Intensive outpatient programs (IOPs) are treatment programs used to address addictions, depression, eating disorders, or other dependencies that do not require detoxification or round-the-clock supervision. They enable patients to continue with their normal, day-to-day lives in a way that residential treatment programs do not. Whereas residential treatment requires that clients reside on site, clients in intensive outpatient programs live at home.
IOPs are sometimes used in conjunction with inpatient programs as a way of helping clients to more smoothly and seamlessly adapt back into their families and communities. They are designed to establish support mechanisms, help with relapse management, and provide coping strategies.
Why Choose an IOP Over Residential Treatment?
IOPs are an important aspect of care for people seeking help in overcoming addiction. For many people, inpatient care – whether in a hospital, clinic, rehab, or other facility – can be challenging. These live-in treatment options often provide the highest level of care, separating people with addictions from access to the drugs or alcohol they abuse and from other people who may encourage relapse or actively sabotage recovery efforts; however, they aren’t always feasible. People often have family or work commitments that prevent them from entering fulltime care. They simply can’t leave their lives behind for an extended period of time.
For these people, IOPs are often the best choice. They still get intensive treatment but they are able to reside at home.
Ideal candidates for intensive outpatient treatment have a safe home environment. This means encouraging family members and friends who are ready to support their loved one in their recovery efforts. If a person lives with other people who use drugs or drink, residential treatment is generally recommended to get the person away from these triggers for relapse.
IOPs are generally not recommended for those with severe cases of addiction or co-occurring disorders. Generally, these cases are referred to inpatient treatment since they require more immersive treatment and 24-hour supervision.
Stages of Addiction Treatment
There are several stages of treatment for issues with addiction. The American Society of Addiction Medicine has defined five levels of treatment as part of a “continuum of care.”
- Level 0.5: early intervention services
- Level 1: outpatient services
- Level 2: intensive outpatient or partial hospitalization services
- Level 3: residential or inpatient treatment services
- Level 4: medically managed intensive inpatient treatment services
IOP is considered Level 2 treatment.
What to Expect
The care received via an intensive outpatient program will vary from facility to facility and from provider to provider, but it generally consists of 10-12 hours of group and individual therapy each week, plus encouraged participation in a 12-step program. These sessions usually occur on site at a medical or therapeutic facility, but some options are being developed for individuals to participate in online programs. This can be especially useful for people who live in remote locations or in towns where adequate treatment services simply aren’t available.
Clients in IOPs usually visit a facility three to four times per week, often for three hours at a time. Again, the specifics will vary from program to program, but according to the Substance Abuse and Mental Health Services Administration (SAMHSA), most programs require 9 to 20 hours of participation per week. An IOP provides a higher level of care than standard outpatient programs, and this means more time spent in treatment each week.
Group therapy tends to serve as the core of most IOPs. Some studies show group participation is as effective as individual therapy in treating addiction.
Participation in a group offers support for clients in a variety of ways.
- It offers clients the chance to enhance their communication skills and provides a new resource for socialization. This is especially important in addiction, as individuals’ previous socialization is often with others who use drugs or alcohol.
- It gives participants access to an environment where people in similar situations provide support, comfort, and honest feedback.
- It can reinforce healthful ways of interacting and provide a safe space that is vital to recovery efforts.
- Group members who are farther along in their recovery often offer valuable assistance and empathy to those who are early in the recovery process.
- It provides a forum for therapists and group leaders to pass on important information, teach new skills, and guide clients.
- Groups can be a place to witness more positive behaviors associated with recovery and to practice new modes of dealing with addiction.
IOPs may include a variety of different groups.
- Skills-development groups are designed to help clients practice specific behaviors in a safe setting.
- Psychoeducational groups provide emotional support and the opportunity to learn about addiction, dependence, and the consequences of abuse. These groups often focus on developing problem-solving skills and techniques for altering ineffective belief systems.
- Refusal training allows clients to participate in role-playing exercises where they can rehearse how to effectively handle invitations to use the substance they are trying to break free from.
- Relapse prevention groups help clients to identify triggers and high-risk situations, and develop techniques to avoid and manage them.
- Family groups focus on ways the client and their family can support each other. In these groups, participants will also learn about the effects of addiction on relationships and how to best deal with those challenges.
Sometimes groups will be specialized, focused on a single type of client, such as men or women, LGBTQ individuals, veterans, or sexual abuse survivors. Groups generally contain between 8 and 15 members, per SAMHSA, though private IOPs often feature smaller groups, allowing a more individual focus.
Those seeking treatment from IOPs will also usually have access to individual therapy as well. While this is important, it is not usually the primary form of treatment, according to SAMHSA.
Individual therapy focuses on the pressing problems caused by clients’ substance abuse and their efforts to remain abstinent. In individual therapy sessions, clients often dig deeper into the work done in group therapy, allowing them to spend more time on individual issues. Some individuals don’t feel comfortable talking in a group setting so individual therapy gives them the space to talk about more personal matters.
Individual therapy sessions are part of most IOPs and will usually be scheduled on at least a weekly basis, if not more often, especially early in treatment. Each client is assigned a therapist who will endeavor to establish a close, honest relationship based on mutual trust and commitment to recovery.
Many IOPs offer alternative therapies to complement their traditional offerings. Treatments such as art therapy, music therapy, adventure therapy, or equine-assisted therapy may be offered. These treatments allow clients to tap into nonverbal ways of healing. Therapists that are trained in the particular treatment lead these sessions, and they often take place in a group setting.
Most IOPs recommend that clients participate in peer support groups like Alcoholics Anonymous or Narcotics Anonymous. In fact, many intensive outpatient programs host meetings on their premises, making it easy for clients to join when they are there for their treatment sessions.
These 12-step groups provide a structure for recovery that serves individuals well as they exit formal treatment. Meetings are held around the world at various times, allowing people to easily fit them into their schedule.
Choosing the Best Option
The National Institute on Drug Abuse outlines what individuals should look for in any treatment program. If you’re searching for an intensive outpatient program, take the time to ensure that the center you choose meets the following requirements:
- Treatment should be easily accessible. You shouldn’t have to wait a long time to enter a program. While public treatment options are available, they often have long waiting lists. Oftentimes, private IOPs are able to ensure a more prompt entry to treatment.
- Care should be personalized. Be wary of programs that offer a one-size-fits-all approach to recovery. Each client should receive tailored treatment that fits their individual situation and progress.
- Medical treatment should be provided. If medical care is needed for the individual case, it should be readily available.
- Treatment should be based in empirical research. Evidence-based treatment is essential. While alternative treatments can be used to complement care, the basis of treatment should be medical detox and therapy.
- Social support should be provided. People in recovery need a strong support system to avoid relapse. Treatment should involve peer support in group therapy and support group meetings, and an aftercare plan that includes opportunities to build and strengthen one’s support network.
- Treatment should be ongoing. Duration of treatment is critical to its success. NIDA recommends that individuals participate in therapy for at least 90 days to ensure the best chances at sustained recovery. Oftentimes, individuals may begin in an IOP and then transition to less intensive outpatient treatment after 30–60 days.