Who Benefits From Intensive Outpatient Drug Rehab?
Drug abuse treatment comes in many shapes and sizes – variations in environment and type of services, range of services and number of services offered abounds. People addicted to drugs also differ widely in the severity of their illness, sometimes fluctuating over a period of time. Because patients have varying treatment needs, there are varying types of rehab. Addiction professionals are tasked with placing patients in the correct level of care, matching severity of the addiction with the intensity of treatment and selecting services that will best meet the patient’s needs.
Addiction professionals use objective criteria when deciding where to place a patient; the criterion usually come from the Patient Placement Criteria for the Treatment of Psychoactive Substance Use Disorders or medical association or governmental guidelines. The Addiction Group of the American Psychiatric Association (APA) has embarked on a project to establish addiction treatment guidelines for use in intensive outpatient treatment (IOT) placements. Although the guidelines are widely accepted and generally considered useful, it is always important to remember that some patients may not fit into just one classification and will need a modified treatment plan.
The standardized guidelines have been developed to improve the effectiveness of drug rehab in the least expensive manner possible. Particular emphasis has been placed on making the criteria acceptable to all addiction professionals, as well as all those who pay for treatment (especially insurers). In order to gain broad acceptance, the guidelines provide for a common language of addiction and seek consistent placement choices. Once the guidelines have been used and studied, they will likely require revisions for effective future use.
The guidelines aim to put a patient in the least intensive level of care for his particular drug abuse issue, without sacrificing safety or security. This should improve the quality of addiction treatment while keeping costs down. Addiction treatment is broken into four main types – outpatient treatment, intensive outpatient treatment, medically monitored inpatient treatment and medically managed intensive inpatient treatment.
Outpatient treatment is defined as non-residential addiction treatment (sometimes in an office) run by addiction professionals and clinicians. It typically happens during weekly sessions, for no more than nine hours per week. Some examples of outpatient drug treatment include weekly individual therapy, weekly group therapy or a combination of both.
Intensive outpatient treatment, on the other hand, offers much more in the way of treatment options. Addiction professionals and clinicians conduct regularly scheduled sessions for a minimum of nine hours a week. Programs can be offered during the day or at night and patients can live at home or in designated facilities.
Medically monitored or managed intensive inpatient treatment is what we typically think of when we hear the word “rehab”. For medically monitored patients, addiction professionals and clinicians provide twenty-four hour treatment in a residential group setting. There is constant observation, monitoring and treatment, typically supervised by a doctor. For medically managed patients, care is provided at a hospital or similar facility that is able to address withdrawal, medical, emotional or behavioral issues. Patients who are going through detox are treated in a medically managed program.
There are some drug rehab programs that do not fit neatly into one of the four main classifications of addiction treatment. For instance, halfway houses, sober living houses and extended residential programs offer some, but not all, of the levels of care typically seen in inpatient programs. In fact, such facilities are often used in conjunction with intensive outpatient therapy.
Intensive outpatient therapy (IOT) bridges the gap between traditional intensive inpatient treatment and less intensive outpatient treatment. Although not as intensive as traditional inpatient therapy, IOT typically provides treatment over a longer period of time.
IOT offers a range of options that can be adapted for use over various settings. Levels of care are a combination of different intensities (scope and frequency of service combined with number of resources utilized) and treatment settings. During the course of treatment, a patient will likely move from one level of care to another. IOT can offer withdrawal management, group therapy, relapse prevention training, individual counseling, family counseling and pharmacotherapy.
Although the number of therapy hours per week does have some bearing on the level of intensity of any drug rehab program, it is less important in the IOT context. Due to the number of different services provided, hours can range from nine to more than seventy and can also be dictated by state law.
An IOT program must be flexible in the level of intensity of treatment it provides to a patient given where they are in their treatment cycle. Some treatment techniques can even be modified to deliver varying levels of treatment intensity.
Day IOT can last from early morning to early evening and meet seven days a week. These programs are capable of treating patients with severe drug addictions. Other programs last a couple of hours a day or meet in the evenings or during the weekend. These reduced-hour programs are geared toward patients that have a strong support system, are very motivated to recover, or who have already participated in more intensive treatment. Many IOT programs will gradually reduce the number of required participation hours as a patient reaches pre-determined goals.
While some patients in IOT live at home, others will live in special sober houses or apartments rented by the program. The level of supervision a patient will be subject to when not in treatment will depend upon his or her stage of recovery. Some programs have a resident manager who runs group meetings; other programs require the manager to live-in. IOT has also been successful at homeless shelters or in prisons.
All IOT patients should experience a minimum amount of education and be taught certain skills prior to moving on to the next care level. The patient should be able to demonstrate the positive changes in behavior, cognition and mood that occurred as a result of past therapy. IOT is successful because it is individualized to every patient and, more importantly, the course of treatment has not been pre-determined. Length of treatment and decisions on placement are based on patient progress and reaching treatment goals.