Intensive Outpatient Program (IOP) is one critical piece in the vast continuum of care
for addiction treatment. But how do you know if it’s where you start or what you need? And what is IOP anyway?
Dr. Ryan Drzewiecki
, the program director of the IOP at All Points North Lodge (APN) and a trained psychologist with a decade of addiction experience, fills us in on everything we need to know about IOP and what makes APN’s IOP worth a look.
What is an IOP? What are the basics?
IOP is short for Intensive Outpatient Program. It is an intermediate level of care in substance abuse treatment. Some people might start off their journey in detox, residential, partial hospitalization program (PHP), or an intensive outpatient program. Typically IOP’s will meet three or four times a week, and that will include group therapy and individual therapy.
IOP is good for either people who are stepping down from a higher level of care or people who . . . maybe their struggle with addiction is a little bit less severe. Maybe this is the first time that they’re seeking treatment and they’re not sure if they have a problem or not but they’ve started some problematic patterns. Or maybe they haven’t had a long history of addiction but they were prescribed something and they’re finding it’s really difficult to get off of it. Or somebody who has a lot of background with addiction treatment and has had some good sobriety time but has recently relapsed. They may not need a full residential setting so IOP might be appropriate for them - they have all the tools they need, they just need a kick start to get back on track.
So there are a lot of places you can come from to get into an IOP as the right fit?
Yeah absolutely. Typically, we see a lot of people stepping down. But when you’re dealing with insurances, a lot of people for their first time may only be authorized to come to IOP. So that’s also another consideration.
Is there any concern that someone would enroll in an IOP and then realize, “I actually need a different level of care?” What happens if IOP’s not the right fit?
All of our services start with a really comprehensive bio-psycho-social-spiritual assessment where we’re really digging into the question of “what’s the appropriate level of care?”
We can usually get a good sense when somebody calls in on the phone as to what works. But their first appointment whenever they come is really sitting down and looking through their history in detail and their addiction history in detail, checking out treatment history, talking about trauma and other mental health concerns, and making sure that we are the right level of care.
If somebody needs more - and of course that’s the wonderful thing about a place like APN is that if somebody needs more, we can refer in-house - or if somebody doesn’t need a full IOP level of care, we can make that referral as well.
Tell me about APN’s IOP in particular - some of the details. What can people expect?
At APN’s IOP, we generally expect an 8-week commitment. Some people stay a little bit longer, depending on their needs. IOP meets three days a week for group therapy. We do three hours on Monday, Wednesday, Friday. Anybody who is involved in IOP also gets a weekly individual therapy session, a weekly family therapy session, and case management services where we can communicate with other professionals they might be working with.
Okay, and does everyone start IOP at the same time for a round or do you jump in whenever?
You can jump in whenever. We have a rolling curriculum and base it on where the group as a whole is and what the group needs at any given point in time. So if we did have a lot of new people, we might shift gears and focus on some of the early coping skills and some of the building blocks for therapy. Whereas if we had a lot of people who are more experienced, we’re focusing on deeper issues and patterns that relate to addiction.
A lot of people find value in a 12-step program. What are some of the differences between 12-step and IOP?
Yeah, we love AA and other self-help support groups. The biggest difference is that clinical groups are facilitated by addiction professionals who have been doing it for a long time, and they’re structured in a very different way. AA meetings are peer-led and focus around one speaker or everyone sharing in smaller portions, but with IOP, you’re getting psychotherapy from a trained professional and focusing on different areas. We recommend clients attend as many other support groups as possible for the best experience in recovery.
We have different specialties and do a lot of different things with the groups including a lot of experiential activities that you wouldn’t find anywhere else. We also have a background in dealing with co-occurring mental health issues - developmental and relational trauma, depression, anxiety, and interpersonal issues, all of these different things that tend to come with long term substance abuse.
Are those co-occurring mental health disorders typically treated in an IOP? Is that unique to APN or does it just vary depending on the facility?
It can vary based on the facility. At APN, we look at the co-occurring stuff and say, “How does this need to be treated? Is it something we’re working on directly in IOP or is it something where we’ll set up some continuing care or are we making a referral maybe to APN Rise or to the trauma program at some point?” We’re really just trying to keep our eye on what they need and what optimal treatment looks like.
Old school AA philosophy focuses on sobriety first, and rightfully so. A lot of times what seems to be a co-occurring disorder actually looks very different after a period of sobriety. But at the same time, we don’t want to push all of that stuff off until after IOP completely.
We like to make sure that people feel secure in their ability to remain sober, and then really look at some of the underlying stuff - the interpersonal relationship patterns, depression, anxiety, and history of trauma. We try to do what’s appropriate to do within the length of time that they’re at IOP and where to send them afterward that’s going to be the most helpful.
How does the transition out of IOP work? Do they graduate from the program and the therapist decides what’s next? Or do the clients decide when they’re done and ready to do something else?
In theory, it could work either way. Our usual expectation is that they complete eight weeks of IOP. Usually, in working with individual therapists, they determine at what point the client has benefited from the IOP and are ready to move on. The individual therapist is the one who’s working most closely with them and figuring out what they’re working on while in IOP and what happens afterward - outpatient, a different program, case management, self-help groups, psychiatry.
Is IOP doable for someone who is working full-time and has a family, or will they need to take time off from work?
I would think it would be very doable for someone who is working. We meet from 5 pm-8 pm, so they might take off work a few minutes early. But it’s all a matter of prioritizing what’s most important for themselves in the course of treatment.
Who is staffing the IOP at APN?
I’m a trained psychologist. I have a lot of experience with addiction - close to 10 years. I trained at Hazelden and some other top-notch addiction treatment facilities. Dustin Straight is the primary therapist and group facilitator. He also has a lot of experience with addiction treatment. He has some in-depth experiential training that’s fantastic for groups. Dustin is an excellent and gifted group facilitator.
Right! Can you tell us a little bit more about what experiential groups look like?
Experiential groups really define APN’s program and color how we approach these groups and sessions. At the heart of experiential therapy is the philosophy of “how you do one thing is how you do everything.” What that boils down to is that even the way you come to the group or come to an individual session tells therapists a whole lot about how you’re doing and what needs to happen.
We try to be very focused on the process of what is happening in group for experiential therapy - even with our psychoeducational piece. We check in with everybody. “How is this group for you? How are you experiencing this? What is happening for you as you’re hearing this information? What’s happening as you’re talking to each other and supporting each other? What roles are you playing, and what patterns are you continuing?” What we see in the group and individual therapy, a lot of times, are the very patterns that lead a person to have a susceptibility to substance abuse.
Everything has an experiential flavor to it. But we also do spend at least half the day, one or two days a week, doing something that is very concretely experiential. That might be getting out to do an exercise, doing psychodrama, empty chair work, etc. We also get out and about to do some shorter activities like snowshoeing or taking a walk. Then we come back to process how the activity was, what it brought up, and how that might mirror some of the issues they’ve been dealing with in sobriety.
What if people come in and they’ve never done therapy before? If they don’t like sharing and are nervous about opening up to people, what does their process look like? Can IOP work for them?
I think IOP is a great place for somebody like that to come. It’s a great first step to get a sense of what treatment is all about. That’s one of the patterns we would pull out in terms of taking an experiential approach. If they are shy or reserved or have difficulty sharing with other people, that’s going to be a major barrier in their addiction.
The reason AA is so successful is that above and beyond everything else, it’s a community. It’s a place to go with like-minded people to realize that a lot of other people are struggling with the exact same thing. So if you’re having trouble communicating, reaching out, and being vulnerable, that’s going to be a roadblock. The IOP also has a very strong emphasis on community, which is what makes it successful, and we also focus on what the individual is experiencing as barriers to connecting with others— what prevents them from being a part of a community and connecting to people. IOP is a great place because you’ll find a group that’s been doing it for a while is super supportive and knows how to bring people in.
Do we have any stories of hope or success stories so far at APN? Is this working?
Yeah, it’s working incredibly well. From the direct feedback we’ve gotten so far, we’ve had several people that have said fantastic things about their experience. One person talked about how it has very much changed their life. They said, “In the years and years I’ve been working on this, trying different things, and going to meetings, this has been by far the most helpful thing I’ve experienced to date.”
Another person recently said that IOP was the best thing that had happened to them, ever. They had such a history of trauma, shame, and being closed off from everybody else that the opportunity to have a group of people who listen, care, are going through the same thing, and are supporting each other is one they hadn’t had before. The opportunity to feel real human connection is one they hadn’t had before.
I love that. I think that’s probably one of the coolest side benefits. You said experiential therapy and the trauma focus color our IOP. What else sets our program apart?
Those two things are definitely huge and defining factors of the IOP at APN. We also do interpersonal process groups that are very research-based and intentional in the way they’re structured. There is a lot of research into the best ways to run these groups, and we take all of that into account.
We run these groups in a really effective way that allows us to get at what’s going on and see what patterns are being played out. The staff is very well trained in how to best run groups based on all the research that’s out there. That allows us to run these groups in a qualitatively different way than most groups out there are run. You’re able to see your patterns, take a step back, and reflect on it.
What advice do you have for someone whose loved one is struggling with substance abuse? How can they encourage their family member to check out IOP?
That’s a great question with a lot of different answers depending on the family. An honest conversation is almost always a good place to start - letting them know you’re concerned and have heard about this option at APN. Above and beyond that, it’s great to go ahead and give us a call. We can talk through different options.
When we know what has worked or what hasn’t worked or where the potential client is, we’ll be more than happy to give some thoughts on what might or might not be effective. And if push comes to shove, they can always come in for outpatient sessions to get to know the staff and the way we operate and do things.
To speak with a staff member about the IOP at APN Lodge, call 855.904.1042.