an indication that a patient needs to be stepped up the continuum of care to an enhanced level of treatment.
How Does IOP Differ From Residential Treatment?
The obvious difference between inpatient programs and intensive outpatient programs is the living situation. Inpatient means living in a facility and outpatient means living independently, but attending sessions daily.
While residential programs cost much more than IOP, they are also much more intensive and offer many more services than IOP. They also call for a far greater time commitment and demand time spent away from family. That said, if the patient doesn’t have a home that provides a supportive and amenable base, this can render intensive outpatient programs sub-optimal. It’s commonplace for someone successfully completing a residential program to step down to an IOP to continue their recovery.
Primary Benefit of Residential Treatment
- Around-the-clock care in a highly structured environment with a distance from the normal triggers for addictive behavior
Primary Benefit of Intensive Outpatient Programs
- The ability to live at home – assuming the environment is suitable – allows for more streamlined integration back into the community
Are Family Members Allowed to Attend an IOP?
Family members play a crucial role in an IOP. These programs are most effective when there’s a solid system of support in place at home and an atmosphere conducive to recovery.
Family education programs help to provide family members with the knowledge, information, and skills they need to help maximize the chance of their loved one recovering without relapse. Family members will receive the support they need to get through such a tough time.
Does IOP Actually Work?
A 2014 study published by the American Psychological Association gave a meta-analysis of multiple studies into the effectiveness of intensive outpatient programs. Most of these studies found that 50 to 70% of participants were still abstinent at an initial follow-up after completion of the program. To put this into perspective, roughly the same success rate follows from inpatient treatment.
The other primary benefits of IOP are the increased duration of the program and the ability of patients to reintegrate into family life and enjoy going home every day. While it’s tough to establish success rates, with the right degree of commitment, IOP following residential treatment can be successful for most types of addiction.
Upon completion of an intensive outpatient program, the patient will meet with their therapist to establish whether the patient has met all the goals of the program. Assuming this is the case, the therapist normally recommends the patient steps down to a slightly less intensive stage of care. In some instances, this might be a continuation of IOP but with less frequent group sessions. On other occasions, the therapist might reduce care to weekly individual meetings. This can sometimes be achieved over the phone. There are other ways to continue treatment including attending 12-step groups in the community.
It’s also possible the therapist will suggest combining several of these approaches. As with all aspects of an IOP, treatment is personalized to increase the chances of success. There’s no silver bullet strategy that works best.
Following an intensive outpatient program, community resources like training, family therapy, and ongoing medical care are a vital component of sustained recovery. Arguably the most critical part of completing IOP is the understanding that recovery and lifelong sobriety requires ongoing work. Rather than being cured, a patient who successfully completes this form of treatment is one stage further along in their journey to continued abstinence. Regular meetings with therapists and attendance at recovery groups can increase the chances of success. A supportive family can also make a dramatic difference.
Call 888-448-0302 for more information on IOP.
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