Intensive Outpatient Programs: What They Are, and How They Work
Intensive Outpatient Program and the Continuum of Care
The continuum of care for addiction treatment ensures an individual enters treatment at the appropriate level of care. Then participants move through the continuum until treatment is complete and support is no longer needed.
Four levels of care are identified by the American Society of Addiction Medicine:1
Level 1: Outpatient Services
Outpatient treatment is the least restrictive of the four levels and involves living at home while undergoing rehab at an outpatient treatment center. Outpatient treatment provides nine or fewer hours of programming each week.
Level 2: Intensive Outpatient Services
Intensive outpatient programs are divided into two levels: Intensive outpatient services, which involve nine or more hours of outpatient programming each week, and partial hospitalization services, which involve 20 or more hours of weekly programming.
Level 3: Clinically Managed Residential Services and Medically Monitored Inpatient Services
Level three involves four sub-levels. Three levels of residential care are clinically managed and range from low to high in intensity. The highest level of care under level three is a medically monitored, high-intensity inpatient treatment program for people who have significant problems that require medication and supervision.
Level 4: Medically Managed Intensive Inpatient Services
Level four is the most intense and restrictive level of care available and involves 24-hour nursing care and daily care under the guidance of a physician. Level four is for people with severe problems and for those in severe withdrawal and in need of medical support.
Where a person enters the continuum of care depends on factors like:
- The length and severity of the addiction
- Whether a mental illness co-occurs with the addiction
- Whether they have a safe and stable living environment
- The extent and severity of personal problems
- The personal motivation to recover
Inpatient treatment is essential for some people, but an outpatient program or IOP will typically work for people who have:
- A high level of intrinsic motivation to recover
- A safe and stable place to live
- Good physical and mental health aside from the addiction
- A high level of support at home and in the community
- A high level of engagement in treatment
- Reliable transportation to and from the treatment center
As treatment progresses and clients become stabilized and ready to move on, they will step down to the next lowest level of care. In some cases, an individual may need to be reassigned to a higher level of care if the current level is not working. If you enter the continuum at an IOP, once that program is complete, you’ll step down to an outpatient program for additional support as you create a sober life for yourself.
The Four Stages of Treatment
According to the Substance Abuse and Mental Health Services Administration, regardless of where you enter the continuum of care, you will move through four stages over the course of treatment:2
The more engaged you are with your treatment plan, the better the outcomes of rehab. The engagement phase typically takes place during detox and is designed to motivate clients to stay in treatment for the duration of the program.
After detox, clients are engaged in a routine that supports abstinence. At the end of the early recovery phase, they’ve demonstrated an ability to sustain behavioral changes, resolve personal problems and make essential lifestyle choices to support a life in recovery.
During the maintenance phase, clients practice the relapse prevention skills they learned in treatment. They develop a sober support network and continue to address their problems and issues and improve their emotional functioning.
The last phase involves developing independence from the treatment program and creating a life that supports recovery, including engaging in the community, participating in support groups and establishing new interests and hobbies.
Intensive Outpatient Programs Starts with Detox
Detox is the first step of treatment regardless of the level of care you enter. During detox, all traces of drugs or alcohol leave your body so that brain function can begin to return to normal and you can focus on treatment.
During medical detox through a high-quality treatment program, medications will be administered as needed to help reduce the severity of withdrawal symptoms and shorten the time it takes to detox. Complementary therapies like yoga, acupuncture, massage or meditation improve your sense of wellbeing and help improve withdrawal symptoms.
A major focus during detox is engaging the client in treatment. The more motivated you are, the better your chances of successful long-term recovery.Therapies like motivational interviewing will help you identify your own intrinsic reasons for wanting to recover from an addiction. A variety of assessments helps you and your treatment team determine the best level of care for you. Together, you’ll develop a treatment plan that addresses your unique needs, issues and challenges.
Once detox is complete, treatment for the addiction begins.
Intensive Outpatient Programs: What to Expect
Addiction is far more complex than dependence, which is characterized by physical withdrawal symptoms that occur when you stop using. Addiction is the result of physical and chemical brain changes that lead to compulsive substance abuse despite negative consequences. Addiction almost always has underlying causes, often including a history of trauma, chronic stress or a co-occurring mental illness.
For an IOP to be successful, it must address all of an individual’s multiple needs. An individualized treatment plan will include a variety of traditional and complementary therapies, classes and interventions that are chosen based on your unique needs. This holistic approach to treatment addresses issues of body, mind and spirit for whole-person healing.
Depending on the program schedule, you will head to the treatment center for programming three to five days each week. Therapies commonly used in IOPs include:
Traditional therapies like cognitive-behavioral therapy, acceptance and commitment therapy, dialectical behavior therapy, and family therapy. These therapies help you learn to think and behave in healthier ways and address a variety of underlying issues behind the addiction.
Complementary therapies like art or music therapy, restorative yoga, mindfulness meditation and outdoor adventure therapy. Complementary therapies help you develop greater self-awareness, express difficult emotions and experiences, increase self-esteem and self-confidence and look at old problems in new ways.
- Address the underlying issues issues of the addiction
- Develop essential coping skills for stress, cravings, negative emotions and other relapse triggers
- Identify and change dysfunctional patterns of thinking and behaving
- Find purpose and meaning in a life of sobriety
- Learn to relax and have fun without drugs or alcohol
- Repair damaged relationships and restore function to the family system
- Learn to develop healthy relationships
Treatment through an IOP helps you remove the need to use drugs or alcohol, and it can lead to a higher quality of life, greater sense of wellbeing and authentic happiness down the road.
The Goals of an Intensive Outpatient Program
Although IOPs vary in their location, programming and comprehensiveness, they all address the same general goals, according to the Substance Abuse and Mental Health Services Administration. Goals include:
- Achieving abstinence
- Fostering behavioral changes and a new lifestyle
- Facilitating participation in a community-based support group, such as a 12-Step program
- Addressing a wide range of needs and problems
- Helping with development of a strong and positive support system outside of treatment
- Improving problem-solving and coping skills
The recommended minimum duration of an IOP is 90 days. Anything less, according to the National Institute on Drug Abuse, is of limited effectiveness.3 Once you complete the IOP, you’ll be referred to an outpatient program that will involve fewer hours of programming and help you transition into solo recovery. In many cases, the outpatient program will be housed in the same facility and involve the same treatment providers as the IOP.
An Intensive Outpatient Program Can Help End an Addiction for Good
Intensive outpatient treatment can help you recover from an addiction for the long-term. According to an article published in the journal Psychiatric Services, a high level of evidence shows that an IOP can be equally effective as an inpatient program, but IOPs offer flexibility and the opportunity to continue working, attending school or caring for the family while in treatment.4 If an IOP is right for you, it can help you achieve abstinence and enjoy a higher quality of life for the long-haul with minimal disruption to your life.