Intensive Outpatient vs. Partial Hospitalization for Alcoholism

Intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs) provide varying levels of care for treating alcohol use disorders. When considering whether IOP vs PHP is most appropriate for you or a loved one, understanding their similarities and differences is key. The two program types are both appropriate for someone who has mild-to-moderate withdrawal symptoms. They also both have connections to hospitals, providers, and rehab facilities for higher-level care referrals.1

Intensive outpatient and partial hospitalization programs are often step-down options for someone who completes inpatient hospitalization or residential alcohol rehab treatment. That is, they provide support during the transition out of an inpatient setting.1

In this article:

What Are Intensive Outpatient Programs?

Intensive outpatient programs (IOPs) are for anyone with alcohol use disorder whose withdrawal symptoms do not require medical supervision around the clock. When a person does not meet the criteria for inpatient treatment programs, an IOP is an excellent option because it provides many of the same services as an inpatient program in an outpatient setting. An IOP typically provides between 9-19 hours of services each week.2

Many IOP facilities are public or private treatment facilities in the community or a branch of an inpatient treatment facility. IOP treatment is available is also available for people with an alcohol use disorder and a mental health diagnosis, or co-occurring disorder.2

IOPs have multiple service goals to help you achieve long-term sobriety from alcohol. Your treatment plan goals may include:2

  • Learning early recovery skills
  • Building a support system
  • Addressing relationship concerns
  • Developing coping strategies
  • Dealing with mental health or co-occurring disorders

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Intensive Outpatient Program Schedule

One of the similarities in partial hospitalization vs intensive outpatient programs is services offered on a weekly schedule. A hypothetical IOP schedule may look like:3

  • Monday
    • Educational group: Early recovery skill building (3 hours)
    • Group activities focusing on topics such as understanding triggers, interpersonal effectiveness, self-care, etc.
  • Tuesday
    • Individual counseling or community support activity such as an Alcoholics Anonymous 12-step meeting (1 hour)
  • Wednesday
    • Educational group: Early recovery skill building (3 hours)
    • Group activities focusing on topics such as stress management, emotional regulation, mindfulness, etc.
  • Thursday
    • Individual or family counseling or community support activity (1 hour)
  • Friday
    • Group therapy for relapse prevention (3 hours)
    • Group activities focusing on topics such as communication skills, anger management, financial wellness, etc.
  • Weekend
    • Recovery activities

Your IOP sessions are based on your needs, such as more or less focus on a specific topic, and may be held at different times of day. For example, IOPs for adolescents may include educational supports and take place during the daytime, while IOPs for adult clients only may accommodate work through evening sessions.

What Are Partial Hospitalization Programs?

According to the American Society of Addiction Medicine, both intensive outpatient and partial hospitalization programs are “Level 2” programs. However, IOPs and PHPs differ in criteria and the number of hours spent in treatment each week.4

PHPs offer 20 or more hours a week, with most participants attending the program five days a week, all day. The goals of a PHP are the same as an IOP, specifically to teach early recovery and relapse prevention skills, enhance your support system, address mental health symptoms, and learn emotional coping skills.4

Partial Hospitalization Program Schedule

PHP vs IOP is considered a more intensive form of outpatient treatment. A PHP schedule may include longer educational and therapeutic sessions. A sample PHP schedule may look like: 3

  • Monday
    • Group therapy (4 or more hours)
    • Activities focusing on topics such as emotional regulation, goal setting, healthy relationships, etc.
  • Tuesday
    • Educational group (4 or more hours)
    • Activities focusing on topics such as vocational skills, finances, setting short-term and long-term goals, etc.
  • Wednesday
    • Group therapy (4 or more hours)
    • Activities focusing on topics such as healthy boundaries, mindfulness and self-care, interpersonal effectiveness, etc.
  • Thursday
    • Educational group (4 or more hours)
    • Activities focusing on topics such as improving life skills, co-occurring disorders, employment, etc.
  • Friday
    • Group therapy (4 or more hours)
    • Activities focusing on topics such as the 12 Steps, recognizing internal triggers and cues, etc.

Your PHP sessions are also based on need, but more frequently include medical and life skill interventions.

What Can I Expect in IOP and PHP Group Counseling?

Group therapies can be psychoeducational and therapeutic. A licensed addiction therapist specializing in group techniques facilitates the group sessions.

Group counseling offers many benefits for people overcoming alcohol use disorders. Early recovery and relapse prevention groups teach skills necessary for maintaining sobriety from alcohol. In therapeutic groups, counselors often use cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT) to help members learn more about themselves, their substance use disorder, and how to move forward.5

Peer groups, which focus on peer support rather than professionally facilitated sessions, offer daily encouragement and motivation in recovery. In groups, you feel less alone in the process of recovery, witness the success of others, get feedback and advice on coping, and improve social skills. You get support in working through personal issues in a safe and confidential environment.5

What Can I Expect in IOP and PHP Individual Counseling?

Individual counseling opportunities are available in both IOPs and PHPs, usually weekly. With a licensed therapist, you review what you’ve learn in other sessions and how it applies to your life. If you have issues or questions regarding the group or information learned, you can ask them one on one, without peers present.5

IOP and PHP individual counseling services focus primarily on what you are doing to maintain abstinence from alcohol, struggles you may have, and motivation to continue recovery.5

What Can I Expect From IOP and PHP Case Management?

Case management services assist those in intensive outpatient and partial hospitalization who have lifestyle problems on top of a substance use disorder. Lifestyle problems may include applying for employment, finding housing, dealing with legal issues, or obtaining special training. Case managers help you prioritize all your needs, then connect you with the necessary resources.5

Standard case management services include getting help for:5

  • Learning vocational skills that can help you get a job
  • Searching for jobs
  • Dealing with child welfare agencies
  • Dealing with legal problems, like obtaining an attorney or managing parole or probation requirements
  • Taking care of yourself physically and psychologically by setting appointments with doctors, therapists, or specialists
  • Taking parenting classes
  • Volunteering in the community
  • Creating a schedule for attending community support groups, like Alcoholics Anonymous 12-step meetings
  • Applying for housing
  • Locating transportation services
  • Helping you find ways to have fun, engage socially, and cope with stressors without using alcohol

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What Happens in IOP and PHP Withdrawal Medication Management?

Alcohol detox and ongoing medication management can occur in outpatient settings like intensive outpatient and partial hospitalization. Each program has medical staff available to assess withdrawal needs and prescribe appropriate medication as needed.

There are no specific criteria for receiving medication for alcohol withdrawal, but many doctors evaluate the severity of the symptoms you exhibit. If someone you experience mild symptoms, like nausea, vomiting, and cravings, you are a better candidate for outpatient treatment than someone with seizure activity or severe withdrawal symptoms that pose profound health risks, such as delirium tremens. These individuals may require medically supervised detox provided in an inpatient setting, like medically supervised inpatient detox or hospitalization.6

Disulfiram and naltrexone are common medications used for alcohol detox and maintenance. These medications can help you maintain sobriety by taking away cravings and easing withdrawal symptoms, which allows you to focus on learning the skills for recovery.6

What Can I Expect From IOP and PHP 12-Step Facilitation Groups?

Twelve-step fellowships based on the Alcoholics Anonymous’ (AA) 12 Steps is often a key element of intensive outpatient and partial hospitalization programs. The goal of the group is to teach the principles of AA and get you started on working the 12 Steps.5

Groups in both PHPs and IOPs build a bridge between 12-step groups at a treatment facility, which may be facilitated by a licensed mental health professional, and 12-step groups in the community, which are peer-led. It is often recommended you attend both onsite and a community group in an outpatient program. As you complete treatment at an IOP or PHP, your case manager can provide a schedule for your AA 12-step home group, which is where you can find an AA sponsor, peer support, and learn about other recovery activities in the area.5

The 12 Steps complement IOP and PHP by providing a spiritual component to healing. Studies show that those participating in 12-step groups maintain sobriety longer than those who don’t.5

Who Can Benefit From Treatment in an IOP or PHP?

Intensive outpatient and partial hospitalization programs are flexible and can meet the needs of people at any stage of alcohol use disorder. Both programs can serve the following:7

  • People starting treatment for an alcohol use disorder—Individuals start treatment from where they are. Some attend individual counseling, community support groups, or both. Some start at a medically supervised detox residential program. Starting is the most important part, not necessarily the exact program. Assessment occurs during intake to any program, and if you meet the admission criteria for an IOP or PHP, you can start services immediately.
  • People who have been in a higher level of care—Many individuals enter IOP or PHP after higher levels of care, like inpatient rehab. Stepping down typically means you have completed inpatient treatment successfully and wish to return home with the most support available to help you maintain sobriety.
  • People who have been in a lower level of care—IOP and PHP are also appropriate for individuals who started treatment in lower levels of care, like individual counseling, and need to step up to a higher level of care. Stepping up means you need a more structured program offering services each day of the week or, at a minimum, three days a week. You may also need withdrawal management.

Intensive outpatient and partial hospitalization programs can help anyone who needs support and treatment for alcohol misuse, alcohol use disorder, or recovery maintenance.

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When Should I Seek Treatment in an IOP Program or PHP?

Alcohol use disorder is not a one-size-fits-all diagnosis, a spectrum that ranges from mild to severe. However, there are signs to look for when deciding to seek treatment, like the following:8

  • Drinking large amounts of alcohol in a short time, which causes your blood alcohol content to increase quickly. This is classified as binge drinking. Binge drinking can occur occasionally or habitually, but can indicate the need for treatment in either case.
  • Experiencing negative consequences due to alcohol use, like estranged relationships, financial issues, job loss, or legal issues..
  • Wanting to reduce the amount of alcohol you use or stop use alcohol, but being unable to do so.
  • Spending a lot of time seeking alcohol, using alcohol, and recovering from alcohol use.
  • Being unable to stop using alcohol although it interferes with personal, professional, and social obligations.
  • Experiencing withdrawal symptoms when not using alcohol. Withdrawal symptoms may include nausea, vomiting, shaking, sweating, chills, headaches, dehydration, depression, sleep troubles, and in severe cases, seizures.
  • Craving or having strong urges to use alcohol.

If you have any of these symptoms, call our specialists at 800-839-1686Who Answers?. We can discuss addiction treatment services and facilities near you.

Resources

  1. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP), No. 45. Rockville (MD):Substance Abuse and Mental Health Services Administration (US).
  2. McCarty, D., Braude, L., Lyman, D. R., Dougherty, R. H., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014). Substance abuse intensive outpatient programs: assessing the evidence. Psychiatric services (Washington, DC), 65(6), 718–726.
  3. Mochrie, K. D., Lothes Ii, J., Guender, E., & St John, J. (2020). DBT-informed treatment in a partial hospital and intensive outpatient program: the role of step-down care. Research in psychotherapy (Milano), 23(2),
  4. Chuang, E., Wells, R., Alexander, J. A., Friedmann, P. D., & Lee, I. H. (2009). Factors Associated With Use of ASAM Criteria and Service Provision in a National Sample of Outpatient Substance Abuse Treatment Units. Journal of addiction medicine, 3(3), 139–150.
  5. Center for Substance Abuse Treatment. (2005). Substance Abuse Treatment: Group Therapy. Treatment Improvement Protocol (TIP) Series, No. 41. Rockville (MD): Substance Abuse and Mental Health Services Administration (US).
  6. Myrick, H., & Anton, R. F. (1998). Treatment of alcohol withdrawal. Alcohol health and research world, 22(1), 38–43.
  7. Center for Substance Abuse Treatment. (2006). Clinical Issues in Intensive Outpatient Treatment. Treatment Improvement Protocol (TIP) Series, No. 47. Rockville (MD): Substance Abuse and Mental Health Services Administration (US).
  8. S. National Library of Medicine. (2021). Alcohol Use Disorder. MedlinePlus.

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