Intensive Outpatient Treatment
Principles of Intensive Outpatient Treatment
This section presents 14 principles that integrate the findings of addictions research with the opinion of the consensus panel. By synthesizing research and practice, the consensus panel will assist clinicians in applying these principles to the clinical decisions they face daily. The 14 principles are expressed throughout this TIP in the form of specific recommendations. They are summarized here to provide a concise overview of effective intensive outpatient treatment (IOT) principles.
The Principles of Drug Addiction Treatment: A Research-Based Guide (National Institute on Drug Abuse 1999) offers a valuable starting point for the principles that are described in this chapter. The National Institute on Drug Abuse (NIDA) principles pertain to the full spectrum of addiction treatment modalities, not only to IOT. The consensus panel chose to accentuate the principles that are critical to effective IOT.
The 14 principles described in this section are
- Make treatment readily available.
- Ease entry
- Build on existing motivation.
- Enhance therapeutic alliance.
- Make retention a priority.
- Assess and address individual treatment needs.
- Provide ongoing care.
- Monitor abstinence.
- Use mutual-help and other community-based supports.
- Use medications if indicated.
- Educate about substance abuse, recovery, and relapse.
- Engage families, employers, and significant others.
- Incorporate evidence-based approaches.
- Improve program administration.
Principle 1: Make Treatment Readily Available
Accommodate a Wide Spectrum of Clients Who Are Substance Dependent
Clinical research and practice have established that IOT is an effective and viable way for individuals with a range of substance use disorders to begin their recovery. In the 1980s, it commonly was believed that only clients who were relatively high functioning, employed, and free of significant co-occurring psychiatric disorders could benefit from IOT and that IOT was not effective with clients who were compromised by significant psychosocial stressors such as homelessness or co-occurring disorders. Today substantial research and clinical experience indicate that IOT can be effective for clients with a range of biopsychosocial problems, particularly when appropriate psychiatric, medical, case management, housing, and other support services are provided.
IOT programs have adjusted successfully to the challenges of working with many special population groups that include
- Clients who are economically disadvantaged (Gruber et al. 2000; Milby et al. 1996)
- Clients who are psychiatrically compromised (Drake et al. 1998a, 1998b; Rosenheck et al. 1998)
- Pregnant women (Eisen et al. 2000; Howell et al. 1999)
- Individuals involved with the criminal justice system and other clients coerced into treatment
IOT programs have modified their treatment models to be responsive to the needs of adolescents (Jainchill 2000) and women