Dr. Kolodner On The Crucial Role Of IOP

Editor’s Note: Outpatient alcohol and drug rehabilitation received a boost last week when CareFirst/Blue Cross launched an initiative to promote its use. I was invited to participate in a press conference on December 13th with Baltimore Mayor Catherine Pugh and CareFirst CEO Chet Burrell to speak about this type of addiction treatment in which Kolmac has pioneered. The following is the text of my remarks.

Drug and alcohol rehabilitation programs work by providing intensive, structured group therapy patients who are abstaining from substance use. This treatment was initially restricted to inpatient settings. Because of progress in the use of medications and abstinence monitoring techniques, rehabilitation can now be done on an outpatient basis. Delivering these services in an outpatient setting provides the same level of effectiveness as inpatient treatment without taking people away from their homes and jobs. Work is done on managing day-to-day stresses in a real-life environment rather than an artificial and protected one.

The advantages of outpatient rehabilitation are enhanced when it is preceded by outpatient detoxification and followed by less intensive continuing outpatient treatment. By providing all three levels of treatment in a single facility, premature dropouts can be reduced, especially if the treatment phases are designed so that they overlap. This approach not only avoids the initial disruptiveness of inpatient treatment but also eliminates the re-entry transition problem that occurs when people return to their homes after they have been discharged from the inpatient treatment facility. This is particularly important because the chronic nature of substance use disorders makes continuing treatment, at a less intensive level of care, critical to successful long-term recovery. The lack of follow through after inpatient treatment is disappointingly high, leading to relapses, repeated treatment attempts, and sometimes death.

Expanding access to intensive outpatient treatment is particularly relevant at this time because of the challenges presented by the continued opioid addiction crisis. While concerned voices call out for more treatment beds, I would suggest that more people can be treated effectively if funds were directed toward outpatient rehabilitation instead of toward inpatient treatment. Four patients can be treated in outpatient rehabilitation for the cost of one patient treated on an inpatient basis. Inpatient treatment is a necessary level of care for a limited number of patients who require more physical containment, but using it as a default first option for everyone is clinically unnecessary and financially wasteful.

I will end by mentioning that the intensive outpatient model originated right here in Maryland. The program was designed by myself and my colleagues in 1973 to operate during evening hours to meet the needs of working individuals. We later broadened the program by adding morning hours. Over the past 44 years, I have spent my entire professional career working to improve this treatment model and have overseen the treatment 30,000 patients at Kolmac.

The intensive outpatient treatment model has now become mainstream and programs are operating throughout the country. Studies have documented its equivalent effectiveness to inpatient rehabilitation. Despite all the advantages provided by outpatient rehabilitation, however, this treatment approach is underutilized. My hope is that this CareFirst initiative will stimulate an increase in its use in facilitating recovery and saving lives.