Treatment at home or away? How does one determine the type of treatment a person with a substance abuse problem truly needs.
A common question we hear is, “What treatment does my spouse, significant other, or child need to help them overcome their addiction issue?” Those of us who work in the addictions field struggle with the answer to this question. We are trained that the individual should be encouraged to utilize the least restrictive level of care prior to advancing to more restrictive levels. Even though this is the academic approach, it seems that when faced with someone who is obviously severely struggling with addiction issues, there is a tendency to encourage him or her to go to a “rehab”, i.e. 30 or more days’ inpatient as opposed to a less restrictive setting such as Outpatient or Intensive Outpatient.
Recently, Dennis McCarthy, PhD and a team of PhD researchers assessed the long-term value of Intensive Outpatient Programs (IOP) compared to inpatient programs. In their 2014 article, Substance Abuse Intensive Outpatient Programs: Assessing the Evidence, they concluded that there were insignificant differences between IOP and inpatient treatment services regarding patients who remain abstinent. They reported that reductions in substance use and increases in abstinence were basically the same when comparing types of treatment settings. They did note, however, that patients with significant impairment might do better in an inpatient setting but that a conclusive point was elusive.
In summary, McCarthy et al. reported that IOP services have advantages for individuals who do not meet ASAM Portal of Entry Criteria for residential treatment or those who need more support than weekly sessions provided in traditional outpatient care. The positive advantages for IOP treatment that they discussed were:
- Individuals can live at home which allows them the opportunity to practice newly-learned abstinence support skills in their normal environment and
- Increased duration of care while allowing the individual the opportunity to learn abstinence-based skills in their home support system as well as develop personalized post-treatment support groups for long-term abstinence.
It is difficult to determine what level of treatment a person needs. What this article is effectively saying is that rather than a rush to judgment that someone needs inpatient care, perhaps IOP treatment should be considered as a least restrictive level while a person is able to continue to work and live at home.
