IOP for Addiction: About Intensive Outpatient Programs

Intensive outpatient programs, or IOPs, treat addiction while offering home-life flexibility and freedom.

However, IOPs are not for everyone. Nor are they all created equal. Anyone considering an intensive outpatient program should understand both their limitations and the commitment required. 

In this guide to intensive outpatient programs for addiction treatment, we’ll try to answer all of your IOP FAQs.

You’ll learn the answers to:

• How do intensive outpatient programs work?
• What is the difference between inpatient programs and outpatient treatment programs?
• What services are offered in IOPs for addiction?
• Where do IOPs fit in the continuum of addiction care?
• Is outpatient treatment the right choice for me?
• How should I choose an intensive outpatient program?
• Should I choose out-of-state IOP treatment?

There’s a lot to consider but we’ll do our best to make it easy to understand.

So let’s start with the basics.

What is an Intensive Outpatient Program?

Intensive outpatient programs provide part-time addiction recovery treatment through licensed treatment centers. Also known as IOP or IOT, they provide post-detox therapy to guide clients through early recovery into sustainable sobriety.  IOP treatments build life skills via onsite sessions. Unlike residential programs, however, clients live offsite.

The best IOP services are therapeutic-based substance abuse treatment plans.  Clients use part-time programs when residential inpatient treatment is not required or possible. They are a powerful tool for many, including those in early recovery.  Others use IOP as their primary intervention to gauge their recovery needs.

Intensive outpatient programs offer recovering addicts the flexibility they need to maintain their lives and get the help they need for substance abuse and mental health issues simultaneously.

IOPs are designed for people who apply to any of the following:

• In an emotional crisis that disrupts daily life at home, work, and/or socially.
• Need extra support in early addiction recovery stages.
• Must continue to work, attend school, or care for family.
• Not in need of inpatient services, like medical detox, and 24-hr safety watch.
• Willing and able to attend and engage with all phases of the program.

Entry into IOP is flexible. Clients may be stepping down from detox, residential treatment programs, or a partial hospitalization program.  Other clients may be stepping up from more independent outpatient recovery to allow for extra accountability in the recovery process.

Difference between Inpatient and Intensive Outpatient Treatment

The term “intensive outpatient” is easy to confuse with the term “inpatient.” Understanding the difference is important if you want to find the best treatment plan for you.

Inpatient clients live strictly onsite at a residential treatment center (RTC) during treatment. These programs isolate them from triggers, provide medical detox, may give dual diagnosis treatment, and actively prevent suicidal or homicidal behaviors. This may be a good fit if you need 24-hour monitoring for medical care and/or substance detox services, distance from triggers, and protection for your safety or others. 

Outpatient clients may live at home or in transitional housing.  They attend treatment sessions onsite during a scheduled time block.  Outpatient services are more flexible for clients to maintain their essential duties like work and family care. This is a good fit if you need to remain in work, get lower costs for care, as well as have additional accountability like check-ins and therapy to maintain sobriety.

IOPs bridge inpatient care and pure outpatient services like sober living.  They don’t restrict residential location but structure a client’s life more than other outpatient options.

IOP Addiction Treatment Explained

Intensive outpatient programs for addiction support are part-time treatment.  However, they are still “intensive,” meaning clients must stick to a fairly strict structure.  As always, accountability is an important part of any legitimate addiction treatment program.

Steps of Attending an Intensive Outpatient Program

• After intake, screening, and assessment, clients are given a custom treatment plan.
• Attendance and full engagement is required of clients for all IOP sessions.
• IOP sessions are located onsite at a medical or therapy facility.  Schedules usually run in 3-4 hour daily blocks for 3-5 days a week.  Some IOPs offer day or night sessions.
• Treatment intensity may rise and fall along the course of an IOP.  Clients commit more time at the start and step down as they progress.  But, relapse and other challenges may require a client to step back up into higher intensity treatment.
• Full length of treatment is recommended at a 90-day minimum.  Some programs may also offer 30-day and 60-day programs depending on the needs of the client.

Because recovery is a lifelong battle, it’s not uncommon to revisit IOP after years away.

Summary of IOP Treatment Services

Each treatment plan will include services selected for the client’s specific needs.

Primary Services of IOP usually offered according to Substance Abuse and Mental Health Services Administration

• Counseling therapy sessions (group, individual, family)
• Peer support group sessions (12 steps program, etc.)
• Substance intake monitoring (alcohol, drugs)
• Additional resources including case management, life skills trainings, and medication management
• Extended access to 24-hour crisis lines and other mental health and medical services

Other Services of IOP may include but are not limited to: ambulatory detox, complementary therapies, nutritional services, physical fitness services, childcare programs, and vocational training. Services will vary, so it’s important to browse based on your needs.

Explaining the Services Provided in an Intensive Outpatient Program

Group-based Counseling Therapy

Group therapy is the main social component to an IOP’s therapeutic treatment.  The goal is to foster healthy socialization and build communication skills in clients.  Clients meet in a therapist-guided peer session to discuss their addictions and coping skills. 

In group, clients learn to deconstruct old behaviors together with their peers.  As they reform with their peers, they integrate new life skills to support their goal of sobriety. Group sizes are usually intimate at around 8-15 members.  You may find even smaller groups in private IOPs, designed to give a more individual focus. 

In therapy, the counselor will check-in with clients.  Then, peers all share personal stories. The group will then pivot to discuss the day’s topic on cognitives that foster recovery. As therapy progresses, peers learn to receive and provide support, comfort, and feedback.

Clients may engage in some of these types of group therapy:

• Skills development trains clients in life skills to thrive in sobriety.
• Psychoeducational teaches clients about their disorders and coping methods.
• Refusal training helps clients adopt ways to effectively refuse substances.
• Relapse prevention equips clients with skills to rebound in case of relapse.
• Family groups reveal and address any challenges in the client’s family system.
• Demographic specializations may be available for specific needs.  These may include gender, LGBTQ, veterans, and sex abuse survivors.

Individual Counseling Therapy

Individual therapy is the personal component of IOP addiction treatment.  In these sessions, clients privately discuss anything not shared in group sessions.  Individual counseling may expand points of concern revealed in group therapy. They also dive deeper into the more intimate needs of the client. Individual sessions are the more traditional approach to therapeutic intervention.  With one-on-one meetings, a counselor can get a better understanding of a client.

Some common individual therapies may be in a client’s treatment plan:

• Cognitive-Behavioral Therapy (CBT) helps clients reform thoughts into more effective behaviors.
• Dialectical-Behavioral Therapy (DBT) helps clients develop emotional resilience and other life skills.
• Dual Diagnosis helps clients with simultaneous mental health and substance abuse disorders.

As a more intimate process, individual therapy may present personal challenges for the client.  The level of effectiveness will depend on the client’s ability to confront themselves and apply new ways of thinking to their life. However, individual therapy clients have a unique advantage in an IOP.  Clients can apply new concepts immediately after sessions, and return to therapy with real life feedback the next day.  As a result, this can rapidly enhance the reform process.

Peer Support Groups

Support groups offer continuing care via community in and beyond IOP treatment.  Groups like 12 Steps are community-based to support members into post-treatment. Clients find a sense of fellowship to keep them sober beyond treatment.  These groups reinforce therapy and provide ongoing accountability. Peer support groups are optional in IOP treatment but are strongly recommended.

Community-based groups help to support clients beyond the course of IOP therapy.  Clients dedicate part of their non-therapy time to engage in support groups.

12 step programs are the most common support group structure.  However, they come in many variations to address different disorders. These include AA, NA, Al-Anon, Sex Addicts Anonymous, Food Addicts Anonymous, Nicotine Anonymous, and Overeaters Anonymous. Clients will interact with recovering individuals all along the spectrum of recovery.  Support groups unite newly recovering clients to those with years of sobriety.

Complementary or Experiential Therapies

Complementary therapy gives a philosophical component to IOP treatment.  Clients confront their emotions through physical, creative, and social activities.  New forms of expression give clients insight into themselves and the world. These outlets can also replace clients’ former substance-related activities.

Complementary therapies are a companion to the lessons gained in IOP therapy. Clients may partake in complementary therapy sessions as a group or individually.  Activities reveal clients’ emotional challenges without directly speaking about them.

Examples include:

• Art therapy helps clients use techniques like painting, sculpting, and drawing.
• Music therapy has clients of all skill levels create and listen to music.
• Adventure therapy uses various outdoor activities like kayaking and camping.
• Equine-assisted therapy clients interact with or care for horses.

Notably, these may not be offered in every IOP.  However, many clients find these programs helpful if they have trouble talking about their problems.

Where IOP Falls in the Continuum of Addiction Care

The duration of an IOP may only run for a short time, but recovery is lifelong. A continuum of care threads clients through full recovery, from intake to sobriety. Continuum of addiction care helps clients get treatment at every stage of recovery.  As they pass through each “level”, facilities collaborate to bridge the gaps in care.

The continuum of care has five levels defined by the American Society of Addiction Medicine:

• Level 0.5: early intervention services
• Level 1: outpatient services
• Level 2: intensive outpatient or partial hospitalization services
• Level 3: residential or inpatient treatment services
• Level 4: medically managed intensive inpatient treatment services

Clients enter an IOP at Level 2 in the early stages of their recovery. An IOP will have clients “step-down” in treatment as they show progress.  Daily sessions become less frequent, shorter sessions. If IOP is successful, clients eventually demonstrate a capacity for independence.  They will then get referred to appropriate Level 1 outpatient services like sober living. You should always select an IOP that plans for a client’s continuum of addiction care.

How to Choose an IOP Program

Every IOP offers different services, so clients should be served based on their needs.

Here are a few things one should look for:

• Custom treatment plans are essential to treat a client’s specific challenges.
• Avoid long waitlists to deter any life-threatening delays of treatment.
• Medical treatment may be important if detox is needed at any point.
• Insurance coverage may make an IOP more affordable under some providers.
• Clinical certifications ensure you receive care from a legitimate therapist.
• Night or day schedule options should fit the client’s existing commitments.
• Location must be nearby.  Distance can inhibit clients attendance in sessions.

Beyond these core needs, a client may want to recover in a specific environment. If the presence of triggers in a client’s home community may inhibit growth, one may want to consider an out-of-state IOP program.

Benefits of Out-of-State IOP Care

Out-of-State IOP treatment can distance clients from their addiction triggers. OoS IOPs blend outpatient benefits and the absence of triggers for inpatient care. These benefits include: removal of daily triggers, program options not available locally, and other specifications that can be found outside of your local area. A sober living program with IOP is often a great choice for out-of-state treatment.  These use the continuum of care model to move clients from “structured” IOP into “supportive” sober living.

Ultimately, IOP is ideal for those who need the flexibility to balance treatment and other life demands.  It’s one of the essential pieces to what we offer here at Next Step Recovery.