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An intensive outpatient program (IOP) is a form of substance abuse rehabilitation in which people visit a treatment center several days a week for a few hours at a time. An IOP is more time-intensive than most standard outpatient programs. However, unlike an inpatient program, it does not require participants to live at the facility.

Intensive outpatient programs typically meet on weekdays in the morning or evening. Programs primarily consist of group therapy, though they may offer other services such as individual counseling and employment assistance. Most programs last about 90 days and include drug testing.


What Is an IOP?

person talking to a doctorOutpatient substance abuse treatment is a form of rehabilitation in which people are treated on a part-time basis and return home after each session. These programs are typically well-suited for people with less severe addictions, minor to no mental health issues, and a solid base of support.1

Intensive outpatient programs (IOPs) take place more often than typical outpatient programs—usually 9 hours or more of treatment per week for 3 to 5 days.2

Group therapy is the main component of many intensive outpatient programs. Groups allow IOP participants to improve their communication, learn how to socialize without drugs or alcohol, support each other, and experience structure and discipline.3

Other IOP services include individual counseling, medication management, case management, introduction to support groups, psychiatric screening, and vocational training.3

IOP Goals

Goals of intensive outpatient programs include:2

  • Maintaining abstinence.
  • Achieving behavioral change.
  • Participating in support systems such as 12-step groups.
  • Addressing psychosocial issues such as housing, employment, and meeting probation requirements.
  • Developing a support system.
  • Improving problem-solving skills.

Can I Detox in the Program?

Detox is the first stage of substance abuse treatment. It involves allowing the body to eliminate any traces of drugs or alcohol before treatment begins.4 After detox, a person is ready to engage in treatment with a clear head and a clean system.

Most intensive outpatient programs do not offer detox services. However, programs that are located inside a large hospital may be able to offer medical detoxification.3

If you need detox, the IOP will probably refer you to a standalone detox facility, residential facility, hospital, or other program for detox before you begin treatment with them.

Some people do not experience serious withdrawal symptoms and can manage the process on their own. These people can start treatment right away without going through a formal detox first. However, the majority of people who have been alcohol- or drug-dependent for any significant amount of time will struggle with at least some unpleasant withdrawal symptoms that, left unmanaged, may make them more likely to relapse. In some instances, withdrawal complications can be quite severe. For these reasons, supervised detox is often recommended to provide the support necessary to make it to the other side of withdrawal unscathed.

How Is an IOP Different from Inpatient?

The major difference between an IOP and an inpatient program is that people treated in an inpatient program live at the facility while they receive their care. Residential programs also offer services and amenities that IOPs do not, such as meals, housing, recreation, and access to medical care.

Inpatient programs are usually a good fit for people who have longstanding or more severe addictions. Some people in these programs have had multiple relapses and need to be kept away from drugs and alcohol for an extended period of time. Inpatient facilities are also good options for people who live in home environments that are particularly unstable or triggering or who have mental health conditions that require dual diagnosis treatment.

Pros and Cons

Each program has pros and cons, and which one is best will differ for every person.

  • Benefits of inpatient: 24-hour medical monitoring, a structured drug-free environment, and distance from triggers.
  • Drawbacks of inpatient: a higher cost than outpatient, the time commitment, and being away from loved ones and work.
  • Benefits of IOPs: ability to live at home while in rehab, lower cost, and flexible schedule.
  • Drawbacks of IOPs: returning to an environment where there may be temptations to use and the lack of medical care/detox services.

In some cases, people may transition or step down to an intensive outpatient program after completion of an inpatient or residential rehab program. That way, they can ease back into their normal routine while still receiving care and building on the skills they need to remain sober.2

On the other hand, some people may move up to a more intensive outpatient program if standard outpatient interventions are inadequate in promoting their recovery. For example, they may increase the number of groups they attend in the program each week.2

How Long Does It Last?

Intensive outpatient programs generally consist of 9 hours or more of treatment for 3 to 5 days per week, though some programs may offer fewer hours per week. You can expect IOP treatment to range from 6 to 30 hours per week and to last about 90 days. Typical therapy sessions will be between 1 and 2 hours.2

Even though 90 days is the standard length of treatment, the duration can be adjusted based on the person’s needs, support system, and mental health status.2  A person that builds skills and remains clean, for instance, may require fewer and fewer sessions over time, while someone who relapses while in the program may need more sessions or even need to be moved up to a higher level of care.

What Can I Expect?

IOPs use several different types of therapies. The most common include:5

  • Cognitive behavioral therapy: CBT is based on the idea that thoughts and behaviors—including self-destructive behaviors such as drug abuse—are learned and that people can learn new ways of thinking and behaving. Participants learn the triggers—or people, places, and things that lead them to use drugs—and acquire skills to deal with these triggers.
  • Motivational interviewing: For this approach, the therapist helps a person understand their reluctance to engage in treatment and work through that hesitation. The therapist asks the user to examine how drugs are interfering with their life goals and teaches them to take responsibility for developing healthier behaviors.
  • Matrix Model: The Matrix Model draws on several other approaches, including CBT, motivational interviewing, and the 12 steps. It is mainly used with people who are addicted to stimulant drugs, such as cocaine and amphetamines. The Matrix Model focuses on establishing a strong therapist-client relationship, teaching clients how to effectively manage their time, practicing relapse prevention techniques, and engaging in community peer support groups.
  • 12-step facilitation: IOPs that incorporate this approach help participants to learn the principles of 12-step programs, start to work the steps, and attend 12-step groups in their communities. Twelve-step groups such as Alcoholics Anonymous and Narcotics Anonymous usually hold meetings onsite in IOPs that use this approach.

Schedule

Most IOPs begin with an assessment of the person’s needs. A therapist then creates an individualized recovery program for the person based on where they are in their recovery process. The person works with the therapist on a schedule for how many days and hours they will attend the program each week. As mentioned above, this schedule can be adjusted depending on how the person progresses through the program.

Group talking in a circleMost programs meet on weekdays. Many centers that offer IOPs have day and evening programs that usually meet for 3 hours each day. For example, day programs may run from 9 a.m. to noon and evening programs may run from 6 p.m. to 9 p.m.

During that time, participants meet for groups and take breaks in between. Common types of groups found in IOPs include:

  • Relapse prevention.
  • Skill-building.
  • Codependency support groups.
  • Family groups.
  • 12-step groups.
  • Addiction education.
  • Process groups.

Drug Testing

Most intensive outpatient programs conduct drug testing. However, the frequency of testing varies. Some programs test once a week, while others test 2 or 3 times per week. Others test participants randomly.

Drug testing is a normal part of many treatment protocols. But programs don’t test participants to “catch” them using drugs. Instead, they test them to ensure that they adhere to program rules and to protect other members of the program from people who are using drugs. A positive drug test is also a sign that a person may need to step up to a higher level of treatment.

What Happens Afterward?

After a person completes an IOP, they will meet with their therapist to determine next steps. If the person met all their goals in the program, the therapist will usually recommend the person continue on with a less intensive level of care.

Options may include:3

  • Less frequent group therapy sessions in an outpatient program.
  • Weekly individual meetings with a therapist or psychologist.
  • Attendance at 12-step groups.
  • Alumni meetings at the IOP.
  • Periodic check-ins by phone.

A person may participate in a combination of these—it all depends on their situation. They may also be referred to other community resources such as vocational training, family therapy, or medical care.3

The important thing to remember is that a person isn’t “cured” when they complete an IOP. Staying clean requires work, and most people who have been addicted to drugs or alcohol need to continue to be involved in ongoing care.3 Meeting with a therapist or support group helps a person stay motivated, work on relapse prevention skills, and help other people with their sobriety, all of which can help maintain abstinence.


References

  1. National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: Treatment Settings.
  2. Substance Abuse and Mental Health Services Administration. (2006). Intensive Outpatient Treatment and the Continuum of Care.
  3. Substance Abuse and Mental Health Services Administration. (2006). Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Treatment Improvement Protocol Series, No. 47.
  4. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Types of Treatment Programs.
  5. Substance Abuse and Mental Health Services Administration. (2006). Intensive Outpatient Treatment Approaches.
Last updated on March 1 2019
2019-03-01T16:45:32+00:00
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