ADDICTION PARTIAL HOSPITALIZATION AND INTENSIVE OUTPATIENT TREATMENT
Partial hospitalization should be considered for patients who require intensive care but have
a reasonable probability of refraining from illicit use of substances outside a restricted setting. Partial hospitalization settings are frequently used for patients leaving hospitals or residential settings who remain at high risk for relapse. These include patients who are thought to lack sufficient motivation to continue in treatment, have severe psychiatric co-morbidity and/or a history of relapse to substance use in the immediate post-hospitalization or post-residential period, and are returning to a high-risk environment and have limited psychosocial supports for abstaining from substance use. Partial hospitalization programs are also indicated for patients who are doing poorly despite intensive outpatient treatment.
Partial hospitalization and intensive outpatient programs can provide an intensive, structured treatment experience for individuals with substance use disorders who require more services than those generally available in traditional outpatient settings. Although the terms "partial hospitalization," "day treatment," and "intensive outpatient" programs may be used nearly interchangeably in different parts of the country, the ASAM patient placement criteria define structured programming in partial hospitalization programs as 20 hours per week and in intensive outpatient programs as 9 hours per week. Partial hospitalization programs provide ancillary medical and psychiatric services, whereas intensive outpatient programs may be more variable in the accessibility of these services. Some patients enter these programs directly from the community. Alternatively, these programs are sometimes used as "step-down" programs for individuals leaving hospital or residential settings who are at a high risk of relapsing because of problems with motivation, the presence of frequent cravings or urges to use a substance, poor social supports, immediate environmental cues for relapse and/or availability of substances, and co-occurring medical and/or psychiatric disorders. The goal of such a "step-down" approach is to stabilize patients by retaining them in treatment and providing more extended intensive outpatient monitoring of relapse potential and co-occurring disorders. Partial hospitalization and intensive outpatient programs may also be used as a brief "step-up" in treatment for an outpatient who has had a relapse but who does not require medical detoxification or who has entered into a high-risk period for relapse because of life circumstances or recurrence of a co-occurring medical and/or psychiatric symptom (e.g., depressed mood, increased pain).
The treatment components of partial hospitalization programs may include some combination of individual and group therapy, vocational and educational counseling, family meetings, medically supervised use of adjunctive medications (e.g., opioid antagonists, antidepressants), random urine screening for substances of abuse, and treatment for any co-occurring psychiatric disorders. Intensive outpatient programs use individual therapy, group therapy, family therapy, and urine toxicology but vary in the amount of other therapeutic components used. An advantage of intensive outpatient programs is the availability of evening programs that accommodate day-shift employees. The availability of weekend programs varies for both partial hospitalization and intensive outpatient programs. Both kinds of programs aim to prepare the individual for transition to less intensive outpatient services and increased self-reliance through the practice and mastery of relapse prevention skills and the active use of self-help programs.
Limited data are available for the efficacy of partial hospitalization and intensive outpatient programs. Randomized, controlled trials have demonstrated that some individuals who would ordinarily be referred for residential- or hospital-level care do just as well in partial hospitalization care. One study comparing a more time-intensive day hospital program to an intensive outpatient program that was actually less time intensive found no differences in outcome for cocaine-dependent individuals, and another study comparing intensive with traditional outpatient treatment of the same population found no differences in outcome.
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