Recovery That Works With Your Life: Intensive Outpatient Treatment in Massachusetts

The Need for IOP for Addiction Treatment in Massachusetts

The opioid epidemic has affected Massachusetts communities for many years. The state continually ranks high in the number of deaths caused by addiction.[1] Statewide, there are thousands of overdose deaths each year. Opioids may get more media attention, but many people misuse alcohol and are hospitalized because of it, or develop chronic health problems and a lower quality of life.[2] Use of stimulants like methamphetamines and cocaine has increased substantially over the last several years throughout Massachusetts.[3]

Even with these disturbing trends, the number of people who seek treatment is much lower than needed. The Substance Abuse and Mental Health Services Administration estimates that only a small percentage of individuals with a substance use disorder ever access treatment.[4]

Many people wait to seek treatment because it is believed that an extended absence from work is required for recovery, or that they will have to relocate to a residence far away from home. IOPs (intensive outpatient programs) reduce these barriers by providing rigorous, effective, evidence-based treatment that enables individuals to continue with their daily lives without interruptions.

Understanding Intensive Outpatient Treatment Models

Intensive outpatient programs (IOPs) fill a critical gap in the continuum of addiction treatment services. IOPs provide structured, evidence-based therapy that is much more comprehensive than that of traditional weekly therapy but does not require a full-day commitment like partial hospitalization or an around-the-clock hospital stay (inpatient treatment). IOPs are about striking a balance between intensity and flexibility, whereas the defining feature of IOPs is that they combine both of these characteristics.

Participants typically attend three to five treatment sessions each week for three to four hours per session, or a total of nine to twenty hours of programming every week. This amount of therapeutic contact provides reasonable therapeutic intervention to allow for creating positive changes while at the same time allowing flexibility to be able to work, go to school, care for family, or take care of other things that are important.

Most IOPs schedule sessions on evenings or weekends to allow flexibility for individuals with other daytime obligations, such as work or school. However, some IOPs may offer morning or afternoon tracks for those who prefer those schedules.

Therapy Modalities

IOPs incorporate multiple therapeutic components that work synergistically to treat addiction in a holistic manner. IOPs primarily consist of group therapy, which is designed for between eight and twelve participants. Group therapy allows the members of groups to share their experiences, learn from each other, challenge distorted thoughts, develop safe and effective communication patterns, and develop accountability. Structured curricula are utilized in groups to address multiple core objectives related to recovery, which include but are not limited to:

• Understanding addiction as a chronic, ongoing condition
• Identifying triggers and high-risk behaviors
• Developing and practicing healthy coping strategies
• Developing and implementing relapse prevention plans
• Improving relationships and communication with others
• Producing better quality of life

Individual counseling is typically scheduled on a weekly or bi-weekly basis (every two weeks) in order for the individual to address issues that are not appropriate to discuss in a group setting in a private setting with their individual therapist. Many times, the issues addressed in individual counseling may relate to trauma histories, family systems, shame and guilt, specific barriers to recovery, and personal goal attainment. Individual therapists are also the main point of contact and the treatment coordinators for individuals in IOP; they work with individuals to coordinate care for them and advocate on their behalf.

IOPs also recognize that addiction is a family disease and involves the entire family system. The involvement of family members significantly improves treatment outcomes and the repair of relationships damaged as a result of substance use. Education of family members regarding addiction and recovery, establishment of healthy boundaries, and improving communication patterns among family members are important objectives of family therapy.

Family therapy may also include an educational component for both the individuals in IOP and family members regarding the neuroscience of addiction and the recovery process, as well as alternatives to traditional medications, nutrition and wellness, and the various resources available in the community to assist with addiction recovery. IOP creates a structured therapeutic environment with regular peer interactions, clinical consultations, and support systems to engage and hold individuals accountable during the most vulnerable periods in early recovery.

Who Benefits Most from IOP

Individuals of all experience levels along the spectrum of addiction recovery can benefit from IOP. Examples of when it is most appropriate to enter IOP are:

Transitional Support – Step-Down from Higher Levels of Care

One of the more common pathways to enter IOP is as a step-down from a higher level of care, such as partial hospitalization or inpatient/residential treatment. Many individuals who complete a higher level of treatment do not feel ready to jump from a higher level of treatment to weekly outpatient therapy, yet no longer need the daily full-time treatment of the higher level of care. IOP provides a bridge to maintain clinical support and continued therapeutic progress while enabling a return to their daily living. This method of gradual transition enables individuals to transition more gradually from a high level of treatment, thereby decreasing the likelihood of relapse.[5]

Primary Treatment for Moderate Substance Use Disorder

For some individuals, IOP will serve as their initiation and primary level of care for recovery from moderate substance use disorder. This scenario works well when an individual:

• has completed a medical detoxification if needed
• is medically stable and ready to begin treatment
• does not require 24-hour medical supervision or monitoring
• has safe and supportive living arrangements
• can maintain abstinence from alcohol/drugs during the time that they are not in treatment
• has reliable transportation to attend IOP group sessions
• has the motivation to actively participate in recovery.

Typically, those individuals with moderate substance use disorders who are in IOP and are privileged to have substantial external support will have high success rates beginning their recovery process with IOP.

Treating Co-Occurring Mental Health Conditions

Many individuals from Massachusetts who are experiencing addiction also have anxiety, depression, PTSD, or many other psychiatric conditions. Most IOPs will provide an integrated dual diagnosis treatment program that works to address both substance use and psychiatric symptoms at the same time. The integrated approach is essential because if the mental health issue is not treated, the risk of relapse is much greater, and the substance use exacerbates the mental health condition.[6] The therapeutic relationship developed in the IOP will enable regular contact with clinical staff to assess and adjust treatment plans for both conditions during active participation.

Maintaining Work and Family Life

IOP is very beneficial for individuals who cannot take a great deal of time away from work or family responsibilities, childcare, education, etc. An individual working in healthcare could attend evening IOP group therapy sessions after completing a working shift. An individual with children may schedule IOP group sessions around school drop-off and pickup times. An individual could attend IOP group therapy sessions between their college classes while maintaining their education. Providing treatment to individuals who otherwise would not be able to receive it due to practical issues creates tremendous access improvements over residential treatment for individuals who may have delayed or potentially never sought treatment for substance use.

Extended Recovery Support

Many individuals participate in IOP to maintain their recovery support after completing more intensive but shorter-term treatment. An extended period of time in IOP provides individuals with an opportunity to navigate through life transitions, process triggers that may arise, maintain connections with a recovery community, and avoid relapse due to stressful times. This model allows for the recognition that addiction is chronic and requires ongoing management of addiction rather than a short-term intervention.

Structure and Process of IOP

The schedule for an IOP in Massachusetts typically requires participants to attend therapy sessions three to five times each week, for three to four hours per session. A typical session schedule would be Monday-Wednesday-Friday evenings from 5:30 p.m. – 8:30 p.m., or Tuesday-Thursday mornings from 9:00 a.m. – 1:00 p.m., with an additional Saturday morning group. Programs create IOP session times around the needs of working individuals, parents, and students, and understand the relationship that accessibility has on the success of recovery treatment.

It is common to participate in IOP for eight to twelve weeks; however, this may vary depending on each individual’s progress, ongoing clinical needs, and the structure of the program. Some will participate and complete programming in six weeks, while others benefit from extending their participation in IOP from three to six months. Each individual is monitored regularly by IOP treatment teams, and the treatment teams provide recommendations regarding continued participation, lowering the level of care, or increasing the level of care if more support is needed.

What to Expect in Therapy Sessions

Typical components of each three-hour group session will include:

Support Groups will be provided to allow participants an opportunity to share the current challenges that they are facing and receive feedback from their peers on how to deal with them, practice their skill sets of interpersonal communication, and work through emotions and feelings in a safe and supportive environment. Supporting each other creates a connection between individuals, helps combat the feelings of isolation and loneliness that often accompany a significant emotional crisis, and allows them to share their mistakes and learn from others who are experiencing similar issues.

Skill-Building Groups will allow participants to learn practical strategies for managing their own triggers and cravings, refusing when offered substances, coping with stress without the use of substances, appropriately managing their emotions, developing good problem-solving skills, and maintaining healthy activity routines. Skill-building groups will typically assign homework that will be completed between sessions in order for participants to practice the skills learned in the real world.

Psychoeducational Groups help participants understand their addiction. Psychoeducational groups include lectures about addiction neuroscience, how drugs and alcohol affect the brain and body, the recovery process and what to expect, how to use medication-assisted treatment, how mental health disorders can accompany addiction, and the importance of nutrition, sleep, and wellness in recovery. Learning about addiction will give participants more information to help them make informed decisions and also to help them put their personal recovery experience into context with what others are going through.

Individual Therapy participants will have time with their primary therapist once a week for 30 to 60 minutes, where they can discuss specific concerns, work through difficult emotions, focus on family issues, create individualized coping strategies, and coordinate care with the IOP staff.

Family Participation

IOP programs promote and facilitate family involvement with the participant through family therapy at least once a week, family psycho-education programs, and ongoing communication as appropriate. Family treatment helps families to better understand addiction and recovery, learn about supportive vs. enabling behavior, rebuild trust and communication, set appropriate boundaries, and meet their needs for support and healing.

Outside of the Schedule, What Are My Responsibilities?

To work on recovery between scheduled treatment appointments, IOP participants commonly attend mutual support group meetings (such as AA, NA, or SMART Recovery), complete homework using the skills they learned in the group sessions, have continued contact with their peers who attended treatment for support and accountability, create and implement healthy habits (nutrition, sleep, and exercise), and attend their individual therapy and psychiatrist appointments as needed. This work between IOP sessions reinforces treatment and continues to build on their skills, thus creating the opportunity for independent recovery maintenance.

Intensive Outpatient Treatment Effectiveness

Based on studies published in addiction medicine journals, individuals in IOP make improvements to their substance use, mental health symptoms, stability of employment, relationships with their families, and overall quality of life.[7]

Most programs have a very good completion rate for IOP; however, programs that offer flexible scheduling options, along with addressing barriers to access, typically yield higher completion rates than those that do not.

Research shows individuals who complete IOP programs maintain their recovery at rates similar to those completing residential treatment.[7] However, the best chance of maintaining recovery is to continue to receive the proper support through continued outpatient treatment.

There are many reasons why IOP programs are effective. One reason is that the substantial number of contact hours (typically 9 to 20 hours per week) will provide plenty of therapeutic exposure for the individual to make behavioral changes. Secondly, frequent sessions offer the opportunity to solve problems in real-time when they occur, rather than having to wait for the next appointment.

The ability to build peer accountability and support through group therapy that cannot be achieved through individual therapy helps create an atmosphere of safety and support.

Being able to practice skills during treatment and in the community setting increases the learning experience, creates confidence, and increases the likelihood of an individual remaining sober.

Ongoing Support After Intensive Outpatient Treatment (IOP)

Most individuals who complete an IOP will transition into a lower level of care, which is generally referred to as outpatient therapy or outpatient counseling, typically at least once a week (individual or group session). This step down will provide continued support, yet with increasing independence. Additionally, continued participation in mutual support groups (such as NA, AA, and SMART) will provide continued peer support and accountability.

Most providers in Massachusetts offer a continuum of care, providing a seamless transition to the next level of care to maintain continuity between the same therapist and treatment philosophy. Continuation of treatment maximizes therapeutic value by maintaining relationships and building upon the progress that has been made in previous levels of treatment.

Once the individual has completed the IOP, the individual is able to integrate continued recovery supports, which are sometimes overlooked by individuals in treatment. Continued recovery supports include mutual support/growth groups, ongoing individual therapy to address underlying issues, recovery coaches or sponsors, sober recreational activities, faith-based communities/spiritual supports, and continual monitoring of medical health.

All of these dimensions are critical to creating a stable lifestyle for long-term recovery.

Start Healing With IOP in Massachusetts

If you are struggling with addiction and living in Massachusetts, and you want an effective treatment that fits with your life, rather than disrupting your life, then Epiphany Wellness provides the comprehensive, individualized treatment options for continued recovery. Our evidence-based IOP provides both clinical depth and therapeutic intensity needed for overcoming substance abuse, while our flexible scheduling allows you to maintain your other responsibilities at work, home, and family. Call or contact us online now to start your journey toward a healthier, substance-free life.