Intensive Outpatient Treatment as Step-Down Level of Care

Drug and Alcohol Treatment IOP

Substance misuse does not always result in addiction requiring residential treatment. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—the principal authority for psychiatric diagnoses—no longer uses terms like alcohol abuse or chemical dependence. Instead, the DSM-5 refers to substance use disorders (SUD), which are defined as mild, moderate, or severe to indicate the level of severity. In his 2016 report on addiction, the surgeon general used this terminology, too, equating a severe substance use disorder with addiction.

Since not all SUDs are equally severe, they consequently require different levels of intervention. Only a careful assessment can determine what level of care is appropriate for each patient. Severe opioid use disorder frequently requires comprehensive, residential treatment by addiction professionals. A moderate cannabis use disorder or a mild alcohol use disorder on the other hand may only require an intensive outpatient program (IOP).

When appropriate, IOPs provide effective treatment with fewer disruptions of social, family, occupational, and educational routines and relationships. An IOP typically allows patients to continue working, maintain their current living situation, and improve relationships affected by substance misuse, all while receiving services right in their local community.

A typical IOP requires patients to participate in the program for several hours 3–4 times a week. Should that level of care prove inadequate, patients may choose to intensity their recovery efforts in a residential program.

IOPs serve another crucial function: as a step-down level of care. After weeks of comprehensive addiction treatment, the person in recovery is transitioned to the intensive outpatient program from an inpatient or residential facility. In that case, clients have been stabilized in the residential treatment program and now need to continue with intensive treatment services to maintain sobriety and work on the underlying causes of their substance use disorder.

The IOP functions as a safe buffer zone for patients discharged from residential treatment but wary of returning to their previous environment. Being once again exposed to the people, places, and things associated with their substance misuse is a serious challenge for most people in early recovery that cannot always be avoided. Many need additional help after returning home and joining an outpatient program might be the answer.

Relapsing during the early stages of recovery is not uncommon, but can be dangerous. Once they stop using drugs and alcohol in rehab, patients lose their tolerance and are more likely to experience negative side effects or overdose when using again. Best to taper off treatment slowly and improve the chance of a successful recovery. An IOP could also become a step-up option for people struggling with their recovery, but who don’t require another stay at a residential facility.  

The Farley Center at Williamsburg Place recognizes the important role IOPs play in the recovery process. Farley currently offers four locations for intensive outpatient treatment in Virginia. The program is open to adults 18 and older who are experiencing substance use disorders along with co-occurring mental health conditions. To participate, patients must commit to attending a minimum of three hours of therapy four times per week.