Intensive outpatient treatment (IOP) is known to be incredibly effective, as much as residential treatment. In fact, research has shown that the length of time in treatment is more important than whether it is inpatient or outpatient. Unfortunately, few people understand exactly how drug treatment works and even fewer people know exactly what to expect during treatment.
- Understanding the Concept of Intensive Outpatient Treatment
- Can Intensive Outpatient Programs (IOPs) be Successful?
- How Long Does IOP Last?
- How Effective is IOP?
- The Process and Procedures of IOP
- The Benefits of IOP
Understanding the Concept of Intensive Outpatient Treatment
The first thing to understand is that a lot of research has been completed in terms of what type of treatment is and is not effective for people who suffer from an addiction. In fact, since 1999, the National Institute on Drug Abuse (NIDA) has been updating their Principles of Drug Addiction Treatment: A Research-Based Guide, and is now on its third edition.
“Drug addiction is a complex illness. It is characterized by intense and, at times, uncontrollable drug craving, along with compulsive drug seeking and use that persist even in the face of devastating consequences.”
Guiding Principles of Addiction Treatment
In the guide, 13 principles have been incorporated, which must be adopted in order for the treatment to be effective. This is true for all forms of treatment, from non-intensive outpatient treatment to long term residential rehab. These principles are:
- Addiction is a complex but treatable disease that affects brain function and behavior.
- No single treatment is appropriate for everyone.
- Treatment needs to be readily available.
- Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.
- Remaining in treatment for an adequate period of time is critical.
- Behavioral therapies – including individual, family, or group counseling – are the most commonly used forms of drug abuse treatment.
- Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
- An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs.
- Many drug-addicted individuals also have other mental disorders.
- Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.
- Treatment does not need to be voluntary to be effective.
- Drug use during treatment must be monitored continuously, as relapses during treatment can occur.
- Treatment programs should test patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk-reduction counseling, linking patients to treatment if necessary.
Interestingly, these principles have been demonstrated to be true, that they have also been adopted in treatment facilities in other countries throughout the world.
Can Intensive Outpatient Programs (IOPs) be Successful?
Intensive outpatient treatment programs can be incredibly successful, so long as it is done properly. This means, first of all, that the 13 concepts above are incorporated. Secondly, the IOP must incorporate the right types of services, as has been reported in the Substance Abuse: Clinical Issues in Intensive Outpatient Treatment guide.
“A set of core services is essential to all intensive outpatient treatment (IOP) efforts and should be a standard part of the treatment package for every client. Enhanced services often are added and delivered either on site or through functional and formal linkages with community-based agencies or individual providers.”
Before patients go for an IOP, they must be completely assessed and evaluated. The goal of this is to determine whether they are a suitable candidate for intensive outpatient treatment, or whether they would be better served by going to a residential facility. This is in accordance with Principle 2, which recognizes that no single treatment is suitable for every individual. Someone who requires intensive medical supervision, someone who has a history of relapse, someone with a chronic drug abuse history, someone in a destructive relationship, and/or someone who is a danger to themselves or others, for instance, should not attend an IOP.
Research has shown IOPs to be a successful and integral part of continued care. When enrolled, people should receive social, behavioral, and psychological support services. The key to these programs, however, is that the patient can continue to live at home.
How Long Does IOP Last?
Commonly, patients will need to attend an IOP session three times per week, either during the day or during the evening. When they first enroll, they will take part in therapy for a number of hours, often five times per week. However, over time, this frequency and intensity is reduced, so that people can once again learn to be independent and rely on their personal support network. The Matrix Model is a 16-week IOP program, with social support groups that continue free-of-charge for 52 weeks.
How Effective is IOP?
A comprehensive study, Efficacy of an intensive outpatient rehabilitation program in alcoholism: predictors of outcome 6 months after treatment, has been published on the long-term efficacy of IOP programs.
“Treatment of alcohol-dependent patients was primarily focused on inpatient settings in the past decades. The efficacy of these treatment programs has been evaluated in several studies and proven to be sufficient. Results of this study indicate a favorable outcome of socially stable alcohol-dependent patients and patients with a lower degree of depression, anxiety and craving in an intensive outpatient rehabilitation program.”
Key to the effectiveness of IOP is the type of treatment that they offer.
Types of Therapy in IOP
Numerous forms of treatment have been identified to be effective in the treatment of addiction. Each of these options have their own pros and cons, however, as identified in Chapter 8 of the Substance Abuse: Clinical Issues in Intensive Outpatient Treatment guide.
“Intensive outpatient treatment (IOP) programs use a variety of theoretical approaches to treatment. No definitive research has established a best approach to treatment, and many factors (such as client characteristics and duration of treatment) influence research outcomes. However, studies have found positive associations between several treatment approaches and client outcomes.”
The different types of therapy utilized in intensive outpatient treatment are:
- Group therapy, whereby the patient interacts in a safe, secure environment with their peers, who are at varying stages of recovery. This enables them to learn from and be inspired by others, and do the same for those who are newly arrived.
- Cognitive behavioral therapy (CBT), which is delivered on an individual basis, and whereby the patient learns to recognize their thought processes and make adaptations to their reactions to certain triggers. CBT also includes homework in order to be effective, however, and this can be somewhat of a downfall, particularly if people are not motivated enough.
- Individual therapy, which is very important in the earliest stages of treatment. Here, the patients are in a private environment where they can discuss their private fears, feelings, thoughts and situations. These often must be resolved before they can join and benefit from group therapy.
- Workshops, which are designed to educate people on a variety of subjects. This includes how to get in touch with inner emotions, how to develop coping skills, how to prevent relapse, and understanding sobriety.
- Goal setting, which is one of the key parts of IOP, as this is necessary to empower patients to move towards the future. Goal setting starts with short term goals that are easy and simple to achieve, moving on to more intensive, complex goals. A plan to make these goals come true is also included and regularly reviewed.
- Family therapy, whereby the patients can rebuild bridges with their loved ones and understand the damage they have done. At the same time, families can learn how they can offer better support to the patient. Key here is that these sessions should be non-judgmental. Rather, they should be about love, compassion, empathy, and understanding.
- Drug testing, which will be completed when someone first enrolls, but also at regular intervals thereafter. This isn’t about not trusting patients, but rather about motivating them to stay sober. This also makes them accountable for their own recovery.
The Matrix Model, endorsed in the 2016 Surgeon General’s Report, Facing Addiction in America, combines all of the above modalities in a cohesive drug treatment program.
The Process and Procedures of IOP
- Engaging in treatment and beginning the journey
Getting the first treatment stage right is vital to making sure that patients can recover. Usually, this stage lasts just a few days, although it can be extended to several weeks if that is needed. The goal is to stop people from dropping out of treatment. During this stage:
– Client goals are set and responsibilities of both patient and professionals are set out.
– Acute crises are resolved if they are present.
– A relationship between the patient and the counselor is formed.
– A treatment plan is designed.
- Early Recovery
Over the course of six weeks to three months, patients enter what is known as ‘early recovery’. This is characterized by developing services suitable to the specific needs of the individual. Usually, it includes group therapy, educational sessions, family counseling, psychotherapy, CBT, and so on. During this stage, recovering patients learn to understand their relationship with substances, and they develop the skills to make positive life choices. The goals are:
– To encourage and help maintain abstinence.
– To remove drug using activities and replace them with sober activities.
– To practice treatment routines in order to sustain behavioral changes.
– To understand what the root personal issues are, and to resolve them.
– To encourage full participation in help programs.
The Benefits of IOP
There are numerous benefits associated with intensive outpatient treatment, one of them being that it is highly effective. Furthermore, it is a lot more affordable and convenient. As such, it breaks through some of the greatest barriers to people accessing treatment. People attending IOP groups in the evenings are able to continue school and/or work while receiving treatment. Because research shows that the length of time in treatment is the most critical part of recovery success, it is a better use of funds to attend a longer IOP program, rather than a 30-day residential program, for example. Of course, it all depends on severity, as mentioned above. Those with severe withdrawal symptoms are likely better off first going to detox. Those with severe mental health disorders, severe social circumstances, or inability to stay sober in an outpatient setting may require residential treatment.
The overall goal of all addiction programs is to help patients live a happy, healthy, sober life, and IOP can play a very important role in that.
Learn more about Matrix Intensive Outpatient Treatment programs.
This article is presented for informational purposes only and does not constitute medical advice. If readers are in need of medical advice, they should consult a doctor or other appropriate professional.