Is An Intensive Outpatient Program Right for You?

By Deborah Rasso, LMHC, CAP, ICADC, NCC, LPC, QS, CH

Intensive outpatient programs are offered at two different points in the recovery process. The first point at which a client might choose Intensive outpatient programs is when he first realizes he might have a problem with drugs and alcohol.

If a client calls his insurance company or his Employee Assistance Program, the advice given is often to start treatment with an intensive outpatient program. The benefit of this level of care is that it is usually easy to find an intensive outpatient program that offers treatment close to a person’s home. The hours are usually fairly flexible, which allows clients to attend programming around their work schedules.

Requirements Of Intensive Outpatient Programs

The requirements for most intensive outpatient programs are to attend therapeutic groups and/or counseling three times per week for three hours per session. The total requirement is usually a minimum of nine hours; however, many programs may require more than that. Some will expect a client to begin with five three-hour sessions per week later reducing to three times per week. Clients who start intensive outpatient programs as their first attempt at treatment will usually be living at home while attending.

The programs may last for one to three months. If the client is successful and is able to remain abstinent during intensive outpatient programs, he will be able to graduate from the program and continue his recovery using support groups and possible individual therapy. If the client is unable to remain sober, then he will likely be recommended to increase the level of care to either detoxification, residential, and/or partial hospitalization treatment.

It is often difficult for a person to remain sober when they begin treatment at the intensive outpatient programs’ level of care. The client is unlikely to receive any medical support to help him stop using his drug of choice. This can be dangerous and is not recommended if the client has been consuming high quantities of alcohol or benzodiazepines due to the risk of seizures during detoxification. Most intensive outpatient programs will require complete abstinence (no use of mind or mood altering drugs).

Drug tests will be given randomly to ensure that the clients remain abstinent. If a client fails a drug test, he may be discharged from the program. Not all programs will discharge clients for using. This practice allows for the possibility of risk to the other clients in the program as it can be triggering for them to see their peers under the influence. Usually, if a client is unable to pass the random drug tests, they will be referred to a higher level of care.

The clients in intensive outpatient programs will often have an individual session with a therapist each week. Many programs offer family support via a family program or counseling. The clients will also learn about the disease of addiction, will work on triggers and coping skills, will learn life skills, and will work on relapse prevention during the groups.

An important component of substance abuse treatment is participation in “process groups”. A process group gives clients the opportunity to share anything they are struggling and get feedback and support from their peers. Clients gain a great deal from the interactions they have with peers. It helps the client to realize they are not alone and that others understand what they are experiencing. Peers are able to confront each other and help by suggesting ways to change their addictive thinking and behaviors.

Attending Intensive Outpatient Programs After Higher Levels Of Care

The second point at which a client will attend intensive outpatient programs is when he has completed the higher levels of care such as detox, residential, or partial hospitalization programs. The benefit of these programs after higher levels of care is that it allows the client to acclimate back into his environment while still having the support of therapists and peers.

Residential treatment can often be like being in “a bubble”. The client has been surrounded by sober support and has been under the supervision of staff (sometimes around the clock). Often when a client returns to work or home following treatment, they find that all of the triggers that caused them to drink or drug are amplified. It is difficult to cope with the triggers as they present themselves.

The client who attends an intensive outpatient program can bring his struggle to group and seek assistance from staff and peers as to ways to cope without using substances. Staying in an intensive outpatient program also means that he will be drug tested to remain accountable. If he does relapse to substance use, it will be detected quickly before the client experiences the serious consequences that will occur.

When clients “steps down” to intensive outpatient programs following a higher level of care, it is usually recommended that they live in a sober living environment.  Research studies of the brain have shown that it takes up to 24 months to repair from the damage done by addiction. Further studies have shown that the best chance of avoiding relapse is with 9 to 12 months in a treatment environment.

Attending an intensive outpatient program and living in a sober environment makes it possible to achieve that goal.  The client will be encouraged to return to work or school and acclimate back into the normal routine of life. Clients will be encouraged to attend support groups such as AA and NA and to begin working a program of recovery.

While sobriety is achievable at this level of care, it is also not uncommon for relapse to occur. The transition back to a normal life can be stress inducing; sometimes a client has not fully accepted that they are no longer able to use mind altering substance. Remaining in intensive outpatient programs as long as possible is the goal — most clients will likely have anywhere from six to 12 weeks of intensive outpatient programs available through their insurance.

Intensive outpatient level of care is offered as a step-down at Delphi Behavioral Health Programs. It is recommended that clients who have completed the higher levels continue intensive outpatient programs with the same provider if possible, since this allows for a continuum of care. In the event that clients are unable to follow the recommendation to remain through the completion of Intensive Outpatient, case managers will help clients to find a program in their hometown that they will be able to attend to continue their care.

One final note: it is important to understand that once a person is at intensive outpatient level of care he is no longer able to be provided housing at no cost. Sober living costs vary, but the average is around $175 per week, and that cost does not include the treatment program. However, insurance will continue to pay the cost of attending intensive outpatient programs, but won’t cover the cost of housing.

If a program offers a client free rent in exchange for attendance in intensive outpatient programs that should serve as a “red flag”.  Clients attending intensive outpatient programs should look for programs that have a variety of groups, cater to people who are motivated for recovery (be cautious of programs that are mostly filled with court ordered clients), and employee Master’s level and licensed clinicians.

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