Intensive Outpatient Programs for Alcoholism

More than 14.5 million Americans have an alcohol use disorder.1 There are five levels of treatment for alcohol use disorder on a continuum of care established by the American Society of Addiction Medicine. Intensive outpatient programs (IOPs) are level two in the continuum of care.

A continuum of care means you start treatment at one level and move up or down in treatment intensity based on services you need.2 IOPs are recommended for individuals who have an alcohol use disorder who do not require 24-hour medical supervision or detoxification but do need at least nine hours of treatment services each week.2

In this article:

Criteria for Intensive Outpatient Treatment

Clinicians use six dimensions to assess whether you meet the criteria for an intensive outpatient program (IOP) recommendation.3

1. Acute Intoxication and Withdrawal Potential

To qualify for IOP, intoxication and withdrawal symptoms must not interfere with treatment. If you are experiencing extreme withdrawal symptoms like delirium tremens, seizures, or muscle spasms, you need a higher level of medical supervision. In this case, a better recommendation would be medical detoxification at an inpatient facility.

2. Biomedical Conditions or Complications

Sometimes if you have alcohol use disorder, you may also have a medical condition. You would be able to attend an intensive outpatient program if the medical condition or complication does not interfere with treatment.

3. Emotional, Behavioral, and Cognitive Condition or Complications

Many people with alcohol use disorder have co-occurring disorders. For example, you may have an alcohol use disorder and an anxiety disorder.

Intensive outpatient programs are an excellent option if you have a dual diagnosis or co-occurring disease. The key is to ensure that you IOP provides appropriately trained staff and required services. Your clinician will also evaluate if your emotional, behavioral, or cognitive condition is stable enough for an outpatient setting.

4. Readiness to Change

Some individuals enter recovery due to external motivators, such as family ultimatums or court programs. Some people may want to change but do not have the skills or continued motivation required to maintain recovery.

As long as you commit to participating in the program for at least nine hours weekly, you can qualify for an IOP.

5. Relapse, Continued Use, or Continued Problem Potential

If you have been in a less intensive program—like attending weekly support groups—but are not making progress, you may qualify for an IOP. Your clinician will evaluate your risk of relapse, your need more intensive services, and other factors to determine if IOP is an appropriate treatment choice.

6. Recovery Environment

An IOP provides positive education and the support necessary for recovery. IOPs offer support several days a week, but may not be adequate treatment if you live in an unsupportive, toxic, or enabling environment.

The home environment plays a significant role in recovery. If you live in a non-supportive environment, you may need a residential treatment option or sober housing assistance.

Intensive Outpatient Treatment Settings

Upon meeting the criteria for intensive outpatient services, you can begin a program in a licensed treatment facility that provides a team of professionals to help you succeed. Your team may include a physician or psychiatrist who can prescribe medication to manage withdrawal symptoms and cravings if needed. Typically, a clinical nurse is available to monitor symptoms. Licensed substance misuse and mental health professionals lead educational and counseling services.4

Most intensive outpatient programs (IOPs) take place at a treatment facility or in connection with a treatment facility. You attend services at least nine hours each week, with some sessions offered in the evening and on weekends to meet varying schedules.4

At the beginning of an IOP, activities are more structured and intense. As you progress, you move to programs with less supervision and time spent at the facility. Not everyone completes intensive outpatient treatment the first time without difficulty. That’s okay. IOPs are set up so you can return to a higher level of care within the program or be referred to a higher level of care—like residential rehab—if needed.4

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Common Intensive Outpatient Therapy Types

An intensive outpatient program (IOP) may utilize several therapeutic modalities in group and individual sessions. Common modalities include the following.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) is a technique used in both group and individual intensive outpatient services. It is a form of talk therapy based on the theory that thoughts directly influence behaviors. Therefore, changing negative thought processes and responses to triggers or cues can lead to making better decisions and avoiding relapse.3

Motivational Interviewing

Motivational interviewing is a technique that encourages people who are in denial about having a problem or are not quite ready to change to become more motivated for treatment. It helps you focus on achieving realistic and incremental goals.3

Contingency Management

Contingency management uses incentives to reward you for focusing on recovery and not using alcohol. Incentives can also be used for other actions, like attending your IOP sessions, community support programs, and recovery activities.3

Stages of Intensive Outpatient Programs

The following four stages of intensive outpatient treatment illustrate typical progress through treatment. Each person progresses through the stages at a different pace.3

Stage 1: Engagement

Feeling unsure, confused, and afraid of change is not unusual when starting a new program. To help you overcome these feelings, counselors focus on helping you engage in intensive outpatient treatment during the first stage with motivation and support.3

Some of the activities you and your therapeutic team focus on include results from lab tests or questionnaires. You also review program rules and expectations, start building a support system, and learn more about alcohol use disorder through educational activities. 3

To move out of stage one, you must complete an assessment and, if needed, medical withdrawal. You must also be attending activities consistently.3

Stage 2: Early Recovery

The early recovery stage is intense and highly structured. It can last between 6-12 weeks. You attend educational classes to learn more about alcohol use disorder and how it affects you, relapse prevention strategies, triggers, improving communication skills, and resolving personal problems that hinder your recovery.3

In this stage, you are able to join support groups—like a 12-step group—to aid in your recovery. Family therapy is also an option. To move into the next stage, you must be sober for at least 30 days, obtain a sober home environment, build a positive social support network, set recovery goals, and complete a relapse prevention plan.3

You will spend most of your IOP time in groups that help you enhance communication skills, give and receive peer feedback, and learn more about alcohol use disorders.3

Group therapy is a core IOP service with the following characteristics:3

  • Psychoeducational, where you learn about the disease of alcohol misuse and how it affects your body
  • Skills development, where you learn recovery and relapse prevention skills, how to say “no,” and stress management
  • Support groups, where you meet with peers to learn other skills like anger management, conflict resolution, and communication
  • Interpersonal groups, where you can get support for personal issues—these groups include family and couples therapy
  • Community-based support—like Alcoholic Anonymous 12-step groups—where you receive support throughout treatment and after

Groups are just one service provided in intensive outpatient treatment. Individual counseling is another core service in IOP. In individual counseling, you meet with a therapist to discuss what you are learning in intensive outpatient treatment and how you are applying what you’ve learned to your life. Topics you may not want to discuss in front of the group can be addressed one-on-one with your therapist.3

Medication management is also a core IOP service available to those prescribed medicine to control cravings, reduce withdrawal symptoms, or improve mental health. You meet with a psychiatrist or physician to discuss all medication matters. For people who are not at risk for severe withdrawal symptoms, detox services may be available in IOP. Medications like disulfiram can help prevent relapsing to alcohol use.3

Stage 3: Maintenance

The maintenance stage can last up to a year and may begin partially in your IOP and continue afterward with services planned with your IOP care team. In this stage, you implement relapse prevention skills and build a strong sober social network.

In maintenance, you achieve long-term recovery with long periods of abstinence or harm reduction. Improvements happen in your personal and professional life. Your housing remains drug and alcohol-free. You continue to participate in activities to improve relationships and obtain assistance for other life areas when needed.3

Stage 4: Community Support

This final stage involves ongoing, long-term activities that help you maintain recovery. It is an aftercare plan with personal, professional, and social resources. You may create your community support plan in IOP, but may be in a lower level of care at this stage.

Resources provided in this stage may include vocational training support if you need help finding a job, connection with housing resources, and so on. A case manager is available if you need help managing appointments to doctors, 12-step meetings, counselors, or pharmacotherapy.3

IOP and Other Treatment Components

You can start treatment in an intensive outpatient program. If intensive outpatient treatment is not providing the desired outcomes established by you and your treatment team, they may recommend that you step up to a higher level of care, which include:8

  • Inpatient or residential treatment, which are a hospital, clinical, or facility settings with 24-hour supervision and access to medical personnel
  • Partial hospitalization, which is a step up in care from an IOP
  • Therapeutic communities or long-term residential programs
  • Short-term residential treatment
  • Sober living homes, which are a transition residence that help you transition back into your home environment by practicing the skills you learned in residential or inpatient treatment

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You can also start at any of the above higher levels of treatment and, when complete, step down to an IOP. Or, start in an IOP and step down to a less intensive program. Examples of lower levels of care include:5

  • Outpatient programming
  • Individual counseling
  • Community support groups

If you think an intensive outpatient program may be the right choice for you or someone you know with an alcohol use disorder, give us a call at 800-839-1686Who Answers?. Our specialists can help you find treatment services.

Resources

  1. National Institute of Alcohol Abuse and Alcoholism. (2020). Understanding Alcohol Use Disorder.
  2. McCarty, D., Braude, L., Lyman, D. R., Dougherty, R. H., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014, June 1). Substance Abuse Intensive Outpatient Programs: Assessing the Evidence. Psychiatric Services, 65(6), 718–726.
  3. Center for Substance Abuse Treatment. (2006). Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Treatment Improvement Protocol (TIP) Series, No. 47. Rockville (MD): Substance Abuse and Mental Health Services Administration (US).
  4. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment [Internet]. Treatment Improvement Protocol (TIP) Series, No. 45. Rockville (MD): Substance Abuse and Mental Health Services Administration (US).
  5. National Institute on Drug Abuse. (2021). Treatment Approaches for Drug Addiction DrugFacts.

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