Intensive Outpatient Program (IOP) at North Jersey Recovery Center

IOPs have long been a way to treat addiction when a longer stay at a residential treatment center was not necessary or possible. It can also serve as a step-down from more intensive treatment as people transition back into the community.

IOPs have been shown to be a successful part of a continuing care program. They are direct services for people with substance use disorders or co-occurring mental and substance use disorders who don’t need medical detoxification or 24-hour supervision. It serves as an alternative to inpatient and residential treatment.                    

The programs are designed to provide behavioral, psychological, and social support therapies to patients while they continue to live at home. This allows them to continue participating in work and educational activities and participate in treatment at a facility in the morning or at the end of the day. 

What Does it Treat?

IOP is primarily used to treat these disorders:

  • Eating disorders
  • Bipolar disorder (including mania)
  • Unipolar depression
  • Self-harm
  • A chemical dependency that does not require detoxification
  • Transitional treatment for patients just released from psychiatric treatment

What Is A Typical Program?

IOP is a kind of treatment that operates on a small scale and doesn’t utilize intensive residential or partial day services. Programs are ambulatory services for individuals with substance use disorders who do not meet the diagnostic criteria for residential or inpatient treatment as well as people who are discharged from 24-hour care in a residential treatment facility. These people still need more support than the weekly or bi-weekly sessions provided in traditional outpatient care.    

A psychiatric intensive outpatient program is geared to patients who have primary mental health issues. The dual diagnosis intensive outpatient program is for patients who have problems with drug and/or alcohol dependency and mental health issues.

Participants in IOPs have the opportunity to utilize the therapeutic groups to be able to recognize and understand problematic patterns in their lives. This helps them reinstate life role functions and supportive connections in their community.

Length of treatment       

IOPs offer a minimum of nine hours of service per week in three, three-hour sessions. Some programs offer more sessions per week or longer sessions, and some become less intensive over time. Since services are rendered in outpatient settings, the duration may be longer than that required for inpatient services. Individuals remain in their homes, reduce the use of expensive facilities, and learn to recover in their community.

The duration for intensive outpatient treatment is usually three to four months. More long-term programs may be needed for patients with more serious addictions. When a person completes an outpatient addiction program, they will continue to attend outpatient therapy sessions for several more months and up to a year afterward.

Core Services of Intensive Outpatient Programs

A set of basic services is essential to all intensive outpatient programs. It is a standard part of the treatment package offered to every patient. Enhanced services such as child care or arranging transportation may be offered based on individual needs. The core services are:

Group Counseling and Therapy in IOP

Groups form the most important part of most IOPs. Recent studies confirm that for relapse prevention training, the group approach is as effective as one-on-one therapy. Group counseling allows programs to lower the cost as compared to the more expensive individual counseling. 

The group therapy approach supports patients in IOP by:

  • Allowing clients to develop communication skills and socialization experience. This is especially useful for individuals whose socializing has mainly revolved around using drugs or alcohol.
  • The group experience establishes an environment where patients help, support, and confront one another when necessary.
  • Structure and discipline can be introduced into the lives of clients whose lives are often chaotic.
  • Providing norms that reinforce healthy ways of interacting in a safe and supportive therapeutic environment that is necessary for recovery.
  • Individual recovery can be advanced for group members who are further along in their recovery and can help other members.
  • Group members can impart new information, teach new skills, and guide other members as they practice new behaviors.
  • Offering different types of groups during the course of treatment to address different skills. 

Types of groups in IOP are:

  • Psychoeducational—These groups provide a supportive place where patients can learn about substance dependence and the consequences. These are usually begun early in treatment. They are low-key rather than emotionally intense. Various forms of relapse prevention training are provided.
  • Skills development—These groups offer patients the opportunity to practice certain behaviors in the safety of the treatment setting. 

Skills Training in IOP Includes:

1.) Drug or alcohol refusal training in which clients act out scenarios of refusing the offer of substance use.

2.) Relapse prevention techniques. Clients analyze triggers and high-risk situations for substance use and ways to avoid them.

3.) Assertiveness training teaches clients the differences among assertive, aggressive and passive behaviors and practice in being assertive.

4.) Stress management helps clients identify situations that cause stress and learn techniques to respond to stress.

5.) Support groups include patients in the same recovery stage and who are working on similar problems such as changing negative thinking, tolerance and conflict resolution and examining how one’s actions affect the group.

  • Interpersonal process groups—These groups either focus on a single issue of particular importance such as gender, sexual orientation, or sexual abuse. Or they may be family or couples groups that assist clients in learning about the effects of substance use on relatives and significant others.

Individual Counseling in IOP

Individual counseling is an important supplement to group therapy and not the main form of treatment. However, psychiatric interventions and addiction counseling are appropriate for patients with co-occurring substance abuse and mental disorders.

Typically, counseling in IOPs addresses the immediate problems created by the client’s substance use disorder and their current efforts to achieve and maintain sobriety. A 30-to 50-minute individual counseling session is usually scheduled at least weekly during the initial treatment stage. A primary counselor is assigned to the client to establish a collaborative relationship.

An individual counseling session typically consists of the counselor eliciting the client’s reactions to group meetings. He may want to explore how the client spent his time since the last session. He will ask how he is feeling, inquire about drug and alcohol use, and ask if there are any urgent issues. 

The counselor helps the client review his reactions to group topics. They will go over treatment plans and coping strategies. Issues too sensitive to discuss in group therapy will be discussed. Counselors also help clients access services they need that are outside the program’s capabilities and plan the transition to another level of care or discharge.

Psychoeducational Programming in IOP

Psychoeducational groups are more teaching-oriented and involve a straight-forward communication of facts. The counselors who perform these services need to be extremely knowledgeable about the subject matter. These sessions, like recovery groups, need to prompt discussion that helps the clients relate the topic to personal experience and encourage emotional and behavioral change. Some typical topics discussed in psychoeducational groups area;

  • Understanding motivation and committing to treatment
  • Determining the seriousness of the problem
  • Conducting self-assessment and setting goals
  • Overcoming barriers
  • Understanding the effects of drugs and alcohol on the brain and body
  • Learning about withdrawal symptoms
  • Knowing the stages of recovery
  • Learning strategies for quitting and finding the motivation to stop
  • Identifying high-risk situations and triggers
  • Understanding cravings and urges
  • Understanding abstinence and the use of prescription and over-the-counter medications
  • Understanding relapse and developing personal relapse plans
  • Learning daily living skills, parenting, and educational skills
  • Rebuilding personal relationships

Pharmacotherapy and Medication Management in IOP

These are critical components of effective substance abuse treatment. Medications target specific and limited aspects of substance use disorders. Pharmacotherapy itself does not change lifestyles or restore normal functioning.

Programs that require attendance 3 to 5 days a week are ideal for identifying clients that require medication and monitoring compliance. Pharmacotherapy and medication management services help in several ways:

  • To provide detoxification and relief of withdrawal symptoms if necessary.
  • To prevent relapse by reducing craving.
  • To reduce the medical and public health risks from the use or injection of illicit drugs.
  • To alleviate the original disorder that may contribute to a substance use disorder.
  • To monitor the treatment of some medical conditions associated with substance use disorders.

In spite of extensive laboratory research and clinical trials, there is no compelling evidence of effective medications for treating dependence on cocaine and other stimulants, marijuana, inhalants, or hallucinogens. Research does, however, support the effectiveness of medication-assisted treatment for alcohol and opioid dependence.

Many clients who enter IOP treatment have co-occurring mental disorders. Individuals with moderate-severity disorders may be treated in programs that are designed primarily for clients with substance abuse disorders. 

These programs will work in coordination with mental health services. For example, moderate-severity co-occurring disorders include stable mood and anxiety disorders. High-severity disorders include schizophrenia, mood disorders with psychotic features, and borderline personality disorder.

Monitoring Drug and Alcohol Use in IOP

IOPs include routine monitoring of clients’ illicit drug and alcohol consumption to determine if the therapy selected is having the desired effect. Some programs rely on the client’s self-reporting, but most use the objective method of testing specimens.  

Monitoring helps the clinicians determine the need for treatment modifications, helps families regain trust and helps clients avoid lapses, and discourages them from substituting a different drug or alcohol for their drug of choice.

Case Management in IOP

Individuals who abuse substances are likely to have other interrelated problems in addition to their substance abuse. Services to address these issues may be fragmented across several agencies. It may be difficult to access help without the assistance of a case manager who is knowledgeable about service providers and who can help clients access these services. Case managers help clients prioritize needs that can’t be provided by the IOP.

Case management services include:

  • Provide a core set of social services that include assessment, monitoring, and advocacy.
  • Provide the client with a single contact person who is responsible for finding needed resources.
  • Respond to the client’s needs for individualized assistance.
  • Intervene with providers on behalf of the client.
  • Focus on immediate ways to meet needs (e.g. clothing, shelter)

12-Step Fellowship

Twelve-step fellowships are the most common and widely attended groups for recovery support. Involvement in a 12-step group such as AA, NA or CA is associated positively with both retention in treatment and abstinence. Step groups prove principles of conduct and support for as long as the individual wants to participate.

Is an IOP Right for You?

An outpatient program for drug or alcohol addiction can be very successful, particularly if the individual is a willing participant. Intensive outpatient programs are an important part of the sequence of care for substance abuse disorders. They are as effective as inpatient treatment for most people.  

You have taken your inquiry this far, so make the next move to help yourself or someone you love. Contact us at (800) 741-3300. At North Jersey Recovery Center, we customize our programs to meet your needs. Our intensive outpatient program allows you or your loved one to learn more than just sobriety. We get lives back to their full potential with all that entails and provide continuous monitoring to keep it on track.

Reviewed for Medical & Clinical Accuracy by Brian Ostertag

brian-ostertag-150x150Brian Ostertag, BA, MA, LCADC, CCS, is the Clinical Director for North Jersey Recovery Center. Brian is a compassionate leader with a desire to see others exceed, and who believes that people want to work hard at something they find meaningful and believe in. He is a strong addiction services professional with degrees in Psychology Addiction Studies, and Pastoral Counseling.