The Benefits of Intensive Outpatient Programs: A Director's Perspective

Welcome to the Recovery Dialogues and Sober Stories podcast, where we delve into the latest developments in addiction treatment and recovery. In this episode, we have a conversation with the director of Wish Recovery's Intensive Outpatient Program, to discuss the current and future prospects of intensive outpatient program. Today's episode features Kristin Gennaro, a compassionate advocate for individuals and families affected by addiction. Kristin's personal experiences with substance abuse within her family have fueled her passion for helping others overcome similar struggles with drugs and alcohol. With a master's degree in clinical psychology and marriage and family therapy, Kristin has dedicated herself to enhancing her knowledge and expertise in guiding individuals toward recovery. Today, we are excited to hear about Kristin's involvement in Wish Recovery's newly launched Intensive Outpatient Program. Let's begin. For listeners who may not be familiar, an IOP, or Intensive Outpatient Program, is a structured treatment program for addictions and dependencies such as depression or eating disorders. It allows individuals to maintain their daily responsibilities while receiving group therapy. Individual counseling, and educational sessions to manage stressors and cope with addiction. Kristen, what are some other benefits of intensive outpatient programs over inpatient treatment?

The advantages of IOP is that it really allows for that next level of care. Um, once someone completes a detox or a residential setting, it allows for them to continue with their treatment. Um, sometimes you also might not get a client who technically meets diagnostic criteria for such an intense level of care like residential. So IOP, it allows a little more flexibility while still providing intensive treatment. IOP clients get to go home, they get to sleep in their own bed, they get to have dinner at home. Outpatient programs also oftentimes they offer evening programs. So if a client is appropriate and they have some sobriety, sober time, they're able to maybe continue working while seeking treatment at nighttime. One thing to keep in mind is one of the most important things in my opinion, I believe, is committing to the entire process and really helping our clients truly understand that recovery is a journey. I can't tell you enough how often clients will complete partial programming and think they're healed and they're all better and no longer need the support. One of the most important steps after residential is to continue treatment at PHP, IOP, or OP levels of care. You know, going from a 24-hour supervised care to nothing, it's not setting someone up for success. The idea is to really continue to go through the step-down process, gradually titrating care and reintegrating back into life, really learning how to navigate sober life while still having support system of a treatment team.

What is the importance of individualized care in Iowa?

That's a great question. Individualized care is critical when it comes to treatment. Each client comes with their own history, their own set of struggles, their own journey. What works for one client, it's not necessarily going to work for another. One of the most important things I believe is when working with a client is to truly meet them where they're at. Overall, I believe many things shape who we become. For instance, we are a product of our environment. So some of our experiences, our upbringings play a huge role, our genetics, our family history, et cetera. And when we take this into consideration, it's really hard argue that there's any one-size-fits-all approach to treatment. I think taking the time to truly understand each individual and their real-life circumstances is critical in determining the best approach to take.

Can you explain therapy's role in IOPs and how it differs from traditional therapy?

Clients in our IOP, they will not only get to meet with the professionals who are trained in drug and alcohol counseling, they'll also get to meet with therapists to help work on some of the underlying issues of their addiction, the symptomology clients are presenting with from their secondary diagnosis. Therapy and IOP also might focus on trauma work depending on the client's past history of trauma. You know, upon intake, we'll be doing assessments to see if there is any trauma and how that impacts the client. And based on those assessments, we'll figure out whether they're appropriate for any type of trauma work. Therapy at an IOP level of care opposed to a traditional therapy, it also might be more frequent. For example, traditional therapy, you might see your therapist once a week, you know, twice a month, once a month. Um, a client in an IOP setting, they're going to have 1 to 3 sessions per week, really depending on the need. Um, when an individual is receiving therapy at an IOP level of care, they also have the rest of the treatment team who is also consulting on the case regularly. That might include the doctor, the psychiatrist, the group facilitators. So you really get that all-encompassing level of care. IOP is a space where clients receive integrative care, which includes collaboration and communication. And it's key, you know, there's going to be treatment team meetings throughout the week to talk about the cases specifically, to talk about the clients and their individual needs, and to really reassess the treatment plan and to talk about it and have an open line of communication. Because our job is to make sure that our clients get better. And if we're not doing our job, we need to figure out what we're not doing and tweak it and make sure we're meeting the needs of the client and making sure they get what they want. So I guess The biggest difference would be that when you're receiving therapy at an IOP level, you're really getting that all-encompassing care and integrated care, and you have an entire treatment team behind you to really help figure out how do we get this person in recovery and how do we address all of their needs?

How necessary is the integration of medication-assisted treatment, MAT, and IOPs?

Yeah, so the opioid overdose continues to be a major public health problem in the United States. Um, this question really goes back to my belief in meeting the client where they're at and also doing everything we can to help them get clean and sober. I know this can be a controversial topic. However, I believe again that every individual is unique and treatment should be tailored to the individual. I would never want to deny someone of something that could potentially prevent an overdose death. An overdose death. I have personally seen MAT services save lives. MAT can be seen as a long-term maintenance program, but I've also seen many clients step as a stepping stone to full sobriety and really using MAT as a stepping stone and eventually titrating off of it. When it comes to MAT and IOP, I would really defer back to the treating physician to develop this plan and what's appropriate for the individual and really taking that into what individualized care approach.

Please explain the role of family support in IOPs and how you can involve loved ones in the treatment process.

So addiction really is often called a family disease. And what I mean by that is addiction has a drastic effect on the family as a whole. It impacts the stability of the home. It can impact the family finances and the overall family dynamics are shifted. When an addict is using, the family will often cope with their own set of unhealthy behaviors, which typically revolve around the addict. Family members, they oftentimes begin to become consumed by the addict and his behaviors and his using. The family often start to develop codependent behaviors, which present as enabling the client or enabling the addict. They begin to caretake, they have excessive guilt, They can often have poor boundaries, hopeful and wishful thinking. They might be unable to say no to this person, and the list continues. Just like the addict requires help to get sober and clean, the family often needs help to break free from these unhealthy patterns. With this being said, I think doing family work is critical. Working in this field, getting clients to agree to include their family, it can be really difficult at times. And oftentimes a lot of clients are to the point where family's unwilling to participate and sometimes is not always the most appropriate. So really assessing the appropriateness of including the family and also the willingness. If the client's families are willing, I really, really try to work on explaining to the clients the importance of their involvement. I think family involvement is so important when you're looking at the relapse prevention and setting up a plan for discharge. The family can really be critical in helping the client adjust to a new sober life following treatment. So I would say the family support is huge. Unfortunately, not all clients have it when they are in recovery, but if the family is there, I think it's really, really important to include them in the process.

What is the importance of aftercare planning and follow-up care for clients?

Aftercare planning and follow-up care. Of care is critical. One word that comes to mind when I think about recovery and sobriety is the word community. When our clients graduate from either a residential, an IOP, a PHP, or an OP level of care, they— excuse me— have to reintegrate back into their everyday lives. However, this time without the comfort blanket of their addiction. Our clients' addictions, they've served a purpose for them. They've been what they turn to when they can't face struggles, when they can't cope, So now they're reintegrating back into the world and the one thing they had for so long has been taken from them. And now is the time to really practice the tools and use the tools that they learned while in treatment. And aftercare planning and following up with the client to make sure that they are integrating these new tools into their life is critical and providing that support and the check-ins and making sure that our clients have a sober community or have support outside of treatment. And a lot of this work is often done while they're still in treatment. The therapist might be working with the family and what role they're gonna take when the client discharges. They might be working with the significant other to see what role they take when they discharge. They might be helping the client find a community, help them getting involved in some sort of a program, whether it be a 12-step program, a SMART Recovery program, whatever support system works for this client and trying to find something so that the client does have something to turn to once they leave our level of care.

Can you explain some of the challenges of treating co-occurring disorders in an intensive outpatient program setting?

Substance use disorders more times than not come with a co-occurring mental health disorder, whether it be PTSD, general anxiety disorder, major depressive disorder, bipolar. And so forth. Um, data shows high rates of comorbid substance use disorders and mental health disorders. This is where the importance of individualized care is critical, something we talked about earlier. Um, one of the most important parts of the process, in my opinion, is truly the intake process. I feel like oftentimes this process can really be rushed through as if we're just like checking boxes, you know, do the intake, do the assessment, get this done so we can start seeing the client. However, this is where the clinician really gets a chance to assess the individual's past and present. They get to assess the client's history of symptomology, their struggles, their past trauma, their suicidal ideation, their past suicide attempts, their impulsive behaviors. They really get to ask all of the questions. It is so important, and I can't stress that enough, to take the time to really assess thoroughly. So that we can really create a treatment plan to treat the whole client. I personally think that IOP is a wonderful place to address the co-occurring disorders. You know, at this point, our clients are at a point in treatment where they typically have some sober time. They've already gone through detox. They're hopefully feeling a little better and a little more clear-minded. When assessing and creating the treatment plan in IOP, it's a great time to make sure we are working on developing goals for all of the clients presenting symptomology, not just the substance use disorder. At an IOP level of care, we work as a comprehensive treatment team. We are able to consult frequently and we really truly try to ensure that we're meeting all the needs of the client. At this level of care, it is still intense enough that we are with our clients for the majority of the day, which really gives us the opportunity to see how they're doing. You know, individuals who struggle with comorbid disorders can be vastly different. So when we're approaching each individual with integrated treatment, which means, you know, addressing both the substance use and the mental health disorder, we really want to make sure we do a thorough assessment and develop a really effective treatment plan.

Lastly, what role does peer support have in IOP?

In my opinion, peer support is essential for individuals who are struggling with addiction. Whether it be a sober living environment, attending meetings, or finding whatever sober support in the community that works for them. I believe it's important aspect of the addiction recovery process as a whole. My belief is that when an individual realizes that they are not alone and that their experiences are not necessarily unique or special, that there are others out there that have had their own set of circumstances, stances that have resulted in finding themselves in the same vicious cycle of addiction. It allows clients to really surrender to the fact that recovery is possible, that it could happen for them, that it will happen for them. Building a community, silver supports. Take for example, peer support groups. There's a mutual benefit between peer support groups. You know, the facilitators of peer support groups are typically in recovery themselves. Facilitating groups can often increase self-esteem. It can increase confidence. It creates positive feelings of accomplishments. And increases their own ability to cope with these challenges. It gives them the feeling of giving back and being of service. Evidence has proven that one's belief in their own ability can increase and influence one's behavior by watching other people's behavior. I think peer support, when clients leave our IOP level of care, is the support system they have to turn to when maybe they're having a harder day and, you know, they start to experience those cravings. Having someone in your phone who can relate and be of service to you, giving them a call saying, "Hey, I'm having a really hard day," and just having that person to talk to, it makes a huge difference in just allowing clients to realize they're not alone and that they can get through this and others have and that they can.

Thank you, Kristin, for your time, insights, and expertise. I hope you enjoyed this episode of Recovery Dialogues and Sober Stories. I'd like to express my sincere gratitude to our sponsor, Wish Recovery. Their unwavering support and commitment to helping those struggling with addiction is genuinely inspiring. We encourage our listeners to visit their website and learn more about their innovative programs and services. Well, thank you for listening, and we'll see you next time on Recovery Dialogues and Sober Stories.