When I was serving as a physician in the Navy, I observed my first inpatient treatment program outside the academic environment. After witnessing alcoholics recovering in the Navy program, I saw hope and possibilities for the future of addiction recovery.
When I left the Navy in 1973, I became interested in recreating the clinical success of an inpatient program in a more accessible format. Most people couldn’t take a month off from work to receive treatment. Traditional non-intensive outpatient treatment was accessible but did not provide enough structure to be effective as an initial intervention.
My colleagues and I wanted to treat people for addictions in a manner that allowed them to continue working. We devised a daily three-hour program modeled after the six-hour day programs that typically had been offered. Under that model, patients undergoing treatment participated in six-hour day programs and then transitioned to three-hour programs.
However, our initial impressions of the results of the three-hour program were so positive that we came to view it as a viable model on its own and not just as a step-down from the six-hour model. It became known as Intensive Outpatient Treatment.
Through the years, I continued to be impressed with the results of IOP, but scientific studies were lacking. Not many people were interested in studying outpatient programs, and we didn’t have the research resources to document our success.
But now there’s encouraging news. One of the latest studies in the Assessing the Evidence Base series summarized some key conclusions about IOP (as reported in APA’s Psychiatric News):
- Overall, studies have found that 50 to 70 percent of participants reported abstinence at follow-up, and most studies found that this outcome did not differ for inpatient versus outpatient settings of care.
- IOPs have emerged as a critical facet of 21st century addiction treatment for people who need a more intensive level of service than traditional non-intensive outpatient treatment. IOPs allow participants to avoid or step down successfully from inpatient services. This is an important consideration for policy makers, providers, and individuals engaged in substance abuse treatment services when deciding which level of care is most appropriate for specific clinical situations.
- Compared with inpatient care, IOP services have at least two advantages:
- Increased duration of treatment, which varies with the severity of the patient’s illness and his or her response
- The opportunity to engage and treat consumers while they remain in their home environments, which affords consumers the opportunity to practice newly learned behaviors
- IOPs are an important service for inclusion as a covered benefit for people with substance use disorders.
It’s exciting that someone went back and gathered all this evidence. We now have the credibility that we needed for insurance carriers, employers, patients and other stakeholders in our profession to consider IOP a viable and successful level of care. This recent development reaffirms my interest in and ongoing commitment to IOP as an important treatment option.