Intensive Outpatient Program

Intensive Outpatient Program

Authored by Pin Ng PhD

Edited by Hugh Soames

Reviewed by Michael Por, MD

What is an Intensive Outpatient Program?

When choosing treatment for an addiction, it’s important to choose the right treatment. For many people, inpatient treatment is the only option, and it is seen as the gold-standard for a reason: it means round-the-clock attention in a dedicated recovery environment1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4152944/. However, for some people, this is not be viable, and for those, an intensive outpatient program (IOP) might be the answer.

What is an IOP?

The name — intensive outpatient program — gives a good indication of what it is. While it’s an outpatient program, there is no need to stay in a facility for a prolonged period, it still offers intensive treatment. This means that a client can benefit from the advantages of support without needing to stay in a facility.

IOPs may form part of the discharge process for people leaving residential programs, providing a staged move from inpatient, to outpatient, to recovery. For others, it might be the first, and best, choice for addiction treatment.

Why choose an intensive outpatient program?

When looking at treatment options, recovery is the most important consideration. Regardless of the benefits any option may have, there is no point in choosing it if it is unlikely to result in recovery. However, for many, IOPs can provide the treatment they need to successfully beat their addiction.

An IOP will have almost the same features as an inpatient program, but with the big difference that the client can stay in their own home2https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6985065/. Whether this is simply a matter of personal preference, or because they have responsibilities that mean an inpatient stay is impossible, an IOP can, usually, work around other commitments. For some, this may actually be a benefit, allowing them to move to recovery in their usual environment, rather than starting the process in an artificial, inpatient, environment. This is especially true if they have a support and understanding at home.

It also has the benefit that because it is not residential, it is a cheaper and more affordable option. While cost should not be the prime driver, it is an added benefit for those for whom it is a suitable option.

Why not choose an intensive outpatient program?

The biggest reason not to choose an IOP is for clinical reasons. If the addiction is severe, for example, the best chances of successful treatment will be at a clean, inpatient facility. Even if the addiction is not severe, any benefits of outpatient treatment may be undone if the home environment to which the client is returning is not supportive, or has lots of triggers for the addictive behavior.

It might also not be suitable for people who have, or might have, co-occurring disorders. Addicts will frequently have another mental health condition, and if this is the case an inpatient facility will be the best placed to manage both conditions.

Choosing an intensive outpatient program

Treatment choice should be guided by a medical professional who will be best placed to assess needs and the best treatment options, including whether an IOP is an appropriate treatment. However, if one is being considered, there are several factors that should be weighed as part of the decision. Many of these will apply to any treatment choice.

The most obvious, perhaps, is how close it is. There is little point in choosing an IOP that is not easily accessible. Treatment that is a lengthy commute will be inconvenient, and at increased risk of missed sessions and added stresses that will lessen the effectiveness of treatment3https://link.springer.com/article/10.1007/s11126-019-09681-w.

If a suitably located facility is available, then other factors to consider are the options they offer, such as whether they can provide a personalized program, and whether qualified medical staff are available. The range of treatment options should also be considered, looking for a facility offering research- and evidence-based treatment that is ongoing, providing support even after the initial program has finished.

What to expect in an intensive outpatient program

Each facility will offer something different, and the treatment should be personalized to meet the needs of the client. However, typically an intensive program will still require a considerable commitment. For many it will be the equivalent to a full-time job, attending for full days. This is likely to taper as treatment progresses, but at a minimum, it’s likely that attendance will be required three or four times a week for sessions that will last for half-a-day.

These sessions will likely comprise group therapy and individual therapy. Group therapy sessions will offer a supportive environment in which addicts can communicate, without judgement, offering mutual support and understanding in a safe environment. Individual therapy will focus on understanding the causes behind the addiction, and will be likely to use techniques like cognitive behavioral therapy to equip the client with tools to manage the situations they may face once treatment is over. Ensuring they can avoid triggers and resist temptation when it is presented.

Is an IOP the answer?

IOPs are not suitable for everyone. Those that have severe addictions, especially those like alcohol were medical supervision is essential for withdrawal, will require an inpatient program. And for some people, who perhaps do not have a supportive home or would be exposed to lots of triggers, may not be able to begin their recovery with outpatient treatment.

However, for those whose addiction had yet to become severe and with a supportive home, an outpatient program can be incredibly effective, allowing them to begin their treatment, and integrating into their normal life, right from the start.

Like any addiction, the treatment has to be right for the client and the addiction they seek to beat, and a medical professional is the best placed to advise. But, if the circumstances are right, an IOP can be the first step on the road to recovery.

References: Intensive Outpatient Program

  1. Guydish J, Werdegar D, Sorensen JL, et al. Drug abuse day treatment and intensive outpatient program: a randomized clinical trial comparing day and residential treatment programs. Journal of Consulting and Clinical Psychology. 1998;66:280–289. []
  2. McKay JR, Alterman AI, McLellan AT, et al. Effect of random versus nonrandom assignment in a comparison of inpatient and day hospital rehabilitation for male alcoholics. Journal of Consulting and Clinical Psychology. 1995;63:70–78. []
  3. Tiet QQ, Ilgen MA, Byrnes HF, et al. Treatment setting and baseline substance use severity interact to predict patients’ outcomes. Addiction. 2007;102:432–440. [PubMed] []
  4. Institute of Medicine. Prevention and Treatment of Alcohol Problems: Research Opportunities. Washington, DC: National Academy Press; 1989. []
  5. Finney JW, Moos RH, Wilbourne PL. Effects of treatment setting, duration, and amount on patient outcomes. In: Ries RK, Fiellin DA, Miller SC, et al., editors. Principles of Addiction Medicine. 4th. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins; 2009. pp. 379–386. []
  6. Van Etten ML, Anthony JC. Male-Female Differences in Transitions from Intensive Outpatient Program: Searching for Subgroup Variation by Age, Race, Region, and Urban Status. Journal of Women Health and Gender Based Medicine. 2001;10(8):797–804. [PubMed] []
  7. Mueser KT, Noordsy DL, Drake RE, et al. Integrated Treatment for Dual Disorders: A Guide to Effective Practice. New York, NY: Guilford Press; 2003. []
  8. Beck AT, Weissman A, Lester D, et al. The Measurement of Pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology. 1974;42(6):861–865.[]
  9. Snyder CR. Hope Theory: Rainbows in the Mind. Psychological Inquiry. 2002;13(4):249–275. []
  10. Stewart D, Gossop M, Marsden J, et al. Similarities in outcomes for men and women after drug misuse treatment: Results from the National Treatment Outcome Research Study (NTORS) Drug and Alcohol Review. 2003;22(1):35–41. []
  11. Rosenberg M, Schooler C, Schoenbach C, et al. Global Self-esteem and Specific Self-esteem: Different Concepts, Different Outcomes. American Sociological Review. 1995;60(1):141–156. []
Summary
Intensive Outpatient Program
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Intensive Outpatient Program
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When choosing treatment for an addiction, it’s important to choose the right treatment. For many people, inpatient treatment is the only option, and it is seen as the gold-standard for a reason: it means round-the-clock attention in a clean environment. However, for some people, this is not be viable, and for those, an intensive outpatient program (IOP) might be the answer.
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