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How Can People Prepare For Intensive Outpatient Treatment  



Method: Alcohol-dependent outpatients (N=227; 27% female; M age=42) enrolled in a randomized-controlled telephone case monitoring trial were assessed at treatment intake and at 1, 2, and 3 years postdischarge. Lagged-panel, hierarchical linear models tested whether mutual-help group participation in the first and second year following treatment predicted subsequent outcomes and whether these effects were moderated by gender, concurrent axis I diagnosis, religious preference, and prior mutual-help experience. Robust regression curve analysis was used to examine dose-response relationships between mutual-help and outcomes.




How Can People Prepare for Intensive Outpatient Treatment  



Conclusions: Use of mutual-help groups following intensive outpatient SUD treatment appears to be beneficial for many different types of patients and even modest levels of participation may be helpful. Future emphasis should be placed on ways to engage individuals with these cost-effective resources over time and to gather and disseminate evidence regarding additional mutual-help organizations.


From program to program, the treatment philosophy, services, settings, and clientcharacteristics may vary for any given level of care because some aspects oftreatment may be tailored to a specific population. For instance, a rural residentialprogram primarily treating women who are alcohol dependent would be quite differentfrom an urban residential program treating mostly men dependent on stimulants.Despite variability in the specific features of intensive outpatient treatment (IOT)or Level II care in programs across the country, the continuum of care model tries toensure consistency throughout treatment and to ease the process of moving clientsthrough treatment.


In addition to the levels of care described by ASAM, outpatient treatment can bebroken down into four sequential stages that clients work through, regardless of thelevel of care at which they enter treatment:


Relative to traditional outpatient treatment, IOT provides an increased frequencyof contact and services that respond to the chronicity and severity of substanceuse disorders and other problems experienced by clients. The actual number ofhours and days per week that clients participate in IOT varies depending onindividual client needs. State licensure bodies may require 9 treatment hours;ASAM defines IOT as 9 hours of treatment per week for adults (Mee-Lee et al. 2001). Although IOT programsgenerally provide structured programming for 9 hours or more per week spread over3 to 5 days, some IOT programs provide fewer hours. The consensus panel recommendsthat the number of programming hours be 6 to 30 hours, based on client needs. Someclinicians find that more frequent, shorter visits are of greater benefit to theclient than less frequent but longer sessions. However, some clients requirelonger treatment sessions, similar in intensity to partial hospitalization. Moreresearch is needed on optimal treatment intensity and factors to be considered inincreasing or decreasing treatment intensity.


The recommended minimum duration of the IOT phase often is cited as 90 days.Low-intensity outpatient treatment over a longer period may be a cost-effectivemeans to enhance treatment outcomes because this approach is associated with lesssubstance use and better social functioning in clients (Moos et al. 2001). Duration of treatment should beincreased or decreased based on the client's clinical needs, support system, andpsychiatric status, among other factors. Longer duration of care is related tobetter treatment outcomes (Moos and Moos2003).


The consensus panel believes that, whenever possible, the client should bereferred to an outpatient treatment program with a treatment model (e.g.,12-Step, cognitive-behavioral, combined) that is compatible with that offeredby the IOT program to ensure that the client is not confronted withsignificantly different treatment goals, approaches, and philosophies. If aclient is to be transferred to a program with a different philosophy, theclient should be oriented to the differences so that the transition is notconfusing and the client can benefit from the new program.


An individual transition plan helps the client transition from one level ofcare to another and provides an important link between his or her currenttreatment provider and the next. To prepare an effective transition plan, theIOT counselor can


For clients who are stepped down from IOT, outpatient treatment offers the supportthey need to continue developing relapse prevention skills and resolving thepersonal, relationship, employment, legal, and other problems often associated withearly recovery.


The goals, strategies for treatment engagement, and recovery services ofoutpatient treatment are similar to those of IOT. However, the intensity andduration of the services differ from those provided in IOT.


A study by McLellan and colleagues(1997) compared several components of 6 IOT programs and 10 outpatienttreatment programs. Both types of programs provided group and individualabstinence counseling, relapse prevention programming, and drug and alcoholeducation. The IOT programs' treatment duration ranged from 30 to 90 days, andthey provided 3 to 5 sessions per week. Hours per session ranged from 3 to 6. Theoutpatient programs' treatment duration ranged from 45 to 60 days, and theyprovided 1 to 2 sessions per week. Hours per session ranged from 1 to 2. Whereasthe IOT programs provided more substance abuse counseling than the outpatienttreatment programs, the outpatient treatment programs were more likely than IOTprograms to offer medical appointments, family therapy sessions, psychotherapy,and employment counseling (McLellan et al.1997).


Although outpatient treatment duration is typically 60 days, it is suggestedstrongly that clients be scheduled for periodic followup sessions on a long-termbasis. The best outcomes from treatment of substance use disorders have been seenin clients who participate in continuing care, such as methadone maintenance orAlcoholics Anonymous-style support programs (McLellan et al. 2000). Because the availability of funding for followupappointments varies, outpatient treatment programs might consider strategies forestablishing a service model that supports the delivery of followup sessions.


Having completed stage 3 of their treatment, clients are discharged from formaltreatment to continuing community care. Clients who remain within a system ofongoing care relevant to their needs are more likely to maintain their gains inabstinence and overall lifestyle changes. Participation in continuing communitycare is related to an increase in positive outcomes (Miller et al. 1997; Ritsher et al. 2002). Continuing care planning is therefore a centraltask for IOT program staff whose clients remain in stepdown care within theprogram. IOT programs that refer clients to separate programs for a stepdown levelof care must ensure, through their referral agreements and procedures, that theoutpatient treatment program agrees to engage in continuing care planning.


As part of continuing care services, programs can sponsor alumni meetings andprovide booster or checkup counseling sessions at the IOT or outpatient treatmentfacility. Periodic telephone contact also may be valuable (McKay et al. 2005). Other aspects of continuing careinclude involvement with selected community resources as needed, such asvocational training, recreational therapy, family therapy, or medical care.


The duration of continuing community care varies for each individual. The chronicrelapsing nature of substance use disorders often means that individuals mayremain in this level of care for many months or years, relapse, return tooutpatient treatment or IOT care, regain abstinence, and return to continuingcommunity care.


Once you determine that professional help has become a necessity, the next step is choosing the right level of care for your personal needs. In the vast majority of cases, a short stay in an inpatient detox center comes as a recommended first step. In medical detox, you undergo drug or alcohol withdrawal in a safe and structured environment under the close care of a team of licensed medical professionals. Once you have been physically stabilized you will transition into the next appropriate level of care, which might be inpatient addiction treatment or an outpatient program depending on your needs. If you have been struggling with a moderate or severe substance use disorder or if you have an underlying, co-occurring issues (like anxiety, depression, unresolved trauma or a behavioral addiction), entering a residential rehab program for between 30 and 90 days will likely come recommended.


Most people who complete residential rehab will transition directly into a partial hospitalization program or an outpatient treatment program in order to continue with therapy and addiction education as they begin to navigate independent living.


Substance use disorder treatment programs generally fall into 1 of 2 categories: inpatient or outpatient. While equally focused on rehabilitation, each type has unique attributes and benefits to offer. Inpatient treatment programs, also known as residential treatment programs, are intensive and are designed to treat serious substance use disorders and addictions. Outpatient treatment, on the other hand, are part-time programs that allow for some level of flexibility so a patient can attend treatment without missing work or school responsibilities.


Outpatient treatment is generally considered to be less restrictive than inpatient programs. Outpatient recovery programs fall into 2 different levels of care: partial hospitalization and intensive outpatient. Each level typically occurs after a residential treatment stay or if assessed as the appropriate level to start off at by a behavioral health professional.


Partial hospitalization programming (PHP) is the most intensive type of outpatient treatment, which focuses on stabilizing behaviors in early recovery. Most residential programs have a PHP that patients commonly transition to if they live locally. PHP programs are generally 5-6 hours of treatment per day, usually for 5-6 days a week. This level of care is often done while not working, as the treatment itself can be as time consuming as residential treatment.


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