Intensive Outpatient Program (IOP) and Recovery

The Intensive Outpatient Program (IOP) and its role in the model of today’s addiction treatment and recovery plans is explained in the following guest post by Erika Cormier.

Erika is a writer outside of Boston, right over the border in Southern New Hampshire, and author of the book, As the Smoke Clears, a Memoir, telling of her battles of depression and addiction, and her experience being a suicide survivor and overdose victim. As writing being her longtime career, she chose to reroute her writing direction to covering topics of depression and addiction with the hopes of helping and supporting others who may not have yet found their voices and without resources. Erika is also currently working on a handbook/guidebook for those in early stage recovery, sharing and researching non-pharmacological aspects of addiction recovery, to be released in late summer 2014.

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Erika Cormier, author of the book, "As the Smoke Clears, a Memoir," explains the Intensive Outpatient Program (IOP)  and its role in the addiction treatment and recovery process.

Erika Cormier, author of the book, “As the Smoke Clears, a Memoir,” explains the Intensive Outpatient Program (IOP) and its role in the addiction treatment and recovery process.

Outpatient treatment methods have long been a first line treatment for many patients seeking treatment for addiction and have often been the only level of treatment accessible for a large population, and with steady, definite results. We know this category includes replacement therapies such as methadone and suboxone which are often used in conjunction with non-medicinal treatment through other outpatient services like individual substance abuse counseling & psychotherapy as well as regular follow up with a primary care physician or a psychiatrist for the added treatment of depression, bipolar or anxiety in dual-diagnosis patients or those experiencing temporary mood changes common in those new in their recovery and sobriety. The outpatient level of care has successfully treated millions of addicts spanning several decades who are able to stay sober without ever having to access inpatient care or hospitalization and is an attractive choice for the people who, for a myriad of reasons, are not able to access inpatient care.

Intensive Outpatient Program (IOP) Explained

One area of outpatient addiction treatment which has grown tremendously in popularity and accessibility across the country, are IOP’s, or Intensive Outpatient Programs.

IOP’s have long existed as a separate treatment model but have become more commonly recommended by professionals in conjunction with the transition from inpatient hospitalization treatment. It is within this scope of practice that has made it as well known as it is today in the addiction recovery community.

Addiction treatment centers and psychiatric hospitals alike are now setting up intake appointments for their patients to access an intensive outpatient program near their home, as a continuation of professional treatment upon the patient’s release from the hospital. Knowing that group support systems like the non-medical model of Alcoholics Anonymous and Narcotics Anonymous are popular and can be a helpful resource for some people to stay sober and in recovery, especially newly-sober/clean addicts upon release from inpatient care, the IOP uses that same group support with shared experience (ie: fellow addicts), but IOP’s are headed and facilitated by an experienced, qualified team of medical professionals, who can take the group therapeutic model to a higher success probability by having the credentials needed to counsel patients who may need more individual care in addition to the IOP. They are also able to refer patients in their IOP to other outpatient care providers who can assist and treat any additional treatment a patient may be in need of. Most of the time the IOP’s themselves take place within a medical facility or hospital so these additional services are very easily accessed by the patients in the IOP who can be referred to specialists right in often times, the same building or hospital, or very close in proximity to where the IOP is conducted. These are two major differences between a medical-based group therapy approach like the IOP’s and a community-based support group approach like AA or NA.

It is also common to find among the professional staff who head IOP’s, a counselor or therapist who also is a recovered addict themselves. For decades it has been a popular career choice for recovering addicts to pursue a career in the addiction treatment community and give back by helping to counsel others they can easily relate to. This is an added benefit for many because the stigma surrounding addiction that still exists today, causes many addicts to be skeptical of anyone, no matter the credentials or experience, if they haven’t themselves battled addiction in their past. So in the IOP, many are able to access not only additional medical services through referral, but also the support of a group of fellow addicts in addition to the commonly found counselor who is a fellow recovered addict on the team.

Length of Stay in an Intensive Outpatient Program

IOP’s traditionally are a program that meets very regularly for a period of several weeks. The average IOP meets and convenes 4 days a week, sometimes 5, for 3, sometimes 4 hours a day, for a total length of time being 10-12 weeks with some programs having an 8 week program. Many facilities that have an IOP offer a day program and an evening program, making it an even more accessible treatment option for patients.

Due to the success that has come about by addicts who complete an entire intensive outpatient program, in conjunction with another treatment method, such as prior detoxification, inpatient hospitalization, individual counseling or therapy or replacement treatment like methadone or suboxone, Intensive Outpatient Programs are now, more often than not, covered by major health insurance companies. Almost all IOP’s offer a private cash pay option for the uninsured, where the patient makes payments every week for the duration of the program. When you consider that these groups are headed and facilitated by licensed medical professionals who specialize in addiction treatment, for the total amount of hours a program consists of, the pricing of IOP’s are very reasonable, running between $1200-$3000 on average. Many inpatient treatment centers are now starting to include the cost of their intensive outpatient program in an overall package with inpatient detoxification treatments, further encouraging participation by addicted patients and increasing the odds of long-term success tremendously.

Typical IOP Program Stay Described

So what occurs during all these group meetings? What is done that makes them a success? How is each day constructed? With a schedule matching that of an intensive college class, the tools to be gained in an IOP are just as useful if not more-so than an educational course; the tools that are provided are ones that have a life-long use and stay with each patient throughout their recovery and will apply in many areas of their life for a long time to come.

To begin with, the basic element of Intensive Outpatient Programs, as previously mentioned, is that they’re conducted in a small group, for example, consisting of about 10-20 people, sometimes slightly larger or smaller, who are usually very new in the addiction recovery process, so you have the support, empathy and understanding that can only come from a common shared experience, as life-changing and severe as addiction. We know that this shared experience has long been of much benefit to addicts new in recovery just as much as it helps those who have been clean and sober in recovery for years just like the workings and support of AA and NA groups all over the country. The patients genuinely want to help their fellow “classmates” in the group when they are struggling and can offer encouragement and support that only an addict who has experienced many the same struggles is able to provide them. The group type of support has been steadily successful for several decades and continues to show that having this unique support is indeed very effective, whether it is an AA group or not. When you add the unique benefit that the group is facilitated by a team of professionals with experience treating addiction, the IOP option of care provides the knowledge aspect to the support of the group. This crucial knowledge that is provided to the group is what makes the standard of care increase and the success potential also increase.

Generally, IOP groups are very intensive indeed, seeing that they meet typically at least 4 days a week for a few hours. Usually this block of 3 hours is split into 3 sections of focus. A typical IOP group will spend the first hour of class to be used as a “check-in” process for the patients. The addicts will discuss how their previous day ended and how they are feeling currently, if there are any cravings, if so, why? Are there any concerns with their home-life or work? In this check-in process every single patient is encouraged to participate and almost always, the patients do participate, as they feel supported in their protective, safe group environment. They feel safe because they know the group of patients has that shared experience and that the facilitators have the knowledge and experience. It is helpful for each patient to discuss what is going on in their lives and bring to light any issues that are cause for concern, so that immediately, the team can provide feedback and advice as to how to effectively manage these concerns while also remaining clean & sober. This sharing increases the security the patients feel and unites the group closely, creating a very safe, supportive environment where they can see actual results happening in their own lives and their classmates’ lives through the advice of the team and the practical knowledge that is shared by the team.

The second hour or so, or one section of the day, there is more of a focus on educating the group. The team usually has a previously chosen group of topics that they spread out over the time of the course for these classes. These topics go into great detail of what the group can expect to experience physically, psychologically & emotionally during the different stages of recovery, probably spending more time discussing what to expect and what is typical of someone in the early stage of recovery. The professional team usually takes turns teaching different topics that they have experience or expertise in, providing the information and also feedback, then encourages discussion amongst the group. Other topics include: effective communication, which is crucial in recovery after many patient have family members and friends that no longer trust them, who may question them or are skeptical of their new sobriety and tend to generally have poor relationships. Knowing how to handle their communication and effectively build relationships is information they can put to use in their own lives immediately. The knowledge is not only beneficial but extremely practical and for this reason the patients will and do see the effects and changes and how the IOP course is helping them in their own life. Management of anxiety or restlessness, constructive ways to utilize spare time in recovery, setting goals, control of cravings, the social, physical, emotional and psychological effects of addiction and what to expect in recovery, communication skills and methods, conflict management, recovery-based activities & services, community support centers & services, information about depression or other dual-diagnoses common in addiction and how to effectively treat or manage this, identifying triggers and how to decrease the triggers from your daily environment, identifying a support system in your personal life and knowing who is healthy for you in recovery vs. poor influences and how to safely detach from toxic relationships, building self-esteem and positive self-talk, ways of avoiding potential traps like isolating one’s self & identifying bad habits that lead to craving or use, how to avoid relapse and what to do if one does relapse, managing relapse and identifying the causes, resources for recovering addicts, resources in the community for health services & income assistance programs, career programs & employment information, ways to manage stress; these are all topics that would be covered throughout an IOP and at least 1 hour per day would be dedicated to such discussions and instruction. There are many more and often times the group may be in need of instruction and discussion of a topic that they find important, to what the team would promptly address and discuss.

The other common elements of IOP’s are that at some point in the program, each patient may be asked to prepare and then share his or her own personal story. This is a practice that has long been used in many levels of inpatient care as a reflection exercise to not only prompt the patient to realize how their addiction impacted & affected their life but also as a motivational tool to show them how far they have come and that they are on the right path to maintain their sobriety. In IOP’s since the admission is usually rotating and constant, there are always people who are in their last weeks of the program while others are in the beginning, thus creating a schedule where every day or at least a couple times a week, there is at least one patient who is ready to share their “story” with group. After they share, the group provides feedback and words of encouragement to facilitate a supportive atmosphere and the team will also provide feedback and may ask questions.

Another common activity associated with sharing of a personal story, is a “family letter”. It can be controversial, as some family members may choose to focus on the negative effects of the person’s addiction and how it affected them, but that level of absolute honesty can also be very helpful to the patient in realizing again, how their addiction changed their relationships and identifying behaviors that they do not wish to repeat or amends they wish to make. Often the team will provide a guideline of how to write both the personal story & for the person writing the family letter, which helps guide these to being a helpful and constructive exercise. A family letter is usually written by a parent or spouse, sometimes children or a close friend who writes the letter and gives it to the patient sealed, until the patient shares it with the group. The team and the classmates would then also provide feedback and advice to the person upon reading aloud. There are many other types of commonly used recovery-based activities that addiction recovery programs use that may also or in place of these, be utilized; to further more personalize each patient’s connection to the group and their overall experience.

When the group breaks for the days off, typically over the weekend, possibly longer, the team greatly encourages the group to be involved in recovery-based support such as AA/NA meetings. The team will usually allow time for the group to look up and find what meetings they plan to attend over the weekend and share with the team so they know all of the patients have identified recovery activities and now all they must do is follow through.

Another area that contributes to the high success rates of IOP’s is that most programs have some kind of family-involvement. This is provided by facilities that offer a family support group for family members of the program’s IOP patients. These groups support the family in helping them to understand addiction, how it effects and changes their loved ones’ behaviors and what they can do to be supportive and help their family member through their recovery. Many studies have already long ago shown that any program that involves the family of an addict, will lead to a much better success in recovery for the patient. With the family making an effort to support their loved one, everyone can learn and heal together, being supportive and creating an environment that fosters growth, love and understanding. Usually support groups offered for families by an intensive outpatient program are free of charge and ongoing so to make it more attractive and accessible for the families of the patients, knowing that their involvement is a key element to the success of the patients in the program, and also long-term for each person’s recovery.

Effectiveness of IOPs

Over the course of the program, IOP’s show to be effective through the constant support from the group and the team, by providing a steady increase in motivation and self-esteem, safety and security within their recovery efforts, while decreasing negative behaviors such as anger and anxiousness and decreasing the frequency of cravings as well as the patient making healthy changes in their life. These healthy changes are made, because while in the program, the patients know that they have continuous support and guidance from the team, should they need advice or have questions.

Long-term, as a treatment option by itself, IOP’s have proven higher success rates than other outpatient counseling and therapy-based outpatient treatment options. When used in conjunction with another treatment method such as replacement therapy, or as a follow-up to inpatient care, the long-term success rates are remarkably high. It is thought that the continued, constant access to such a level of support by the group and the professionals, give a great feeling of safety to patients, where they know each day they can discuss anything that is occurring in their lives and in their minds, and that they will not only receive absolute support no matter what, but they will also receive professional guidance and knowledge, tips and tools that are practical and can be put immediately to use. The drastic increase of self-esteem and feeling of confidence in their recovery that patients come away with upon completing the program does have a lasting effect. But it has been shown that if the patient does not choose to continue with some kind of ongoing support service that eventually the success rate drops lower with time after the group is completed. It is recommended upon completion of an IOP, that participants either remain active in AA, NA or another support group like DBSA within their community or that they regularly see a counselor, therapist or psychiatrist who can monitor their well-being, guide them and assist with any issues that arise.

The overall effect from completing an IOP is achieved quickly, remains consistent and is recalled by recovered addicts that attended, years after completing, as having been a more than moderately helpful tool to their overall recovery. I believe that the answer to why is the unique blend of group support blended with the knowledge and experience of medical professionals. It is truly a blend that provides both of the 2 types of support together and provides access to professional guidance & the comfort of shared experience from the group. It is no wonder that this level of care has seen more attention in the recent years, but also that the effects seem to provide a long-lasting benefit of giving addicts the tools they truly need in their lives which to pull out and put to use in many instances, years and years to come in recovery. Such applicable, practical knowledge is absolutely worth the investment for people who have survived unimaginable life struggles, cheated death even, have to live in a society that looks down upon them as being morally defective and have made the admirable effort to change their lives and in many cases, start completely over. Recovery is a life-long commitment and process that everyone agrees requires ongoing support and effort, and the many beneficial contributions to this process, made by Intensive Outpatient Programs, has the potential to make a real, measurable impact that remains with each person. The valuable knowledge and tools gained continually assist those who are striving to make a better life for themselves and commit to their recovery. IOP’s have already made a positive impact on millions of people seeking to overcome their addiction and have proven to be an exceptional choice with great accessibility for the many addicts who will choose recovery in the future and are thus, a definite asset to the addiction treatment community’s efforts and goals for the people suffering every day with the disease and subsequent effects of addiction. ~

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1 Comment

  1. Susan Kelly on April 4, 2016 at 7:05 am

    Thank you, Erika for explaining IOP. My son has struggled with drug addiction almost ten years. This time he initiated recovery on his own and thus I am more hopeful. I am attending Family Night this week, and wondered what to expect. (Of course I attended before, but this time is different). I pray that you are still strong and happy. God Bless You.

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