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The Importance & Role of IOP's in Addiction Treatment

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In my memoir, as the smoke clears, I mention briefly that I attended & completed an Intensive Outpatient Program (IOP).  While I have no bias, since I had both beneficial and negative experiences, I chose this topic to write about for my 1st blog post with addictionland, because while talking with others, I am often surprised that IOP's are not as well known about as a treatment option as other standard methods.  I have done some research and I hope you all find this piece informational & interesting. I look forward to answering any questions. 

~Erika Cormier


Outpatient treatment methods have long been a first-line treatment choice for many who seek treatment for addiction and have often been the only level of treatment, accessible for a large population for various reasons from cost to ease of access, and with steady numbers of definite results.  We know the outpatient category of treatment includes replacement therapies such as methadone and suboxone/subutex/naltrexone, etc., which are often used in conjunction with non-pharmaceutical treatment through other outpatient service models, like individual substance abuse counseling & psychotherapy, group counseling sessions, 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 people new to recovery and sobriety. 

The outpatient level of care has successfully treated millions of addicts spanning several decades with a better than fair success rate.  One area of outpatient addiction treatment which has grown tremendously in popularity and accessibility across the country in recent years is the treatment referred to as "IOP’s", or Intensive Outpatient Programs.  IOP’s have long existed as a separate treatment model but have become much more commonly recommended by professionals to their patients following the release from inpatient hospitalization or detoxification, in order to more effectively integrate patients into the community, thereby lowering the rate of return to inpatient hospitalization. 

We know that group-atmosphere support systems, like the non-professionally facilitated model of Alcoholics Anonymous and Narcotics Anonymous are popular and believed to be successful, (although there have never been any actual statistics due to the basic nature of anonymity), and the IOP uses the same aspect of a group support setup.  IOP's are conducted in small groups of fellow addicts in attendance, yet it differs in the very unique way that IOP's are headed and facilitated by a team of medical professionals and/or licensed substance abuse counselors, who can take the group therapeutic model to an even higher success probability by having the credentials needed to counsel patients who may need more individual & sensitive care, in addition to the support, camaraderie & empathy of the recovering addict group members themselves.  Administration of IOP's also have a network of other professionals they can refer patients in the groups to, for accessing other outpatient care providers who can assist with providing additional treatment that a patient may be in need of or seeking.  This of course is a benefit to all group members, should they face difficult experiences while in the outpatient program and need professional, medical guidance or treatment. 

These are the two major differences between a medical-based group therapy approach like the IOP’s, versus a community-based support group approach like AA or NA.  Both provide those in recovery with what we know is crucial, which is ongoing support, and there is no need to choose one or the other, as it would only benefit someone in recovery more to be enrolled in two supportive, sobriety-based programs, but the inclusion of professionals with experience treating substance abuse in an IOP, is an obvious distinguishing factor and one that only benefits further, those who attend. 

So what occurs during all these group meetings? What is done that makes them a success? With a schedule matching that of an intensive college class, the tools that are provided are ones that have a life-long lesson and stay with each patient throughout their recovery and will apply in many areas of their life for a long time to come.  A typical IOP runs 12 weeks, some programs run as long as 20 weeks while others run 8 weeks.  Most IOP's require attendance of 3-4 days per week, for an average of 3-4 hours per day.  Most centers that offer an IOP have the option for attendees to choose between a day program or an evening program, making it an even more attractive option for those who wish to get back to work or attend school or training for job skills while in early recovery.  The intensive nature of the IOP programs is an extremely effective schedule for addicts entering treatment for the very first time, as it leaves a person little time to be bored, to think about using, to associate with those who still use in their circle of friends, and gives them a much needed structure, a healthy social outlet and a therapeutic treatment course.  All of these combined provide a great chance of achieving but also sustaining longer-term recovery.  Intensive Outpatient Programs, as a model, are conducted in a small group, usually comprised of people fairly new in their recovery process. 

Since those enrolled in an IOP attend so many hours per week, they are encouraged to discuss personal issues arising at home, at work, in relationships, etc, for which they receive professional guidance and resolution feedback & skills, that adds yet another layer of treatment that assists group members to manage their lives in early recovery on a very regular basis, which provides such an intimate treatment experience that helps one manage so many aspects of what is affected by their addiction & what needs to be addressed and treated during the recovery process. 

The level of support, & empathy that is unique to having a "common shared experience", as life-changing and severe as addiction is extensively documented and many can attest through their experience with AA/NA or other group models.  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 due to the well known long-time members of AA and NA groups all over the country.  With all the areas being addressed on a constant basis for group members, IOP's as you can likely imagine by now, are fast becoming not just a standard of care for addiction & substance abuse, but it is regarded as a premier treatment option & the statistics clearly show that this multi-faceted approach is working.  The group model has already proven successful and is indeed very effective, whether it is an AA group or not, which is why group supports are used in almost every inpatient facility for substance abuse treatment across the United States.  The IOP option of care provides the scientific, therapeutic & medical knowledge aspect to the support of a group.  This crucial knowledge that is provided to the group is what makes the standard of care increase and the success potential also increase.  The professional facilitators teach very life-applicable tools. 

These 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.  Also, knowing how to handle their communication and effectively build relationships is information they can put to use in their own lives immediately.  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. 

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, including individual counseling and therapy, when used as a sole treatment method.  This again isn't to say one should discount the benefit of individual services, as the "group" model isn't always for everyone.  But when IOP's are used in conjunction with another treatment method such as replacement therapy, or as a follow-up to inpatient care, pharmaceuticals, meetings, and/or additional counseling the long-term success rates are remarkably high. 

Another important thing to take note of, is that a lot of addicts cannot afford or do not have the access due to work schedules, insurance, proximity, etc., to receive individual counseling or behavioral therapies on a weekly basis as many addiction centers will often recommend, so by attending a program such as an IOP, a newly recovered addict is receiving these same services and skills all in one course, rather than being burdened with trying to squeeze in separate AA/NA meetings, pharmaceutical treatment with doctors, counseling/therapy services and any legal issues which often are unfortunately part of many addicts' lives.  The IOP programs allow an ease of schedule, an ease of burden with managing time & treatment for someone already trying to manage their sobriety which in itself is a challenge, by intertwining so many levels of treatment into 1 schedule & 1 program.  IOP's are also covered by the majority of private health insurance companies as well as most State healthcare assistance programs, largely because they do not themselves, administer medications.  Another benefit of IOP's that attract insurance companies is that most provide what is called an "Alumni Policy" or an "Open Door Policy", which allows and welcomes those who do complete the full program, to come back in at any time and attend any classes for NO charge, indefinitely.  It is a benefit rarely found in other professional treatment programs and has been shown to be an incentive that encourages longer sobriety rates for attendees, a higher program completion rate due to the ongoing level of support, as well as a greater level of recovery for the whole family, as these classes are most often opened to family members as well, and some programs have separate classes designated just for the family members, at no charge, also facilitated by professional counselors. 

They have already survived unimaginable life struggles, cheated death, have to live in a society that looks down upon them as being morally bankrupt, lacking willpower and have made the admirable, outstanding effort to change their lives and in many cases, by making that choice to enter recovery, they have to begin by starting totally & completely over.  

IOP’s have already made a positive impact on millions of people seeking to overcome their addiction and have proven to be an effective treatment option, with rapidly growing accessibility, for the many addicts who will choose recovery in the future and are thus, a definite asset to the addiction treatment community.  Contact your insurance company or assistance program to find out about the IOP's in your area.  If you know someone looking for help, find out about the programs nearest them and call to inquire about the cost, schedules & payment options.




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Erika Cormier, author of  the memoir, "As the Smoke Clears", understands first hand that addiction isn't always a "visible" disease.  She has dedicated her life to helping other women suffering from addiction and has drafted a bill to place caps on the high cost of outpatient addiction-related services.

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