Client Choice among Standard Outpatient, Intensive Outpatient, Residential, and Inpatient Alcohol Treatment in State-Monitored Programs
Treatment for those with substance use disorders has evolved over the years from a largely inpatient to a largely outpatient activity. In the 1970s and early 1980s, treatment providers believed that inpatient was the only acceptable treatment setting because individuals needed to be removed from their environments to overcome their disorders (Washton, 1997). However, several studies conducted in the mid-1980s concluded that outcomes were the same for both treatment settings, and, because outpatient treatment is less costly, it was more cost-effective (Annis, 1985–1986; Miller & Hester, 1986). Those findings, coupled with the growth of managed behavioral health care and the burden on the treatment system caused by the influx of cocaine-addicted clients in the mid- to late 1980s, led treatment to shift from predominantly inpatient to predominantly outpatient settings (Washton, 1997). By October 1, 1998, 89 percent of the almost 1 million individuals in treatment for substance use disorders were in some form of outpatient treatment (Office of Applied Studies [OAS], 2000). By that time, however, there also was a growing recognition that although many clients may not need inpatient treatment, some needed more structure than is provided in the standard outpatient (SOP) settings (Gottheil, 1997). This increased structure could be provided by intensive outpatient (IOP) treatment. By 1998, approximately 20 percent of clients in treatment nationwide were in IOP treatment (OAS, 2000).