What is IOP? (Intensive Outpatient)

May 22nd, 2023

By P. Casey Arrillaga, LCSW, LCDC

The Ins and Outs of IOP

IOP, short for Intensive Outpatient, is a popular type of treatment for addiction and other mental health issues. This is no doubt because, despite the word “intensive” in the name, it is a lot less demanding than residential treatment and can be done while living at home and working or going to school. Like any good thing, though, it’s not right for everyone or is best used as a facet of some people’s treatment rather than being the whole thing. This article is all about how to see where IOP might fit for you or a loved one. To understand that, we have to put it in context of various levels of care.

Levels of Care

The term “level of care” is frequently used to differentiate between types of treatment, sorted by intensity. Do you or your loved one need to go to a hospital to get professional medical help or do they need to start by meeting in a church basement with other laypeople who share their problem? How would you or a family member know? There are many different levels of care available, and it can seem like a maze of acronyms and jargon to the person or their family member who just wants to find help. You may hear various terms used such as: detox, RTC, IOP, PHP, SOP, individual counseling, recovery coaching, and recovery fellowships. How can you sort this out?

To begin, the level of care is ideally determined by the rule of “the least restrictive care that still meets client need.” In other words, we want to preserve the dignity and freedom of the person suffering from addiction while still getting them what they require to get and stay better. Sounds simple, right? Of course, in practice this is difficult to determine and there is not one set of guidelines that professionals all agree should be used. Since many people use health insurance to help pay for treatment, the insurance companies also weigh in on the matter, often seeming to think more in terms of “the least expensive level of care,” leading to a tug-of-war between treatment providers who believe the services they provide are vital and that clients need to remain in care for as long as possible, and insurance care managers who believe that costs are overblown for treatment that seems ineffective and unnecessary. Thus, the level of care is often a compromise between financial and clinical criteria.

To complicate things further, many people with mental health issues, especially addiction, want to engage as little as possible when treatment is first proposed, so they try to find the level of care that requires the least amount of effort and change. If you are a family member, you may find that your loved one initially agrees to go to treatment, then starts arguing for progressively lower levels of care until you wonder what difference will be made anyway. What starts as a discussion of where to get detoxified and get treatment for at least 30 days can quickly become downgraded to a commitment to go to recovery meetings, or just change on their own. For family members who are uncertain about how all this works, it can be hard to counter such arguments or even know if they should try.

How Can You Tell What’s Best for You or a Loved One?

Your best bet to sort through your options is to talk to some professionals. Talk to a therapist who has experience with the issues you are facing. Call a few IOP programs to see what they have to offer and set up a screening. This can usually be done through a phone call or online meeting. The person seeking care will be asked a set of questions to determine what issues are in present and how severe they are. Based on this, recommendations for care will be made. The person doing the screening will be able to say if IOP is a good fit or if a higher or lower level of care is the way to go. If they recommend residential care, IOP is often the next step afterwards, so such programs have no problem giving a referral in hopes that they’ll see you once the more intensive needs are met.

What Should Someone Expect at IOP?

 IOP is usually expected to incorporate 24 three-hour sessions, most commonly conducted three times per week for eight weeks. This may be affiliated with a residential treatment center or may be a stand-alone program. Many of the participants in IOP will have just completed RTC or PHP and were told that this was their next step. Others will have sought treatment when they had less severe symptoms or life consequences and were told IOP was the place to start. 

The three-hour sessions usually include some of the same elements found in residential treatment. Sessions will typically begin with a time for participants to check in about how they have been doing, followed by a process group, and then an educational presentation. Throw in a break or two, and the session is complete. As part of the overall program, there should be one or more individual counseling sessions, but possibly with less frequency than at residential treatment, and there may be a family component offered. Regular drug testing in addiction IOP programs should be expected, especially since the clients live and work in “the outside world,” unlike the residents in a treatment center.

IOP programs are now being offered online. This is a relatively new idea as of this writing, so there isn’t much data to say how this compares in effectiveness, but it certainly offers convenience that can’t be beat. Since the pandemic moved so much of life online, this option has become much more popular and comfortable for many people, and the experience of addiction professionals and their clients so far is promising.

The Bottom Line

Like anything, IOP is a good option for many people but not right for everyone. Educate yourself and consult with professionals to see if it is the best fit for you or a loved one.

About The Author

P. Casey Arrillaga is the Team Leader for Education at Windmill Wellness Ranch, and he is the author of books including “Realistic Hope: The Family Survival Guide for Facing Alcoholism and Other Addictions”. His books, podcast, videos, etc. can be found at CaseyAuthor.com

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