What is an Intensive Outpatient Program (IOP)?
Intensive outpatient treatment (IOP) is an ideal level of addiction treatment care for those who do not necessarily require detoxification or 24-hour supervision but require more intensive treatment than typical outpatient therapy.1,2 It is an appropriate treatment option for individuals who may still require frequent contact with treatment professionals in order to manage their risk or relapse and monitor their behavior.1
This level of care requires relatively fewer treatment hours per week than partial hospitalization programs (PHPs), meeting roughly 9 hours a week compared to 20 or more, respectively.3 Intensive outpatient programs typically meet on weekdays in the morning or evening. Although they vary considerably in the anticipated length of stay, many IOPs span 12 to 16 weeks before individuals “step down” to a less intensive level of care.4
IOPs allow patients to live off-site while going about their daily lives relatively undeterred when not in treatment.2 An intensive outpatient program can offer more flexibility for those who are balancing work, school, and/or family obligations.
This treatment option requires that an individual’s home environment include a safe support system and be alcohol/drug-free.5 As a way of easing the transition back into society, IOPs can sometimes be utilized after completion of an inpatient program.2
Is Detox Offered in IOPs?
Though some individuals at risk for relatively severe and/or complicated withdrawal may be more appropriately managed in an inpatient or residential level for detox needs, some IOPs are able to incorporate on-site ambulatory detox services, including medication management.5 Those who do not experience serious withdrawal symptoms and can start treatment right away.
Additionally, during the course of recovery programming, those suffering from alcohol use disorders (AUD) and complete the detoxification phase could still move into this level of treatment.5
If a more intensive level of detox services and patient monitoring are required at the start of treatment, an IOP may recommend a “step up” in care the IOP will likely refer the patient to a standalone detox facility, hospital, residential facility, or other program before beginning treatment. Often, individuals who have been alcohol-dependent for a significant amount of time may struggle with unpleasant withdrawal symptoms which could become severe or make relapse more likely.6 Because withdrawal complications can be severe, supervised detox is often recommended to manage symptoms and address any issues that may arise in the process.7
Because the symptoms of alcohol withdrawal can be dangerous, consulting with your healthcare provider prior to detoxing is recommended. They’ll have a better understanding of what level of care is needed during the detoxification phase to keep you safe.
How Do I Start Treatment?
Are Co-Occurring Disorders Treated in IOPs?
Yes, many programs offer alcohol addiction treatment in conjunction with mental health care for those struggling with co-occurring disorders. Alcohol use disorders and mental health issues commonly co-occur, and as such, effective treatment should address both disorders concurrently within an integrated treatment plan.8,9 Integrated treatment to simultaneously manage both addiction and mental health needs can result in improved treatment outcomes.8
Prior to treatment, individuals will be evaluated by a healthcare provider for each disorder to provide a more targeted treatment plan.9 Appropriate screening for both mental health conditions and substance use disorders can help determine the nature and scope of the alcohol use disorder and mental health condition in order to establish a primary diagnosis and treatment plan.8
Within programs that offer co-occurring care, treatment may include a combination of behavioral therapies and medications tailored to the specific type of substance addiction, the mental health issue(s) present, as well as other individual treatment needs.9 Patients will also learn how each disorder affects the other and better understand how to manage both going forward.
What to Expect in IOPs
Group therapy is one of the foundations of intensive outpatient programs. It facilitates the development of communication skills, socialization, structure, and support for people who are newly sober.4
IOPs introduce and reinforce healthy ways of interacting with others and provide a safe environment for participants who may feel vulnerable in the early phases of sobriety.4 Patients who are further along in their recovery process often provide support for new participants.4 Most programs provide psychoeducation which may involve stress management, relapse prevention strategies, assertiveness training, and skills development.4
Along with group counseling, individual counseling is also an essential element of intensive outpatient programs but is not considered the primary form of treatment.4 Patients may meet individually with their counselor at least once a week. Unless treatment is needed for co-occurring mental health conditions, individual counseling in IOP programs may primarily focus on the patient’s immediate issues arising from their substance abuse and how to achieve and maintain abstinence.4 Such individual sessions may dedicate relatively less time to evaluating the more longstanding, underlying conflicts that contribute to problematic substance use.4
Medication management is sometimes an additional component of an IOP. Certain medications can help alleviate alcohol cravings, while others discourage continued drinking behavior by inducing adverse reactions if the person were to relapse.10 Within facilities that do not treat co-occurring disorders, they’ll often work in collaboration with outside mental health services for additional care. These outside services may provide psychopharmacologic monitoring, psychological assessment, and consultation for those with moderately severe mental disorders.4
Lastly, patients should expect routine monitoring of any illicit drug and alcohol consumption to determine whether the program is working for the individual.4 While some programs may rely on patients to self-report, many will use objective tests such as urine, saliva, blood, or hair samples to ensure abstinence.4 The results of these tests help program staff accurately monitor an individual’s treatment course and determine the need for any treatment plan modifications.
. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
. McCarty, D., Braude, L., Lyman, D. R., Dougherty, R. H., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014). Substance abuse intensive outpatient programs: assessing the evidence. Psychiatric services (Washington, D.C.), 65(6), 718–726.
. ASAM Continuum. (2015, May). What are the ASAM Levels of Care?
. Substance Abuse and Mental Health Services Administration (SAMHSA). (2006). Services in Intensive Outpatient Treatment Programs.
. Center for Substance Abuse Treatment. (2006). Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Treatment Improvement Protocol (TIP) Series 47. DHHS Publication No. (SMA) 06-4182. Rockville, MD: Substance Abuse and Mental Health Services Administration.
. MedlinePlus. (2019, January). Alcohol Withdrawal.
. Myrick, Hugh M.D., Anton, Raymond F. M.D. (1998). Treatment of Alcohol Withdrawal. Alcohol Health & Research World; 22(1): 38-43.
. Yule, Amy, Kelley, John. (2019). Integrating Treatment for Co-occurring Mental Health Conditions.
. National Alliance on Mental Illness. (2020, May). Substance Use Disorders.
. National Institute on Alcohol Abuse and Alcoholism. (2021, March). Treatment for Alcohol Problems: Finding and Getting Help.