Intensive Outpatient Treatment for Addiction

Intensive outpatient treatment, sometimes referred to as IOP, is a form of treatment for addiction recovery. It can be undertaken without the patient needing to remain in their chosen facility for the duration of their treatment. Instead, they will attend each a treatment programme each day for a pre-determined amount of time.

An IOP is similar to an outpatient programme but generally requires more time and input from the patient. These types of programs may also be used to help patients with conditions such as eating disorders and other mental health issues such as depression and are ideally suited to those who do not need 24-hour care.

An IOP may sometimes be integrated with an inpatient programme and in this case, will serve as a way to gradually move the patient back into their normal surroundings.

How Can We Help?

Rehab 4 Alcoholism is here to advise on the suitability and availability of intensive outpatient treatment for addiction. As the name suggests, outpatient treatment allows you to return to your home following the completion of daily therapy sessions.

This contrasts with residential rehab, where you must remain in the treatment clinic both day and night until your treatment programme concludes.

The main benefit of intensive outpatient treatment over residential rehab is that you may continue to undertake important responsibilities such as childcare whilst you undergo your treatment programme.

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What Is The Difference Between Outpatient And Inpatient Treatment?

When looking at addiction recovery programs, you will often be given the choice between outpatient and inpatient treatment – the key difference between these two is that an inpatient programme requires you to remain in the rehab centre whilst you treatment takes places whereas an outpatient option allows you to undergo treatment whilst still living at home.

Another notable difference of the outpatient programme is that whereas with inpatient treatment, you relinquish control to the rehab centre, you do not need to do this with an outpatient program, you remain in control of your life and do not have to give up your responsibilities such as work and taking care of your children.

Why Choose Intensive Outpatient Treatment Over Residential Treatment?

Whilst an inpatient programme will provide patients with the best care and great chances at success, the disruption to life or the uncertainty of staying in an unfamiliar environment can prove too much for some people and so an IOP is an excellent alternative.

This is especially true for those who have to remain at home to take care of children, go to work or fulfil other responsibilities but who still require help with their addiction.

Unlike a regular outpatient program, an IOP delivers an intense treatment that can be very effective but they do require the patient to co-operate and participate. 

These programs usually work very well for people who have a good support network within the community such as family member and close friends who can support them through their recovery.

What Are The Main Benefits of Intensive Outpatient Treatment?

Intensive outpatient treatment is geared towards treating alcoholism and co-occurring mental health problems. Intensive outpatient treatment is available in a female-only or men-only setting. Alternatively, you may begin treatment at a mixed-sex clinic.

Intensive outpatient providers offer a rich offering of therapy and counselling. These offerings make use of evidence-based treatments such as one-to-one therapy, group therapy, 12-step work, cognitive behavioural therapy and dialectical behavioural therapy. You will also be subject to daily drug and alcohol screening.

Debunking The Criticism Around Outpatient Treatment

In the past, some criticised outpatient treatment for lacking intensity. This was because some programmes may have required you to undergo as little as one or two therapy sessions per week.

This criticism has largely been overcome by the introduction of intensive outpatient treatment. These programmes offer up to four or five sessions per week.

Generally, the number of weekly sessions is reduced over a twelve-month period. This means you may attend five daily sessions at the beginning of your treatment programme. This number will then be tapered down to as little as one session per week once your programme begins to conclude.

Who Is Eligible For Intensive Outpatient Treatment?

Many people might be able to take advantage of an IOP, and the most common eligibility falls into one of the following categories:

  • A patient who has completed an inpatient programme and wishes to use an IOP as a way to transition back to their regular lives or who still needs medical care but can cope living independently
  • People who have experienced many relapses
  • Those who are unable to afford to pay the high costs of an inpatient program.
  • Patients who are suffering from domestic abuse or lack of family support and other such stressful issues
  • People who will not benefit from a regular outpatient programme but who cannot/do not wish to stay in a rehab centre
  • People who have been diagnosed with another condition alongside their addiction such as a mental health disorder

What To Expect From Our Intensive Outpatient Treatment Programme

Any kind of addiction treatment can be overwhelming, intimidating but ultimately life-changing and it can help to relieve your anxiety if you understand what can be expected from the program.

In the case of an IOP, there will be many treatment options and what you take advantage of will depend on your personal care plan and your circumstances.

For the most part, IOP’s require patients to take part in between 10 and 12 hours of treatment and therapies each week, in addition to this, you will also be encouraged to seek out and take part in a community 12-step program, many of which can be found around the world.

When taking part in this type of treatment, you will usually visit a centre around 3 times per week and each visit can be expected to last for around three hours. During these visits, you will have access to a wide range of therapies, such as:

  • Group therapy – this will allow you to develop your communication skills and allow you to meet new people, most of whom will be dealing with similar problems and can, therefore, act as a support
  • Individual therapy – this will be a safe space for you to explore your emotions and personal issues with a therapist who can advise and offer support
  • Complimentary therapies – this may come in the form of music therapy, art therapy and equine therapy among others and provide patients with a way of relieving stress during the healing process and expressing themselves in alternative ways
  • Support groups – often coming in the form of a 12-step program, support groups give patients the chance to explore their addiction and their emotions with other people who are struggling with similar issues

How The CIWA-AR Scale Is Used To Determine If IOP Is Suitable

The CIWA-AR (clinical institute withdrawal assessment – alcohol revised) is a scale used to determine whether a patient has a dependency on alcohol. It is frequently used to decide on whether that patient should receive an ambulatory detox or requires an inpatient treatment program.

A medical professional will answer a series of questions based on the patient’s presentation and score them accordingly.

It is common practise that anyone scoring more than 20 on the scale should be recommended for inpatient treatment. It is also agreed that those who score lower than 8 typically do not require medication for going through withdrawal.

How Soon Can I Expect To Be Treated?

During the beginning stages of your IOP, you will be given a detailed assessment, this will determine your requirements and allow your care team to develop a plan of treatment for you.

What is notably different about an IOP compared to inpatient treatment is that you will be able to work alongside your therapist to come up with a treatment plan that fits in around your day to day life.

Each day of attendance can be altered to suit your needs. Day sessions take place usually from 9 am until midday and evening sessions beginning at 6 pm and finishing at 9 pm.

During these sessions, you can expect to take part in things such as skill-building, family therapy, 12-step programs, relapse prevention, education and support groups. Breaks will be given between activities for you to take a breather and ingest what you have learned.

Intensive Outpatient Treatment Timeline Overview

At the beginning of your treatment programme, you must be willing to commit at least four days per week to your treatment. You will return home during the evening and then return to the clinic in the morning and afternoon.

Once you have completed the initial phase of your treatment, the number of daily sessions will be reduced to two or three sessions per week. Towards the conclusion of your treatment programme, you will attend only one treatment session per week. Typically, intensive outpatient treatment is run over a twelve-month period.

Once your intensive outpatient treatment programme has concluded, you will still be able to attend after-care therapy sessions. After-care is also known as continued care. You will be able to access after-care sessions for as long as you need them.

What Happens Before Intensive Outpatient Treatment Begins?

Before your intensive outpatient programmes begin, you will be assessed by a psychiatrist. This is to determine your general suitability for an intensive outpatient programme. It may be deemed necessary for you to undergo a medically supervised detox before you begin an intensive outpatient programme.

If this is the case, you must undergo treatment at a fully residential clinic for around fourteen days. Once your detox is complete, treatment may then continue via the intensive outpatient treatment provider.

This initial assessment helps to flag up co-occurring mental health problems. If a dual diagnosis is diagnosed, the clinic will seek to treat your alcoholism and mental health issue simultaneously. Doing so is known to result in the best possible clinical outcome.

What Happens Once Intensive Outpatient Treatment Has Begun?

Once you begin your treatment, you will be assigned to a key worker. This person will carry out individual case management to ensure you are achieving your weekly and monthly treatment goals.

Intensive outpatient sessions typically run between three to five hours each day. During this time, you will benefit from psychotherapy, holistic therapies, family therapy and behavioural therapies. The clinic will also monitor any medications you may be taking to ensure compliance.

Therapy sessions help you to develop the skills you need to cope with stress and negative emotions. Emotional regulation and distress tolerance are two major goals of intensive outpatient treatment.

Mindfulness and stress management techniques will be covered in depth by participating in dialectical behavioural therapy. You will build these skills using activities, workshops and group discussions.

What Topics Does Intensive Outpatient Treatment Address? 

Usually, at the beginning of treatment, psychoeducational groups aim to provide patients with an education surrounding substance abuse and its effects. There is some sort of structure given to these groups, with the following topics being discussed in sequence:

1. Treatment engagement

  • Gaining an understanding of motivation and making a commitment to treatment
  • How to counteract denial and ambivalence
  • Finding out how serious the drug or alcohol problem is
  • Setting goals, self-assessment and monitoring
  • How to overcome common barriers of treatment

2. Early recovery

  • Biophysical diseases and the recovery process
  • Gaining an understanding of the effects of certain drugs on the body and mind
  • Symptoms of drug or alcohol abuse in the context of behavioural issues
  • Withdrawal symptoms of specific drugs
  • Stages of recovering and the patient’s place in continuing care.
  • Quitting and find your motivation
  • Lowering the risk of HIV/AIDS, Hepatitis C and STI’s
  • How to identify situations which may be triggers
  • Learning to structure personal time
  • How to cope in risky situations
  • Learning about over the counter medications and abstinence
  • Information on 12-step programs
  • How to use positive support

3. Maintaining sobriety and continued care

  • How to spot warning signs of relapse
  • Tools for relapse prevention
  • Creating a relapse plan
  • How to counteract euphoria and a desire for test control
  • Coping with stress – stress management
  • Relaxation and anger management
  • Improve self-efficacy for coping with risky situations
  • How to safely respond to a ‘slip-up’
  • Resources for recovery
  • Searching out leisure activities
  • Personal health including diet, hygiene, exercise and medical checks
  • Personal inventory
  • How to cope with depression, guilt, shame etc
  • Family dynamics
  • How to rebuild a friendship
  • What is healthy behaviour when it comes to sex
  • Developing vocational and educational skills
  • Day to day skills such as managing money, accommodation and legal services
  • Finding spirituality
  • Relating loss and grief to substance use
  • Understanding parenting: stages of development, child’s needs etc
  • How to maintain a balanced life

How To Choose The Best Option

An IOP should be made up of at least nine hours of treatment each week to fall into this category. This should be the first thing that you look for when choosing an option that works for you.

However, on top of this, other things should be considered when selecting an IOP that you wish to join. These include:

  • A good IOP will provide you with an initial assessment of both your psychological and physical health
  • Each IOP should operate using methods which are based on evidence and have been proven to be geared towards success
  • Those providing your treatment should be professionally trained and qualified, although some adjunctive care is provided albeit sparingly
  • Your IOP provider will be responsible for ensuring that they develop a personal treatment plan for you
  • The focus of the provider should be not only to aim for recovery but also on helping the patient remain in the treatment
  • The IOP should interact with and include the family and close friend of the patient throughout treatment
  • Help in accessing and joining additional support such as community groups should be given
  • The IOP should provide participants with a good level of education surrounding substance abuse

What Happens After Intensive Outpatient Treatment?

Once your IOP treatment has ended, you will have the chance to talk through the next steps with your therapist. This does not mean that your care ends here. You will likely be offered a variety of ongoing support options to ensure your continued sobriety.

Some of these might include attending less frequent group sessions as an outpatient, continuing one to one sessions with a therapist, phone appointments, alumni meetings at the IOP centre and 12-step meetings.

Having this type of continuing support can greatly reduce your chances of relapse and help you to keep your health and recovery as a main point of focus.

FAQs On Intensive Outpatient Treatment

Below we have answered some of the most commonly occurring questions when it comes to outpatient treatment. Take a look at the queries below to see if they address any of your concerns:

1. Is Intensive Outpatient Treatment Effective?

Substantial evidence suggests that intensive outpatient treatment programs are an effective way of combatting substance addiction and rehabilitating patients back into their lives.

There is an out-dated belief that this type of treatment would only be beneficial for those who were considered ‘high functioning addicts’ but this opinion has shifted with IOP being used for a variety of patients with good levels of success.

IOP is effective due to the detailed assessment it begins with. This allows the care team to determine the severity of the illness as well as being able to diagnose and underlying health conditions.

All of this is done under the supervision of a qualified professional to ensure the process runs smoothly and effectively. Besides this, a personalised and ongoing treatment plan is developed to ensure the best chances of success.

2. Can I Detox On The Programme?

Detoxification requires intensive medical supervision and this is often done in an inpatient facility. Therefore, an IOP will not usually offer detox as a part of the programme due to the requirement of remaining in a centre.

However, there are some programmes which are based in a hospital environment that can offer this kind of treatment.

If detox is not available but you need to do one, you will likely be referred on to a separate facility. You will need to detox before beginning the intensive outpatient treatment programme.

3. How Long Does Intensive Outpatient Treatment Last?

Each IOP will be tailored to the needs of the patient and so will vary in length and hours attended each week. For the most part, IOPs can be expected to last between 6 and 30 hours each week.

This process will usually continue for around 90 days but this can vary from person to person. For example, if you relapse during the program, more time may be added on to ensure you have the correct level on support.

4. Can I Still Access Medication In Conjunction With An IOP Programme?

The use of medication is not a separate entity to therapies which focus on your psychological health. Accessing medications whilst taking part in an IOP is a must.

Your healthcare team who are running the programme will monitor your medication. However, it is important to remember that whilst these medications do serve a purpose, they are not the cure for addiction. Attending your regular sessions is a must to tackle your illness.

5. Can I Still Drink Alcohol If I’m In Outpatient Treatment? Will They Know?

Ultimately, the decision to take drugs or alcohol remains your own. But it is important to consider why you reached out for treatment in the first place. Continuing to use a substance during treatment is seriously detrimental to your recovery and certainly not advised.

That being said, most IOP’s will require you to submit to regular urine tests to determine whether there is any amount of the substance in your system. Some will simply ask if you have used the substance.

This is not done as a way to shame you but rather to monitor your progress. If you are relapsing, your care them can adjust your treatment accordingly and provide you with a higher level of support.

6. What If I Need Help At Any Time? Can I Access It?

One of the disadvantages of being in an outpatient programme of any kind is that you do not have immediate access to support around the clock as you would in an inpatient program. However, this doesn’t mean that there is a lack of support available.

There are hotlines which you can call for immediate support and advice which, if necessary, can be used to contact staff from your IOP. In addition to this, you will also have access to an on-call doctor, of which there will be one available 24/7. In some cases, when the IOP is out of hours, patients will have the ability to be put through to a 24-hour rehab centre who can assist.

7. Are The 12-Step Programs Widely Used In IOP?

12 step programs are an integral part of the recovery of many people struggling with addiction all over the world and are often used within intensive outpatient treatment programs.

The most commonly recognised are Alcoholics Anonymous and Narcotics Anonymous and the central focus of these groups is on spirituality and continued support for an indefinite period.

There are a variety of 12-step programs in use with IOPs, some of which are geared towards specific groups such as the LGBTQ+ community or gender-specific groups.

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