Are Intensive Outpatient Programs (IOP) Effective for Treating Addiction?

Over the last 40 years, there have been several studies on the use of IOP in treating addiction. Some of these research studies are referenced at the end of this document. What is apparent is that IOP have consistently shown positive outcomes in treating substance use disorders successfully. Several studies (Guydish et al, Schneider et al.) have, in fact, suggested that IOP have no significant differences in effectiveness to residential programs. While some other studies (Finney et al.) indicate that there is only a small difference in effectiveness favoring residential treatment options. The consensus, however, across most recorded studies, is that clients benefit from both levels of care. In fact, comparing effectiveness between inpatient and outpatient is not necessarily productive as the two approaches tend to have different applications and can be undertaken in parallel or sequentially with good results.

In one of the earliest research studies carried out on outpatient program effectiveness, the American Journal of Psychiatry published strong results based on data from 564 patients. The majority of program participants successfully completed outpatient detoxification and half continued engaging in related rehabilitation programs. Furthermore, only 19% of participants required inpatient care, and there were no fatalities across the patient population. This study, published in 1975, led the way for acceptance of outpatient programs as effective treatment programs for substance use disorders. Up to that point, outpatient programs were largely untested. Up to that point in time, it was also commonly believed that only clients who were high functioning, employed and free from significant co-occurring psychiatric disorders could benefit from IOP. Through clinical and research findings, this belief has been dispelled and it is now widely accepted that IOP is an effective treatment approach for patients with substance use disorders who may also suffer from a range of co-occurring disorders. In particular, patients benefit from the IOP’s intensive approach and emphasis on rigorous case management, support services, and psychiatric counseling services.

In a study by McLellan and his colleagues, it was stated that patients who had access to case management, coordinated medical, housing, parenting, and employment services, had less substance use, fewer mental health problems, and better social function after 6 months of IOP care.

Another study performed by Gottheil, Weinstein, Sterling, Lundy, and Serota, it was found that “patients who completed the intensive program showed significant improvement from intake to end-of-treatment scores on the Addiction Severity Index, the Beck Depression Inventory, and the Symptom Checklist. At nine-month follow-up, patients who had remained in treatment longer had fewer drug problems, a smaller proportion of positive urine drug screening tests, a better employment status, and fewer psychological problems compared with patients who left treatment earlier. Patients who remained in treatment were also more likely to be attending self-help meetings, continuing in outpatient treatment, or attending school.”

Similarly, Cournos performed a study where he found very significant improvements on “seven of nine symptom scales, including depression and anxiety.” Additionally, significant effects were shown on all four of the measures of global distress and symptom severity”, and upon discharge from the IOP program, the average patient had returned to his or her premorbid level of functioning on the Global Assessment of Functioning (GAF) inventory. Cournos also showed that IOP patients gave very high marks on perceived satisfaction with their treatment.

Author: Seda Gragossian, PhD
Clinical Director
Talk Therapy Psychology Center
(858) 205-2490

The role of willpower in addiction recovery – Part 1

What is willpower?

Willpower is the mind’s ability to say ‘Yes’ or ‘No’ when faced with a decision. We are all familiar with the experience of making a decision to make a small or large change in our lives, such as deciding to start exercising regularly, start eating healthy, start arriving to appointments on time, or giving up a destructive habit. Often, we fall short of achieving our goal. What happens?

You tell yourself, “I am so tired of arriving late to appointments and feeling guilty, ashamed, and anxious. I am motivated to change but I just don’t seem to be able to make the change.” Or, “I am so tired of getting drunk and giving in to alcohol and feeling guilty, ashamed, and just awful. I am motivated to change, but I just don’t seem to be able to make the change.” Why is that? When the decision point is out into the future, it appears easy for us to make a choice. However, when the moment arrives, there are multiple variables at play. Let’s look at them:

Delaying Gratification

You have to give up something in the moment, such as an immediate pleasure, for some potential point in the future. If I skip drinking every day, I stand to make my health better, mend my relationships, and even save a bit of money in the long-run.

Ego Depletion

You wake up in the morning and you have all the intention of not giving in to a destructive behavior, such as over-eating. You have your balanced breakfast. You pack your healthy lunch and snacks for the day. You stick to your routine all day. You watch your co-workers devour tasty but fattening foods. You are so proud of yourself for sticking to your diet and saying no as they ask you to go out for lunch or offer you a cookie or some other junk food. According to the theory of Ego Depletion, every time that your mind makes a decision, your willpower gets a little more taxed. You get home after a whole day of eating healthy and abstaining from junk food and you lose it and go for that big fatty chocolate bar. According to the Ego Depletion theory, your willpower runs out of juice. You wake up the next morning and you don’t understand what happened. You had been so in-control all day. You decide today is going to be different. You pack your healthy foods and off you go.

Shifting Priorities

Our decisions are driven by the motivation to reduce discomfort. You wake up in the morning and you feel awful for getting drunk the night before or using drugs “one last time.” Your loved ones are angry with you; you can’t perform at your job because you are hung over and you have a short fuse. This is too painful and you tell yourself, “I am done.” You are motivated and you get back on track. A few days go by and the pain you felt a few days ago is no longer as severe. A new discomfort has settled in: your friends have been going to the bar for happy hour everyday and you have been left out since you have chosen not to drink. To eliminate this discomfort, you cave in and go with your friends and you end up getting drunk again.

The above three variable are in constant interplay when dealing with an addiction. In the near future, I will talk about how to work with these variable, how to expect them, and how to properly manage them.

Author: Seda Gragossian, PhD
Clinical Director
Talk Therapy Psychology Center
(858) 205-2490


Copyright. 2016. Talk Therapy Psychology Center, Corp.

Three Reasons to Choose an Intensive Outpatient Program (IOP)

Intensive outpatient programs (IOPs) are increasingly becoming an alternative to more costly and often less convenient residential (inpatient) addiction treatment programs. Although IOP programs offer more flexibility than residential treatment, there are ultimately no shortcuts when it comes to getting the help we need. A good IOP program will provide the environment and the means for us to get that help.

Proponents of residential (inpatient) treatment programs often argue that we need a more immersive treatment experience, which isolates us completely from our familiar world in order to focus solely on overcoming our addiction. Although it may be beneficial, or even necessary in some severe cases to enter into a residential program, there are many advantages to choosing an IOP. We’ll skip over the obvious benefits, such as “more convenient” and “less expensive” and look at three not-so-obvious benefits of attending an IOP program.

You begin to re-integrate back into the “real world” on Day 1

In a residential treatment program you are isolated from the outside world, save for a “family day” or two. Reintegration back into day-to-day life after spending a month or more in a treatment facility can be a tremendous challenge, even after a month of preparation.

In an IOP program, on the other hand, you have the opportunity to practice newly acquired life skills while you’re “doing the work,” beginning on the first day of IOP. Every day in the program is an opportunity to practice interpersonal communication at home, time management, living a healthy lifestyle, effective work habits, and other daily life skills, as opposed to just discussing them or reading about them in the rehab handbook.

Life does not necessarily need to be put on hold for you to overcome your addiction

What degree of illness or injury would you need to sustain to warrant an extended stay at the local hospital? A major injury? A terminal illness? A coma? If you broke your arm you wouldn’t expect to stay in a hospital until it was healed. You would go about your daily life, despite the inconvenience of having a cast on your arm.

Addiction can be viewed on a continuum. Maybe your addiction is like a broken arm or maybe it’s like a coma. It’s ultimately up to you and possibly an addiction assessment or counsellor to determine the severity of your issue. Just remember when choosing a treatment option that not all addictions warrant putting your entire life on hold. In fact, since addiction is often so intertwined with many aspects of our life, putting our day-to-day responsibilities on hold can actually be counterproductive to our recovery.

Your recovery is in your own hands

Recovering from an addiction is all about learning how to stand on your own two feet and manage your day-to-day life without the burden of a chemical or behavioral dependency. Although on the surface it may seem less immersive, integrating an IOP program into your life is about as immersive as it can get.

In a residential program you are told when to wake up, when to eat, where to go, who to talk to, what to do and what not to do, and when to sleep. It’s very easy to get caught up in the automatic pilot syndrome in a residential program and lose the rhythm of your everyday life. This is especially important if you’re trying to keep a job or care for a family while simultaneously dealing with an addiction. In IOP, since we are expected to report back each day about the progress of our days and weeks out in the “real world”, participants tend to demonstrate a high degree of accountability for their day-to-day behaviors and challenges.

The most important thing is for you to find a path that is individualized and personalized, and that will give you the best chance of overcoming your addiction while maintaining a healthy life balance. If you’d like to learn more about the IOP program at Talk Therapy, please call us at 858-205-2490.

About the Author

Joseph Cervantes is an advocate for the de-stigmatization of addiction in our culture. As a community organizer and journalist in the addiction treatment space he has had the opportunity to work with hundreds of individuals struggling with various addictions and mental health issues. He is also a vocal advocate for the development of new methods and strategies for treating addiction. Having completed several IOP and inpatient programs himself over the past 20 years, he offers a unique perspective into the rehab experience through both a patient and practitioner lens.

The role of goal setting and goal proximity in treating addiction

A comprehensive plan for recovery will often require setting goals. This may include goals around moderation criteria, improving physical health, attending educational and support groups, attaining a new job or housing, and systematically working through relationship dynamics. One key ingredient to goal setting, which is often overlooked, is goal proximity. This simply means how near or far the end-goal is from the present point in time.

Research in motivation theory has consistently proven that, to maximize your chance of success with goals, you must set both near-term and long-term goals that support each other. In the research literature, this is referred to as setting proximal (near) and distal (far) goals. One of the most recognized experts in goal setting is Albert Bandura, who is a Professor of Social Science in Psychology at Stanford University. Apart from being a renowned researcher in the field of psychology, Bandura has also served as the president of the American Psychological Association.

One finding in Bandura’s research is that people perform better when there is a condition that involves both near and far goals, as opposed to just a single, and distant goal. For instance, instead of setting a goal of losing 12 pounds in 90 days, it is more effective to set goals along the lines of this:

  • Lose 1 pound per week.
  • Lose 12 pounds in 90 days.

This can be even more granular by setting smaller goals even more frequently. In the above example, this could be done by introducing small and attainable goals throughout the course of a week, to support moving towards that week’s goal.

It has also been shown that attainment of a near term goal improves one’s belief in their ability to attain a longer-term goal. Another surprising side effect of this approach is that people wind up setting more difficult goals for themselves when setting both proximal and distal goals.

Lastly, the attainment of near-term goals also has the strong benefit of helping one develop intrinsic motivation towards attainment of a given goal. This is very important particularly in difficult and transformational work like addiction recovery. In very general terms, extrinsic motivation is when you do something because someone else is telling you to. This is similar to getting therapy because the court system has imposed it on you. On the other hand, intrinsic motivation is when you do something because it is internally rewarding. For instance, this may be similar to playing a sport because you enjoy it. So, when one attains a near-term goal, the event helps develop intrinsic motivation towards the pursuit of a longer-term goal.

Setting goals is an essential part of the recovery plan. Goals can be set for various areas of life. In doing so, it is important for the therapist and the patient to work together to devise goals that are attainable, are spaced apart properly, and work together in such a way so as to maximize success.

Author: Seda Gragossian, Ph.D.

Talk Therapy Psychology Center


  • Bandura, A; Schunk, D. Cultivating competence, self-efficacy, and intrinsic interest through proximal self-motivation. Journal of Personality and Social Psychology. Vol. 41, 1981.
  • Bandura, A. Self-Efficacy. 1997.

Benefits of IOP for Borderline Personality Disorder

An Intensive Outpatient Program (IOP) can be beneficial for people suffering from borderline personality disorder. By its nature, an IOP program provides structure, active participation, and a forum where maladaptive behaviors can be investigated and evaluated over time in a setting with others working through similar challenges.

One study performed on the use of IOP for borderline personality disorders suggested that: “An intensive outpatient program for patients with borderline personality disorder should contain the four main elements of effective treatment for this population—reliance on structure, the expectation that each patient will be an active participant in the development and implementation of his or hertreatment plan, ongoing identification of maladaptive interpersonal functioning, and a focus on adaptation to community life and a longitudinal perspective on the patient’s life.” Source: An Intensive Outpatient Program for Patients With Borderline Personality Disorder. Smith, Ruiz-Sancho, and Gunderson. Psychiatric Services. 2001.

Author: Seda Gragossian, Ph.D.

Talk Therapy Psychology Center