Alcohol Intensive Outpatient Program and Drug Abuse Levels of Care: Which is Right for You?
If you have made the decision to seek addiction treatment services for a substance abuse or co-occurring disorder, you now need to decide which level of care, intensive outpatient program or inpatient rehab, is most appropriate for you. Determining the right level of care before you show up at a center for alcohol and drug treatment can save you a lot of time, effort and money. In fact, if you plan on using your health insurance to help pay for your treatment, they will most likely have to authorize any care beyond routine outpatient, so read on! Levels of care refers to the idea that there is a progressive dose of treatment to address the least to most severe forms of alcohol abuse or drug addiction. There are basically four levels of care: 1) outpatient; 2) intensive outpatient program; 3) inpatient drug rehab center and 4) residential or long term drug rehab.
Outpatient alcohol and drug treatment primarily consists of individual therapy, seeing a psychiatrist for medication and attending AA meetings. This is the most widely used, traditional model of outpatient care and most patients receive this level of care. Outpatient treatment is designed for individuals who have substance dependence or abuse condition, but who are able to participate in treatment and comply with treatment outside a 24-hour treatment setting. On average, this level of care consists of an hour of talk therapy a week, three to five hours of AA meetings a week and seeing a psychiatrist once every three to four months. Whether the type of treatment is psychotherapy and/or medication prescribed by a psychiatrist, most alcohol and drug treatment occurs on an outpatient basis. Traditional outpatient centers for alcohol and drug treatment are the least expensive and least restrictive settings for addiction treatment services, but since you will only be spending an hour a week with a professional counselor, this is the lowest dose or level of care available.
An Intensive outpatient program for drug and alcohol treatment is the next level of care and consists of nine to fifteen hours of structured treatment 3-5 days per week at a licensed intensive outpatient program. Intensive outpatient programs are targeted to patients who have not responded optimally to traditional outpatient services as described above, have continued to use substances during routine outpatient treatment, and require multiple contacts per week to avoid relapse and are having any medical or psychological problems addressed through consultation/referral. While in an intensive outpatient program or IOP, you will continue to live at home and possibly work. When you return home every day, you are encouraged to apply what you are learning in your alcohol and drug intensive outpatient program. Because the levels of care for alcohol and drug treatment are progressive, the treatment modalities that characterized outpatient, such as seeing a therapist for individual therapy, a psychiatrist for medication management and involvement in a 12 step program may also be incorporated into your intensive outpatient program.
Ambulatory Detox may be provided at a drug rehab center on an outpatient basis for those who are addicted to alcohol or drugs and will need medical treatment to manage their withdrawal symptoms. However, withdrawal can be complicated and ambulatory detox is only indicated when the individual can be seen by the prescribing physician at the drug rehab center often enough to be safely monitored and detoxified. People addicted to opiates and other pain killers are often treated in this modality and then stepped down to an intensive outpatient program in an effort to sustain their recovery.
Inpatient drug rehab centers are hospital based settings where you would be sent if you were medically unstable or unsafe. This level is for patients who have acute biomedical, emotional, or behavioral problems requiring on-site medical or psychiatric care 24 hours per day. For example, a patient might be sent to this level of care for inpatient detoxification to stabilize acute symptoms of withdrawal; make sure the patient is medically stable; identify any co-occurring medical or psychiatric disorders; and to transition the patient to the next level of substance abuse treatment. Alternatively, hospital based drug and alcohol treatment may be recommended after inpatient detox when medical or psychiatric symptoms require 24-hour care and daily doctor visits are needed for medical stabilization. Inpatient hospitalization is designed for those people who are unable to participate in or comply with treatment outside a 24-hour monitored treatment setting. Inpatient drug rehab treatment is usually short-term and then you will be stepped down to a lower level of care of stepped up to a higher level of care upon discharge, such as an intensive outpatient program.
Residential rehab is the highest level and not only involves 7×24 care but typically lasts a relatively longer period of time. This is because alcohol and drug rehab is typically only considered after repeated efforts at other lower levels of addiction treatment services have failed and is required for those who are unable to participate in or comply with treatment outside a 24 hour monitored treatment setting and unable to function on a day to day basis without relapsing. Otherwise known as long term drug rehab, it consists of drug and alcohol treatment 7 days a week in a residential setting. It is intended for people who do not need medical supervision, but need 24 hour a day supervision to prevent a full blown relapse. It may last 28 days or more and typically includes a family component. This level of care is reserved for those who are unable to maintain their gains, despite repeated and adequate doses of lower levels of care. However, it does require a high degree of motivation and a willingness to commit to abstinence. Following residential rehab, most patients are stepped down and will attend an intensive outpatient program.
An important factor to consider in determining the right level of care is the client’s relapse potential. Are they able to reduce or stop their alcohol or drug use? Have they gone longer than 24 hours without using? Relapse is more likely if the client has not able to abstain for at least 24 hours or if they are using drugs with high addiction potential, such as opiods, stimulants, etc. The greater the potential for relapse, the greater the need for a higher level of care. If they can control or moderate their alcohol or drug use, are motivated to change, have a support system, but have reached maximum benefit with traditional outpatient services, then an intensive outpatient program would likely be a reasonable next step.
Deciding Level of Intensive Outpatient Program Treatment
In deciding on which level of care is the right one for you or your loved one, consider the following:
Has the person been attending alcohol and drug treatment consistently and following recommendations of the treatment team, but still drinks/uses?
Do they want to stop or reduce their use of alcohol or drugs?
Are they struggling with any medical complications related to their drug and alcohol use?
Are they safe? Do they pose a danger to themselves or others?
Are they having withdrawal symptoms from drugs or alcohol?
Have they tried a lower level of care ?
What levels of addiction treatment services have not worked?
What level of care would be the next higher level, but least restrictive center for alcohol and drug treatment?
What level of care are they willing to commit too?
A recent review of the literature sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that there is a high level of evidence that intensive outpatient programs are equally as effective as inpatient and residential treatment. They found that the research consistently reported equivalent reductions in days abstinent and measures of problem severity between people who received intensive outpatient treatment, day treatment inpatient or residential care. Additionally, they noted that intensive outpatient programs allow people to avoid or step down from inpatient or residential treatment.
In explaining their findings, the authors referred to the American Society for Addiction Medicine (ASAM) text that concluded that less-intensive services, such as intensive outpatient, may have more benefit than brief, intensive interventions, like hospitalization. The important ingredient seems to be receiving treatment for a longer period of time in an intensive outpatient program, compared to spending a shorter period of time in a high intensity treatment center. Overall, most studies found that the outcomes did not differ for inpatient versus outpatient settings, with about 50% – 70% of all participants, no matter where they were treated, reporting abstinence at follow-up. The SAMHSA study concluded that cost, treatment duration, and living in the community should be the major points of comparison between inpatient and intensive outpatient services for individuals with substance use disorders. We would recommend that you consider those factors in making the choice that is best for you.
There are no easy, one size fits all answers to determine what level of care is best for you or your loved one. However, this information should give you some general guidance about what is available and what options might be right for you. Typically, the best course of action is to begin treatment at a lower level of care in the least restrictive setting. Most people have successful outcomes with intensive outpatient treatment. However, if intensive outpatient programs or partial hospitalization have not brought the desired results, moving to a higher level of care should be considered. As indicated above, severity of addiction should also be considered in making this decision. The right dose of treatment, or the right level of care for alcohol and drug treatment can be highly successful. If you need an intensive outpatient program, or if you need help determining which level of alcohol abuse or drug treatment is right for you, remember that treatment for substance abuse can be highly successful. Call us at 901-682-1434 to schedule an appointment.