Intensive Outpatient Treatment: A Comprehensive Guide
No one has ever said that overcoming addiction is an easy process.
Instead, recovery from addiction requires many steps and a great amount of determination. Even taking the first step toward recovery can be one of the most difficult aspects of getting treatment for alcoholism or drug addiction. After recognizing that your addiction represents a problem in your personal and professional life, it is difficult to know where to start. Those just starting on the road to recovery often have many questions:
- Who can I talk to about my addiction?
- What options are available for treatment?
- What does treatment look like, and what can I expect?
- Can I overcome my addiction?
- Do I have to go to a rehab center?
- Won't rehab cost a lot of money?
Not being able to get answers to these questions often works as a barrier to seeking out the help and support needed for addiction recovery. For those looking to overcome their addiction, intensive outpatient treatment is a great place to start. Because residential rehab can be an intimidating option right off the bat, intensive outpatient treatment programs offer an alternative treatment option that works for many different types of people with all kinds of backgrounds. It is not the only treatment option for drug or alcohol addiction, but it is one of the most common treatment programs. Having a good understanding of what is involved in intensive outpatient treatment will prove helpful for those looking to overcome their addiction or help their loved one through the recovery process.
It is not the only treatment option for drug or alcohol addiction, but it is one of the most common treatment programs.
This comprehensive guide answers all of the questions presented above, and more. If you are looking for support in recovering from your addiction, or have a loved one who is struggling with addiction, this guide gives you the knowledge and resources you need to get started on the right path. To learn more about the individual questions and topics, click through the links provided in the guide, where you will find even more resources on intensive outpatient treatment. The questions addressed in this guide include:
- What is intensive outpatient treatment?
- How does IO treatment work?
- How do I know if this form of addiction treatment is right for me?
- What does an IOP cost, and can it be covered by insurance?
- How does intensive outpatient treatment compare to other treatment options?
- Is IOP a good fit for alcoholics?
- What are the pros and cons of intensive outpatient treatment?
What is Intensive Outpatient Treatment and How Does it Work?
All professional, governmental and medical institutions identify drug addiction as a mental disorder. As the National Institute on Drug Abuse states, addiction is considered a mental illness because it "changes the brain in fundamental ways, disturbing a persons normal hierarchy of needs and desires and substituting new priorities connected with procuring and using the drug." In other words, the compulsive behavior caused by addiction essentially overrides a persons ability to control their impulses, regardless of the consequences. This is the main sign of a mental disorder, and addiction should therefore be treated as such.
The fact that addiction is a mental disorder, rather than a failure of character or self-control, spells out two specific realities for the addict. First, addiction is a physical and mental issue that not only affects nearly every area of life, but also often requires direct and usually external intervention in order to be overcome. Second, the good news is that because drug addiction and substance abuse are mental disorders, they are treatable and can be overcome with proper treatment.
Unfortunately, many people who need treatment for their drug or alcohol addiction never receive the professional and medical help necessary for recovery. Often, the idea of detox and continued recovery can be too daunting. However, some form of help is available in nearly every community and state around the country. There are many different treatment options for overcoming drug addiction, ranging from support groups (like Narcotics Anonymous) to residential rehab programs. One of the most commonly used treatment option for those struggling with drug or alcohol addiction is intensive outpatient treatment.
Otherwise known as an intensive outpatient program (IOP or just OP), intensive outpatient treatment provides those struggling with addiction the support they need on a daily basis, without requiring a residential stay at a detox or rehab facility. In short, an IOP offers those struggling with drug or alcohol abuse the ability to overcome their addiction without interrupting other aspects of their daily life. But what is the overall aim of intensive outpatient treatment for addiction, and how does it compare to other forms of addiction treatment? These are the major questions addressed on this page.
The Purpose of Outpatient Addiction Treatment
The main purpose of intensive outpatient treatment is largely the same as the purpose of other treatment options: to help the individual struggling with alcohol or drug dependence overcome their addiction and restore them to the lives they had before the addiction essentially took over. Just like any form of recovery, this involves a lengthy process, support from those around you, and a good amount of determination. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) the major goals in any form of outpatient treatment include the following:
- Stopping the cycle of addiction
- Identifying external triggers for the addiction or abuse
- Identifying internal triggers for the addiction or abuse
- Introducing support systems, either through 12-step or mutual-help activities
- Giving the patient an understanding of body chemistry in recovery
- Addressing (and overcoming) common challenges in early recovery
- Encouraging those recovering from their addiction to think, feel and do, recapturing their previous life
- Addressing the impact that addiction has had on personal and professional relationships
- Maintaining complete abstinence during recovery
How Intensive Outpatient Treatment Works
As already mentioned above, the main distinguishing factor of intensive outpatient treatment is that it does not require those undergoing treatment to stay in a residential detox or rehab facility. However, this does not mean that participating in an IOP is without structure and discipline. Instead, intensive outpatient treatment for drug or alcohol addiction provides a structured and supportive system for overcoming the addiction. SAMHSA makes it clear that "a set of core services is essential to all intensive outpatient treatment 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."
Core services of intensive outpatient treatment programs include group counseling and therapy, individual counseling, psychoeducational programming, detoxification, medication management, and the monitoring of alcohol and drug use.
Even more than residential rehab (or inpatient programs), IOPs usually encourage the support and involvement of family and friends through the recovery process. In this way, outpatient treatment programs involve a a detox period, followed up by additional group support and counseling. SAMHSA identifies six main intensive outpatient treatment approaches:
- 12-Step Facilitation
- Therapeutic Community
- Matrix Model
- Community Reinforcement and Contingency Management
While none of these approaches have been shown to be more beneficial than any other, each one often presents a more fitting treatment option for individuals depending on their experiences, personality, background and more. The four latter approaches (motivational, therapeutic community, matrix model, and community reinforcement) utilize the first three approaches to form a comprehensive treatment program. To find out which of these approaches seems appropriate for you, you can find a brief overview of the three major approaches to treatment below.
This approach to intensive outpatient treatment utilizes the core concepts of twelve step programs, such as Alcoholics Anonymous, to facilitate recovery. An IOP that focuses on the 12-step approach helps clients understand the principles of the recovery process, starts them working through the twelve steps, taking the first steps of achieving abstinence and encouraging involvement in a community-based twelve-step fellowship, such as AA, Cocaine Anonymous, or Narcotics Anonymous. The key to the twelve-step approach is treating alcoholism and addiction as a disease characterized by a complete loss of control. This requires acceptance of the disease and a determination to take responsibility for the effects addiction has on your life. In short, an intensive outpatient treatment program that includes 12-Step facilitation not only encourages abstinence and sees the addict through detox, but also sets patients up for long-term success.
"Much of the group work focuses on accepting the disease, assuming responsibility for the recovery process and ones own actions, renewing hope, establishing trust, changing behavior, practicing self-disclosure, developing insights into ones behavior, and making amends. Problems often are addressed in the context of step work."
~ SAMHSA on 12-Step Recovery Programs
As the name implies, taking a cognitive-behavioral therapy (CBT) approach to recovery involves focusing on how learned emotions and behaviors can be changed through changing ones actions. Clients are taught to recognize triggers for their addiction - individual people, group settings, situations, or even emotions that are likely to result in either drinking or drug use. CBT then encourages clients to find and utilize new coping skills and strategies for overcoming these triggers. This approach to intensive outpatient treatment for addiction focuses more on individual therapy, and provides a structured way of equipping those struggling with addiction to manage their behavior and actions on a long-term basis.
"Since it is a central tenet of CBT that thought and action can (and do) influence emotions and even brain chemistry, it is no surprise that changing what we think and how we act can have a powerful impact on how we feel, even to the extent of loosening the grip of powerful addictions."
~ Clifford N. Lazarus, PH.D. writing for Psychology Today
A motivational approach to IO treatment focuses on the clients attitudes and beliefs regarding their addiction, and directs those struggling with addiction and alcoholism to realize the problematic behaviors and detrimental impact that their addiction has had over the course of time. Since 40 to 60 percent of people going through addiction recovery relapse at least once in the process, maintaining motivation for recovery is a crucial aspect of treatment.
Through motivational interviewing and motivational enhancement therapy, those struggling with addiction are tasked with identifying gaps between an ideal life and the life lived as a consequence of substance abuse, recognizing that they have the ability to make a change, and taking responsibility to maintain emotionally healthy choices in their personal life. In short, the motivational approach equips those on the road to recovery with the tools necessary to keep going, even when recovery becomes the hardest thing they have ever undertaken.
"The times when self-motivation works are when the addict has discovered that there is something more precious than the addiction. It might be a child, a job, life itself, or a personal value such as dignity. None of these works for everyone, but hitting rock bottom usually means coming to the point where, beyond any doubt, there is a black and white choice between the addiction and something of ultimate importance."
~ Jeffery S. Smith, M.D. writing for Psychology Today
Is IOP Right for You?
The approaches described above give a good idea for what is involved in intensive outpatient treatment programs. IOPs can be one of the best ways to start recovery from addiction - but these programs are not necessarily for everyone. There are plenty of benefits to participating in an intensive outpatient treatment program, but there are some aspects of recovery that are not covered with this treatment approach.
Those who have struggled with drug addiction years, or even decades, may need a more extreme course of action - such as residential rehab. For many, it can be difficult to delineate between the two and determine which course of action is necessary. How can you tell who is a good candidate and who is not a good candidate for IOP drug treatment?
Who is a good candidate for IOP drug addiction treatment?
A good candidate for outpatient treatment is someone who struggles with drug addiction or alcoholism, but has not yet reached the severe condition caused by extensive drug abuse over the course of years and decades. Many of those who struggle with addiction issues may simply need a consistent support system - in the form of both therapy and mutual support groups.
Intensive outpatient treatment programs require a few hours per day on a weekly basis, rather than weeks or months completely out of commission. In this way, an IOP may be a good option for someone who already has a good support system in his or her friends, family or community and is unable to take the weeks away from daily life required in a residential (or inpatient) program. A good candidate for IOP drug addiction treatment will possibly:
- Already be motivated toward recovery and recognize that they need help
- Not be able to leave daily life (i.e. a job or family) for a significant amount of time
- Have a supportive community in place (in the form of friends, family or sponsors)
- Maintained sobriety for a significant amount of time, but need more support in achieving a healthy emotional and relational life
- Be looking for more structure than AA or NA offers
- In need of a less expensive treatment option
Who is not a good candidate for IOP drug addiction treatment?
As mentioned above, intensive outpatient programs are not always the right choice for everyone struggling with addiction or alcoholism. Sometimes a more invasive and disruptive treatment program is necessary to get someone who has struggled with addiction for years on the right path. If you meet any of the following criteria, outpatient treatment for addiction may not be the right fit:
- You have struggled with addiction for years or decades without change
- You have tried recovery in the past, but relapsed back into addiction
- You do not feel inherently motivated to overcome your addiction
- You struggle with other mental illnesses or diseases
- Your addiction has affected your ability to work or to maintain relationships
- You do not have a supportive and healthy home environment
- You have tried outpatient addiction treatment in the past without long-term success
Comparing IOP to Other Treatment Options
Because inpatient addiction treatment does not work for everyone, it is far from being the only option for getting the help you need in overcoming your addiction. While all forms of addiction treatment involve many of the same steps and principles, there are important differences between outpatient addiction treatment and other options, such as inpatient (or residential) treatment programs, sober living homes, support groups, and addiction counselors. Because inpatient and outpatient programs use support groups and counseling to different extents, these are the two options that hold the most differences.
"In addition to stopping drug abuse, the goal of treatment is to return people to productive functioning in the family, workplace, and community. Most people who get into and remain in treatment stop using drugs, decrease their criminal activity, and improve their occupational, social, and psychological functioning."
~ National Institute on Drug Abuse, "How Effective is Drug Addiction Treatment?"
The goal of treatment programs for substance use problems in both residential and outpatient settings is the same, and even many of the strategies look the same in practice. However, there are several differences in the mechanics of these treatment options - or how the programs work on a day-to-day basis. The key differences between outpatient treatment and inpatient treatment for addiction include:
Inpatient programs require at least four weeks of continual, 24/7 care and monitoring while outpatient programs give clients flexibility and freedom of movement.
Residential rehab treatment provides those recovering from their addiction a safe and supportive environment for the duration of the treatment, while those participating in an outpatient program may not have that support in their home environment.
Inpatient programs create camaraderie with others going through the treatment, which can be extremely helpful in the recovery process. While outpatient programs encourage support groups, they rarely reach this kind of therapeutic community.
Inpatient treatment for addiction often involves one-on-one counseling from professional and medical staff. While trained staff usually run outpatient programs, it is less common to have individual, one-on-one sessions on a consistent basis throughout the treatment program.
Is IOP Cheaper Than Regular Drug Rehab?
The short answer: yes.
There is no doubt about it: drug addiction treatment can be expensive. The cost of treatment is often one of the primary reasons people do not seek out the help that they need. However, there is no question that the cost of continued drug abuse and addiction far outweigh the costs associated with getting the treatment that is needed for recovery. Both inpatient and outpatient treatment programs offer those struggling with addiction the opportunity to overcome their addiction and see better financial, career, and relational opportunities in the future.
"Drug addiction treatment has been shown to reduce associated health and social costs by far more than the cost of the treatment itself."
~ National Institute on Drug Abuse, "Principles of Drug Addiction Treatment"
But how does the cost of an intensive outpatient treatment program compare to other treatment options?
The costs of rehab can vary greatly, but overall outpatient treatment is far less expensive than a residential rehab option for addiction treatment. Well-known treatment centers can cost up to $20,000 for a four-week program, while outpatient treatment options usually run up to $5,000 for three months. Because intensive outpatient treatment does not require the residential costs of an inpatient program (such as room and board), and generally requires much less time per week, it is a cheaper option than regular drug rehab.
Whether looking to participate in inpatient or outpatient treatment options, it is important to recognize that getting treatment for addiction is worth the cost. Addressing your addiction head on, now, translates into lower health care costs, better professional opportunities, and healthier relationships in the long run.
Does Insurance Typically Cover the Cost of an IOP for Drug Addiction Treatment?
While there are some complicated rules regarding what Medicare will or will not cover for the treatment of alcoholism and substance abuse disorders, in general insurance does cover the cost of intensive outpatient programs. There are some limitations to what types of medication and services insurance will cover, but both Medicare and other insurance companies will cover at least some of the treatment, provided that the facility is a verified entity for addiction treatment. The following list includes the main guidelines for Medicare coverage and addiction treatment, according to the Centers for Medicare & Medicaid Services:
- Just as with inpatient treatment, the coverage of outpatient treatment depends on the provider of the services
- Coverage for addiction treatment is on a service by service basis (i.e. Medicare covers counseling by a clinical social worker, psychologist, or psychiatrist)
- Outpatient medications (i.e. self-administered) may also be covered under insurance
These are the more general guidelines for insurance and addiction treatment. More specifically, the Center for Medicare Advocacy highlights the aspects of an outpatient treatment program that are covered by Medicare:
- Patient education regarding diagnosis and treatment
- Medical detox, including medications
- Post-hospitalization follow-up
- Outpatient prescription drugs
- Co-occurring mental health conditions
- Screening and assessment for risky substance use behaviors
- Follow-up counseling
- Medication for the maintenance of sobriety
Can I Still Keep My Job and Go to an IOP?
One of the primary draws of an intensive outpatient program for addiction recovery is that it offers flexibility, freedom and anonymity for those starting on the road to recovery. The fear of losing a job, disrupting family life, or facing the stigma of addiction should not be a reason for avoiding addiction treatment altogether. The option of an IOP gives individuals the ability to seek help in recovery from their addiction without giving up their job at all. Outpatient programs often work around client schedules, which means that you can go to work during the day and participate in the program at night and on the weekends.
Many people worry that their employer may find out about their rehabilitation process and associated addiction, resulting in either disciplinary action or termination. It is important to realize that the Americans with Disabilities Act protects those undergoing treatment from facing termination or disciplinary action at their workplace.
According to the Equal Employment Opportunity Commission, "Persons addicted to drugs, but who are no longer using drugs illegally and are receiving treatment for drug addiction or who have been rehabilitated successfully, are protected by the ADA from discrimination on the basis of past drug addiction." There is no reason, then, to avoid getting the help you need to recover from drug or alcohol addiction.
How long do IOP programs typically last, and what does it look like?
While inpatient programs last a minimum of four weeks, intensive outpatient programs for addiction treatment often last much longer. The recommended minimum length for an intensive outpatient program is three months, or 90 days, according to SAMHSA. The longer duration of the program is primarily due to the fact that, while intensive, outpatient treatment generally requires fewer hours per week than inpatient treatment options.
"Intensive outpatient treatment programs are diverse and flexible in order to fit the individual intensity, duration, spectrum of services and settings of different clients. As time passes and patients move forward in recovery, gain more skills and become more independent, the intensity and frequency of treatment sessions is gradually lowered."
~ Debbie Stone, "How Long Does Intensive Outpatient Rehab Last?"
SAMHSA recognizes four stages of outpatient treatment, each of which all "clients work through, regardless of the level of care at which they enter treatment":
- Stage 1 - Treatment engagement
- Stage 2 - Early recovery
- Stage 3 - Maintenance
- Stage 4 - Community support
Because each of these stages requires time, effort, and determination, outpatient treatment programs do not rush the process. Instead, these programs typically address different aspects of the addiction each week, helping clients work through each of the stages. Besides the recommended length, SAMHSA also notes that intensive outpatient treatment programs can have anywhere from 6 to 30 contact hours per week and involve step-up and step-down levels of care in the beginning and end of the treatment program.
The American Society of Addiction Medicine (ASAM) defines an IOT program as having at least nine hours of "therapeutic contact" per week, at least during the initial step-up stage and during early recovery. More specifically, ASAM gives an overview of the typical IOT program:
- Three hours of treatment on three different days or evenings each week
- Two evenings of back-to-back ninety minute groups
- One evening with split time (i.e. half an hour of individual counseling, ninety minutes for a family session, and an hour long "skills training group")
Not all OIT programs following this format exactly, but this is what can be generally expected from outpatient treatment for addiction.
Is an IOP a Good Fit for Alcoholics?
Just as addiction applies to alcohol as much as any other drug, intensive outpatient treatment can be applied effectively to the recovery from alcoholism. In fact, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) recognizes outpatient treatment facilities as one of the primary forms of treatment for alcoholism. According to one academic report, more than 700,000 people in the United States receive alcoholism treatment in either inpatient or outpatient settings on any given day. More specifically, the same report notes that the "vast majority of alcoholic patients are treated in outpatient facilities."
Just as with other forms of IOT programs for drug addiction, outpatient treatment for alcoholism involves counseling sessions two or three times per week. Initially this is to attain complete abstinence - after the first stage of recovery, the program is designed to maintain sobriety and encourage the redevelopment of other parts of the clients life.
An IOP is a good fit for alcoholics because the program can take them through the recovery process from start to finish. From detoxification to maintenance, intensive outpatient treatment gives alcoholics the tools to recover from addiction. To learn more about treatment options for alcoholism and alcohol abuse, visit the NIAAA website.
The Pros and Cons of Intensive Outpatient Treatment
This guide has already mentioned that intensive outpatient treatment for drug addiction or alcoholism may not be the right fit for everyone. While the first step toward recovery is recognizing that you need help to overcome your addiction, the second is to identify which treatment option will work best for your needs. This is dependent on your background, your history of addiction, your support system at home, and more.
Some people who struggle with alcoholism or addiction do very well in an outpatient setting, while others require the intensity and environment of an inpatient, residential rehab facility. If you are still unsure whether intensive outpatient treatment is the right choice for you personally, consider the following list of pros and cons for the treatment approach. This is not an exhaustive list, but should put you on the right track toward recognizing if an IOT program will work for you.
The Pros of Intensive Outpatient Treatment
#1: IOT Programs Have a Lower Cost Than Inpatient Alternatives
Inpatient programs are associated with room and board and more intensive medical services, which often come at a premium. IOT programs instead offer much of the support, trained psychological help, and educational training needed for addiction recovery without the high costs. The cost of intensive outpatient treatment is limited to the amount of care you receive from medical and psychological staff, and includes the participation in directed support groups.
#2: IOT Programs Allow Clients to Live at Home
Flexibility is one of the major benefits of outpatient programs as opposed to residential rehab addiction treatment. Because IOT programs are usually limited to two or three sessions per week, clients are able to continue their daily life at home and attend the treatment program for several hours at a time. The focused nature of outpatient programs means that those in recovery will still have access to the training, accountability, and professional help of other programs without having to live in a rehab facility. Moving away from home is often not even an option for those struggling with addiction - IOT programs give anyone the ability to seek out the help that they need.
#3: IOT Programs Make It Possible to Retain Work Schedules
Just like the flexibility to stay at home, participating in an outpatient program does not require the disruption of work schedules or a career path. Making IOT programs are scheduled either in the evenings or on the weekends (or both), which gives even those with full time schedules to get the help that they need without worrying about decreased performance or reprisals at work. In fact, seeking out treatment is the only way to ensure that your addiction does not affect your work in the long-terms. More specifically, outpatient treatment lets individuals get treatment for their addiction without having to explain long absences or switch jobs altogether.
#4: IOT Programs Have More Flexibility in Recovery
As mentioned above, there are many different approaches to addiction treatment within an outpatient setting. For instance, if you have a supportive family or community back home, outpatient treatment allows you to utilize that support network just as much as treatment itself. In fact, many treatment facilities encourage the involvement of family and loved ones throughout the recovery process, even including family sessions in the program on a weekly basis. Another benefit in this flexibility is that it allows you to keep preexisting commitments and adjust the treatment approach according to your needs, where you are in recovery, and even your personality.
The Cons of Intensive Outpatient Treatment
#1: With IOT programs, there is no 24/7 supervision & support
While IOT programs give you the support and help you need in multiple sessions throughout the week, at the end of the day you do go home. If you have struggled with addiction for years, or even decades, you may need a more intensive approach, at the very least to make it through the detoxification and withdrawal phase of recovery. Inpatient recovery programs provide medical detox and even medication in severe cases, and may be better suited for those likely to experience intense withdrawal symptoms or with a history of relapse.
#2: With IOT programs, there is no change in environment
The success of an outpatient treatment program for addiction is dependent on your having a supportive community, family or friend group back home. If staying at home means you will continue to be surrounded by drugs or alcohol, full recovery may require a change in your environment. This is where inpatient treatment options may be most beneficial.
Related to this, while outpatient programs do involve mutual support groups, it can be difficult to establish full relationships with those going through the program with you, as you are together just a few hours each week. In contrast, residential rehab programs are 24/7, which can make for deeper, mutually supportive relationships for the long-term road to recovery.
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