An Introduction to Intensive Outpatient Treatment

At one time, people with substance use disorders who wanted consistently effective treatment had only one option — inpatient treatment. This changed in 1956 when Dr. Vernelle Fox established an all-day ambulatory treatment program at the Georgian Clinic in Atlanta, Georgia. Both ambulatory detoxification and rehabilitation were provided in a program that borrowed from the advances made in residential treatment and added structure and intensity not previously found in outpatient settings. Such all-day programs are now referred to as "partial hospitalization." The next development occurred in 1973 in Silver Spring, Maryland where Dr. George Kolodner and Jim McMahon designed a three-hour evening program, which became the Kolmac Clinic. Programs of this length are known as "intensive outpatient programs" or "IOP."

Over the next 30 years, programs such as these proliferated and studies demonstrated that their effectiveness matched that of residential programs. The growing interest in this model created a need for information about how to run such programs. In 1984, the Center for Substance Abuse Treatment of the National Institute of Health enlisted a panel of experts, including Dr. Kolodner, to create a guide entitled Intensive Outpatient Treatment for Alcohol and Other Drug Abuse. The continued development of this treatment model was so extensive that a second version was created in 2006, with Dr. Kolodner again acting as one of the panel members. Whereas the first version had been 104 pages in length, the second was 404 pages and required 2 volumes.

While hospitalization and residential treatment is still available, an increasing proportion of treatment for substance use disorders is being given in ambulatory settings, where accessibility is easier and costs are lower without effectiveness being sacrificed. Traditional non-intensive outpatient treatment, while not consistently effective for initiating recovery, can provide a valuable setting for continuing care following detoxification and rehabilitation.

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