According to the National Institute on Drug Abuse (NIDA), there are four major types of treatment for substance use disorders.
- In an inpatient treatment program, the client stays in the facility where they are being treated. There is immediate access to medical treatment around the clock. This means doctors, nurses, and other medical professionals are on site.
- In a residential treatment program, the client stays in the facility where they are being treated, but there is no 24-hour access to medical personnel on site. There is 24-hour access to medical care, but the client must be taken off-site to receive medical treatment if they need it.
- Partial hospitalization treatment programs are sort of in between inpatient and residential treatment programs. Clients reside near the medical unit.
- Outpatient treatment programs allow the client to remain at home or some other place of residence. Clients go to a different facility for treatment. After treatment, they return to where they live.
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The treatment that occurs in an inpatient setting, residential setting, or partial hospitalization setting is typically far more intense than the treatment that occurs in most outpatient programs. However, not everyone can live on site where they receive their treatment.
In some cases, individuals don’t need 24-hour supervision, but they may still need intensive treatment. This is where intensive outpatient treatment programs can be useful.
What Is Intensive Outpatient Treatment?
Intensive outpatient treatment programs (IOP) provide far more intensive treatment than is typically delivered in an outpatient setting.
A joint policy statement by the American Psychiatric Association (APA) and the American Society of Addiction Medicine (ASAM) defined IOPs as programs where individuals do not live at the same facility where they receive treatment, and clients will receive six to 30 hours of treatment per week.
Typically, IOP treatment occurs three to five days a week. When the treatment intensity is six hours a day or more, the program is technically defined as a partial hospitalization program.
The joint statement also defined the interventions in an intensive outpatient program.
- Before clients are admitted to the program, they receive an initial evaluation to determine how severe their substance use disorders are and to identify any co-occurring conditions that need to be treated along with their substance abuse problem.
- Treatment personnel should be licensed professional treatment providers trained in the care of addictive behaviors.
- The treatment uses a formal approach based on the initial assessment (the development of a treatment plan) and maintains contact with the client until treatment is completed.
- The treatment program is responsible for delivering the proper treatment to the client. This should consist of empirically validated treatment approaches, such as therapy, medication-assisted treatments, as well as adjunctive forms of support like 12-step groups.
A standard IOP will consist of at least nine hours of treatment per week that is delivered at least three days per week (three hours per day) and lasts for a minimum of 90 days. Treatment can be more intense and last for longer, depending on the needs of the individual.
What Type of Person Is Best Suited for an IOP?
Intensive outpatient therapy was initially designed for individuals who had to attend outpatient therapy but needed the type of intensive treatment that is delivered in residential programs. For instance, someone who cannot attend a residential treatment program due to family concerns or employment issues could still the same intensity of treatment and still be able to fulfill their personal obligations.
Certain types of people would find an IOP beneficial. Among them are:
- People who were recently released from an inpatient, residential, or partial hospitalization facility
- People who do not need around-the-clock supervision but can still benefit from intensive treatment interventions
- Those who need intensive treatment but cannot pay for residential or inpatient care
- People who have co-occurring disorders (a substance use disorder and a diagnosis of a mental health disorder, such as major depressive disorder)
- Those who have extenuating circumstances, such as domestic issues, significant life stressors, lack of family support, or a history of numerous attempts at recovery and relapse
- People who are not confident in their ability to experience a successful recovery with a traditional outpatient treatment approach
Some individuals who have very severe co-occurring mental health disorders or environmental conditions that are toxic might not be appropriate for placement in an IOP. The decision to become involved in a residential program as opposed to an IOP should be made by the person’s physician, therapists, and the individual when they are discussing the results of the initial assessment.
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The Pros and Cons of Intensive Outpatient Therapy
There are several advantages and disadvantages of intensive outpatient therapy.
- There is a significantly heavier time commitment for an IOP than there is for traditional outpatient therapy. Even though the person will get more treatment, they will have less free time.
- The cost associated with an IOP will be significantly higher than traditional outpatient treatment, but lower than residential or inpatient treatment costs.
- Being able to return home after treatment can be a positive factor for some people who have supportive home environments. It could be a negative factor for someone who does not have significant support at home or who lives alone.
- Being in an IOP allows one to maintain their presence at work or school, which can be viewed as a positive or negative benefit depending on the person’s situation.
- IOPs are generally found to be as effective as inpatient and residential treatment programs, but this really depends on the person in recovery.
People who have numerous complicating issues will fare better in a residential treatment program or inpatient program initially and can be transitioned to an IOP later after their situation stabilizes.
People should consider their current place in recovery before committing to an IOP. For instance, someone going through withdrawal would be better suited to a medical detox program or inpatient treatment. When the person has established a period of abstinence and been able to successfully get through the early stages of recovery, an IOP might be more appropriate.
Those in early recovery should defer to treatment providers and family members if those parties believe they would initially do better in a residential unit or inpatient environment.
For instance, research suggests that higher attrition rates in IOPs are associated with the level of intensity of the person’s substance abuse issue, such that people with more serious substance abuse issues drop out of these programs at higher rates. These people may require the stricter supervision and structure that are more commonly available in a residential unit.
On the other hand, some people (particularly those who have successfully undergone the withdrawal process and established a solid recovery program) may not require the intensive treatment provided in an IOP. Again, it is best to defer to treatment providers and family members.
As mentioned, individuals who have toxic home environments, such as issues with a partner, spousal abuse, or who live in areas where substance abuse is rampant, may not find that intensive outpatient therapy initially suits their needs. These individuals often need to isolate themselves from these stress-producing situations and focus on their recovery.
Although an IOP offers intensive treatment, it does not offer protection from a toxic environment that is stressful and may foster relapse.
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The Cost of Intensive Outpatient Therapy
Finally, affordability is always a major consideration. Even people who have very good insurance policies will often find they have some form of out-of-pocket expenses associated with treatment.
Traditional outpatient treatment where a person attends treatment sessions for only a few hours a week will be more affordable compared to the greater expense that is incurred with the amount of time a person must commit to an IOP.
However, it is important to understand that the cost should only be a consideration if the person and their treatment providers believe they would do nearly as well in an IOP as a traditional outpatient program. If treatment providers are strongly recommending that the person gets involved in an IOP, the person should follow that recommendation.
The cost-benefit analysis associated with getting treatment for any substance use disorder is always in favor of the benefit side of the equation. Getting the right treatment is always far less expensive in the long run than trying to get the least expensive treatment.
(January 2018). Types of Treatment Programs. National Institute on Drug Abuse. Retrieved January 2019 from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states/types-treatment-programs
(June 2014). Substance Abuse Intensive Outpatient Programs: Assessing the Evidence. Psychiatric Services. Retrieved January 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4152944/
(December 2017). Factors Associated with Attrition in Substance Using Patients Enrolled in an Intensive Outpatient Program. The American Journal of Addictions. Retrieved January 2019 from https://onlinelibrary.wiley.com/doi/abs/10.1111/ajad.12619
(January 2018). Is Drug Addiction Treatment Worth the Cost? National Institute on Drug Abuse. Retrieved January 2019 from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/drug-addiction-treatment-worth-its-cost