The Individualized Intensive Outpatient Program
by Tom Horvath, Ph.D., ABPP
Practical Recovery’s IIOP
The Individualized Intensive Outpatient Program
To be clear: An Individualized Intensive Outpatient Program (IIOP) is not an Intensive Outpatient Program (IOP). An IOP is a group that typically meets three hours per day, three days per week. In addition, there may be one individual session per week. The IOP is the backbone of many outpatient addiction treatment approaches, and indeed, Practical Recovery offers one (which includes one individual session per week). One of the advantages of an IOP is that insurance companies are familiar with it, and tend to reimburse this service at a reasonable level.
Nearly 20 years ago Practical Recovery introduced the concept of the Individualized Intensive Outpatient Program. This year we are re-introducing the IIOP under this new name. For selected individuals the IIOP offers a substantial benefit over an IOP or residential treatment. Surprisingly, no other US addiction treatment facilities appear to have implemented an IIOP.
An IIOP is composed of individual sessions with a range of providers. Our IIOP clients typically participate in two to four individual (50 minute) sessions per day, for one to several weeks, with multiple providers. Our providers include psychologists, psychiatrists, continuing care (relapse prevention) counselors, hypnotherapists, and a range of holistic healers (including yoga, massage, acupuncture, mind-body and other forms of meditation, and energy healing). Our experience suggests that three to four sessions per day is the maximum number that most clients can benefit from. For some clients two is the maximum.
San Diego clients typically live at home and come to our offices daily. Clients from out of town live in one of two hotels within walking distance, at one of our sober homes, or in other accommodations. For clients traveling to San Diego, the typical length of stay is two weeks, but treatment can be of any length.
Practical Recovery offers addiction treatment that is radically different than most US addiction treatment in at least three primary ways, all of which are clearly evident in the IIOP.
- Our main providers are licensed mental health professionals (typically doctoral level psychologists)
- We focus on individual sessions rather than groups
- We focus on underlying and predisposing factors in our clients rather than providing “addiction counseling.”
Other benefits of the Individualized Intensive Outpatient Program include:
- Clients have the choice to refine their own treatment teams based on how the relationship with each provider is going
- Scheduling is completely flexible
- There is more actual treatment provided than in almost any residential treatment facility
- The client has more time available for personal use
- The client often has lower overall cost.
Determining if IIOP is a Good Fit:
During an initial phone call we mutually determine that the IIOP is a suitable service. For the client seeking an alternative to residential treatment all parties need to be confident that the living situation will not be a high-risk situation. Some options to consider, to make this living situation workable, include medications (e.g., Antabuse, which persuades drinkers not to drink), the presence of a family member, friend or recovery coach, a Soberlink breathalyzer, or residence in the sober home.
A Look at the Cost:
Although the out-of-pocket expense for treatment is relatively high (typically about $3000 per week for three sessions per day, five days per week), plus the possible expense for travel, lodging and food, there are also financial benefits as compared to residential treatment. A one-month stay in a residential facility (which many facilities insist upon), even with insurance reimbursement, may have comparable co-insurance costs. For a busy professional or executive the free time available after the treatment day ends may mean that vacation does not need to be taken, or business deals or other work need to be delayed. The treatment day can end as soon as noon, as begin as late as 2pm. For someone working from an east coast office a nearly full day of activity can be accomplished.
Should an addiction treatment client always focus on treatment exclusively? For some that exclusive focus is helpful. However, treatment does not occur in a vacuum. The realities of the client’s personal and work life need to be considered. If it is “rehab or nothing” a client may choose nothing, increasing the chances that further major negative consequences are ahead. A major advantage of the IIOP is that it allows flexible scheduling around work commitments as well as personal commitments. Clients can even jet off to events or activities and return as available.
IIOP and the Self-Empowering Approach
As with all services at Practical Recovery, we use a self-empowering approach that assumes the solutions to problematic addictive behavior exist within the client, not outside the client in a higher power, group or sponsor. Although most of our clients believe in a higher power, they want an approach that helps them develop their own capacities to solve problems, as they do in other parts of their lives. Even in our groups, which IIOP clients sometimes also participate in, we tailor our efforts to the individuals involved. The curriculum in our groups is minimal, as we strive to develop immediately meaningful solutions for each participant, and then generalize them in a manner meaningful to all participants.
What deeply appeals to selected clients about the IIOP is the level of individual attention available only in individual sessions, the highly credentialed and experienced staff, the opportunity to have discussions of importance to the client rather than following the curriculum of a group-based addiction treatment program, the completely flexible scheduling, and the choice of providers as treatment progresses. Individual sessions can be used as couples and family sessions, with others included in person or by telecommunication.
For someone seeking intensive treatment for changing a problematic addictive behavior, there may be no finer option than Practical Recovery’s IIOP.