An Interview with Ryther’s Co-Occurring (Substance Use & Mental Health) Program Director, Deanna Seather-Brady, MSW CDP
What is Intensive Outpatient Treatment (IOP)? “IOP” is basically the middle ground between inpatient and outpatient substance abuse treatment. It’s for teens who are transitioning or stepping down from a more restrictive substance abuse treatment program such as inpatient treatment or when there is a need to bump up from a less intensive program.
How do you know if IOP is appropriate? Once a teen has been assessed at Ryther using the American Society of Addiction Medicine or ASAM, the course of treatment is identified. ASAM looks at six criteria: the risks associated with withdrawal; biomedical conditions and complications; emotional, behavioral or cognitive issues; the client’s willingness to change; continued use despite consequences; and, the recovery environment. IOP is recommended when a teen’s substance use has crossed the line from experimentation or abuse to chemical dependency. At this point it’s physiological – the brain has changed. We often see issues such as cravings, preoccupation with getting high, higher tolerance, more drug seeking, difficulty concentrating, memory problems, continued use despite consequences, exacerbating medical or psychological issues, or behavioral and peer group changes. These teens also tend to do more poorly in school and sometimes even start getting in trouble with the law. In addition to the verbal assessment, the parents are asked to provide information about their teen’s strengths and difficulties, and we get information from sources such as court, family, teachers or other therapists/ psychologists. Urinalysis is also done at the time of assessment.
Is Ryther’s Intensive Outpatient Treatment Program different? What I am excited about is that we are making the leap to co-occurring treatment. On Ryther’s campus we have psychiatric and psychological services, dual-certified mental health and addiction therapists, experiential therapists and therapists trained in Dialectical Behavioral Therapy (DBT) skills. The data shows that over 80% of teens who abuse substances also have mental health issues so we treat both simultaneously. A part of the initial assessment dimensions includes mental health challenges, and such issues would be flagged. In these cases, if a client needs a psychiatric or psychological evaluation, an internal referral would be made.
What does the program entail? We use evidence-based practices such as Dialectical Behavioral Therapy (DBT) skills as well as experiential therapies and science-based psycho-education. DBT skills include mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. Among teen boys in our inpatient program, this is what they say was most helpful. DBT skills help answer recovery questions like, “What do I do instead of use drugs when I get stressed out? How do I communicate effectively with other people?” Mindfulness is essential to being able to use the other DBT skills and will be practiced in creative/ fun ways at every group session. With DBT, there are three states of mind: emotional mind, logical mind and wise mind. DBT teaches how to take the best of the emotional and logical minds and find that wise mind for effective decision making. This is about how to be present in the moment and not get bogged down either in the future or the past.
Additionally, participants will at some point in their IOP experience be asked to mentor someone entering the program and will be required to co-lead various modules and the experiential components of those modules.
What should clients expect? There are three sessions per week. Monday and Wednesday evenings for group sessions (each 2.5 hours) and a third day is for individual therapy. Group sessions include experiential activities during the last hour. The activity relates to the DBT skill that is worked on during the first part of the session. The activities are fun and active as well as developmentally appropriate based on adolescent brain development. We have a low ropes course, a climbing wall and a portable ropes course so we can do activities inside or outside. Random urinalysis will be done at Ryther.
How long is the program? In order to graduate from IOP the client must participate in the entire 12 week program. If a client misses a session it can be made up. Clients can join anytime. Among other things each participant’s individual therapist will help support DBT skills group and review the Mindfulness module if missed to get him or her up to speed in order to step right into the group.
What about family involvement? We offer a twice monthly parent group. Plus, once or twice a month a parent might join the individual therapy session. We keep parents in the loop about what we’re working on and provide psycho-education. We will also offer family therapy.
If you would like more information, please call us at 206.517.0234. Currently for this program we only accept private pay or insurance.