What is an Intensive Outpatient Program (IOP)?
An Intensive Outpatient Program (IOP) is a level of chemical dependency (CD) and/or mental health (MH) treatment that allows you much more flexibility while offering more support and structure than just individual counseling or a weekly group. Depending on your state’s requirements, the insurance company’s requirements or the design of the IOP, you will attend several times a week for several hours each time. For example; many Intensive Outpatient Programs are 3 hours long and meet 3-4 days a week (much more than that is closer to a higher level of care called Partial Hospitalization Program or PHP). Intensive Outpatient Programs are meant to be group-based, led by a professional facilitator and cover an array of topics and issues relevant to each client’s needs at a more in-depth level.
Why Should I Go To A CD IOP?
There are many reasons why IOP can make a big difference in your long term recovery success. Some of the benefits of CD IOPs are: lower cost, flexibility with life (work, school, family, etc), the communal design, structure and more. A major facet, beyond the obvious provision of continued support for someone who needs it – is that is increases the time the individual is engaged in an active and involved recovery system. This is very relevant to long-term outcomes and I mean something very different than just attending a 12 step group. Research has shown for decades that length of time in sustained engagement of a recovery support system is correlated to successful recovery in the long haul.
Residential treatment programs that were 90 to 120 days and much longer have all but disappeared, not because of efficacy but because of cost. Most insurance companies would prefer not to cover a 6 month stay in rehab. Obviously, most Americans cannot pay out of pocket for 6 months of rehab. In order to continue to accept insurance and be accessible to the greatest number of clients, treatment centers (those with integrity and purpose) have had to adjust and now continually strive to deliver as much meaningful and progressive treatment as possible in much less time.
So why does this matter? Because we know and have known that your success is very tightly tied to time and en vitro recovery exposure – and you probably aren’t going to get it all in a treatment center. But – after treatment you can extend this time and improve your outcomes by sustaining your engagement in professional, intensive recovery support such as a CD Intensive Outpatient Program. And even after IOP, continuing with Alcoholics Anonymous, SMART Recovery and counseling with a seasoned and experienced professional can extend your immersion in a recovery supportive environment.
Ultimately, you are looking at increasing your chances of success the first time around (I’m assuming you don’t want to keep going back to treatment over and over again). If I ask you to pull the Jack of Hearts of a shuffled deck the chances are slim you’ll get it on the first try. If you’re asked to pull any face card out of the deck, your chances are better than the Jack of Hearts – but there is still a good chance it will take you several tries. But if I ask you to pull a red card out of the deck, you have a much better chance in getting it with fewer attempts than the above two. Recovery takes work and there are many variables, including those in your own unique story, so why would you not want to ensure the best possible chance of your success?
CD IOPs Cost Less than Higher Treatment Levels of Care
It used to be that IOP was only accessed for step-downs; meaning if you were already in a higher level of care like a residential treatment center you could go to IOP after your discharged from residential as a “step down” to a lower (less intensive) level of care. Not so anymore. Now, you can also enter directly into Intensive Outpatient Programs by referral from your physician or therapist. In some cases you can self refer. IOP does not have 24-hour nursing, overnight accommodations, meals, physicians rounding (usually) and so on. It doesn’t require a hospital facility – many are housed in professional buildings and private offices. The overhead is low and the staff expenses are much lower than a hospital – all in all, less costly to run, less costly to you. And guess what, insurance LOVES the IOP option. Most insurance companies know that IOP diminishes repeat hospitalizations (less cost to them) and is less expensive to pay for (again, less cost to them). If you have to pay for IOP yourself, ask about payment plans or discounts. Most programs are willing to work with self-pay clients.
Good CD IOPs Allow for Flexibility
Most of my clients who have gone to Intensive Outpatient Programs were back at work or the university while doing it. It becomes the perfect transition back into “real life living” with support while doing it. In many cases this reduces the strain and stress on the client and their family/employers/etc and this means less anxiety for the client and most likely better focus as well. For parents, the ability to be back at home, or at least engage and be with their children can be a welcome and needed positive in an otherwise difficult period. *One word of wisdom here: don’t be in a hurry to get back home. Sober Living as a transition can be a great help in securing a lasting recovery (I’ll talk more about Sober Living in another article). The excuses are many – but the couple of months that it entails is so much less an intrusion than repeated relapses and re-hospitalizations. The need to really get some solid recovery time under your belt is even more important with children on the line.
Good CD IOPs Are Communal
Using a group design, Intensive Outpatient Programs keep a communal circle going well after residential treatment is over – and unlike basic community support meetings, they have professionals facilitating the process. These two points are important. The old saying “two heads are better than one” is so true in a group process. In a well-facilitated group, members are appropriately bonded and weigh in, both supporting and challenging the views and statements of each other. This level of validation and honesty is not often found outside of these arenas. The seasoned and experienced professional leading these groups is there not only as a guide and teacher, but also to ensure that the personal agendas of other members don’t cloud the issue and that members do not leave with an incorrectly or distorted ideas based on the statements of others. Granted, you need a really good leader and I get to that later on in this article. But one of the risks of many community based support organizations is that there are a lot of untrained self-selected “authorities” who may have great personal experience, but who sometimes don’t realize the transference going on in their relationships with others who may be much more vulnerable at the time.
Good CD IOPs Are Structured
Yes, there is a place and purpose for open, process-oriented group time and that is an important part of many Intensive Outpatient Programs. However, a good IOP will have a concrete, curriculum as its foundation. In early addiction recovery there are many core conflicts that come up frequently for most clients and a lose and unfettered IOP is not likely to cover all of these, leaving some clients without some much needed information and experience when they leave the IOP. Intensive Outpatient Programs that follow the 12 Step model or even another system like SMART, have adopted a well-known structures as their base. They should not however just be a regurgitation of an AA meeting – IOP is a clinical level of treatment and as such should be dealing with many of the emotional and psychological challenges of the recovery journey. (you should not be paying for a copy of what you already get in your 12 Step or support group meetings – if this is the case, talk with your counselor or physician – you may need a different program.)
Choosing the Right CD IOP for You
Here are a few tips to help you find a solid IOP for you or your loved one:
a. Find out how long the program has been around – or at least the host organization. New businesses have a lot of growing pains and your time in the program should be focused on your growth, not encumbered by theirs. And while you are at it – ask. Call the local council on addiction recovery and a couple of doctors or therapists who actually specialize in addiction and ask them who they recommend.
b. Find out who is actually running the groups in the IOP. Many programs (hospitals are known for this) assign their interns or least experienced staff to run the IOP. Make sure the program has a seasoned and experienced facilitator running the actual groups in the program. It’s also helpful to ask to see a print out of the curriculum the program follows.
c. Find a program that is offered at a time you can manage and then commit to it. Most major cities have morning, afternoon and evening IOPs. Pick what you can do, stretch a little if you need to, and then don’t skip or miss. Remember, it’s not just about the content; it’s also about the context – the regular immersion in an intensive, recovery environment.
d. Get your doctor hooked up with the IOP. Sign the release of information to let the program and your doctor talk openly back and forth. And ask them regularly if they are doing it. Do the same with your private therapist or counselor. Continuity of care is everything. These folks work for you – if they can’t communicate with each other, you’re the one who loses.
e. Back fill around the IOP. On every day that you are not in IOP you should make a support meeting, see your counselor or some other dedicated recovery support. (and that doesn’t mean you can’t do these things on the IOP days too). We often say that addiction recovery is a life or death matter. Think of the parts of your recovery plan as your breath. You don’t stop breathing because it’s the weekend or a holiday – so don’t skip out on your recovery plan.
f. Remember this – an IOP is not a replacement for 12 Step Meetings. An IOP is clinical and delivers a very different benefit than 12 Steps. You need both!
g. If you are in a residential treatment facility your Discharge Planner or Case Manager is responsible for helping you to secure an IOP as part of your Discharge Plan and ongoing recovery plan. Be involved and don’t dismiss the value of well-spent time setting this up. Your life and your recovery are a precious commodity – be smart and invest well in them wisely.
One final note – recovery doesn’t happen in a vacuum – you have to get out there and be a part of a community committed to recovery. It also doesn’t happen in an isolated vessel – that means the whole family needs recovery support, not just the addict. Make sure that as you or your loved one embraces their recovery plan the family and loved ones get support and education as well. Addiction is a disease in more ways than one – if you only treat your hand, the rest of your body will still suffer. Disease destroys the whole system – in this case, the family system. Get the family connected with Al-Anon, a counselor or some other support group. It makes a world of difference.
Ben Carrettin / Live Better Live Now / Houston / Texas