What Is Intensive Therapy?
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What is Intensive Therapy (for substance/alcohol use disorders)?
Treatment or therapy for substance or alcohol use disorders is critically important to help individuals recover from the devastation (physically, mentally and socially) of alcohol and drug abuse. It should begin as soon as possible after the individual agrees that they want to change. Most people need to be detoxified from their drug and alcohol ingestion, and allow the immediate withdrawal to resolve before treatment can be effective.
Intensive therapy for substance abuse provides broader, deeper, and more prolonged psychological treatment than traditional therapy.1
It refers to the method of delivery instead of specific types of treatment. It’s only described as intensive in comparison to traditional therapy.
Intensive therapy involves an increase in treatment duration, number of sessions, and/or scope. There are no specifics for these parameters.
Intensive therapy’s ultimate goal is to help people confidently handle their problems. It involves:
- Learning how to recognize triggering events or situations
- Developing healthy coping skills
- Learning relapse prevention techniques
- Receiving social and psychological support
- Addressing barriers to physical, spiritual, and emotional health
Intensive vs. Traditional Therapy
Compared to traditional therapy, intensive therapy typically has:
- More sessions: Intensive therapy usually requires more frequent meetings than the usual once-per-week setup.
- Longer sessions: Intensive therapy may maintain regular intervals but with sessions lasting longer than the usual 50- to 60-minute period.
- Compressed sessions: Cognitive behavioral therapy (CBT) is one type of therapy that looks different in an intensive setting. Traditional CBT requires weekly 50- to 60-minute sessions for up to 20 weeks. Intensive CBT may have longer sessions (90 to 120 minutes each) condensed within a month, week, weekend, or even a single 8-hour session.2
- Longer duration: Traditional CBT usually lasts up to 20 sessions.3 Intensive therapy may extend beyond this (more sessions but the same session duration).
- Broader scope: Other traditional treatments are usually only problem-focused. Intensive therapy focuses on additional areas, like patterns of a person’s unconscious behaviors.
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How Does Intensive Therapy Work?
There are no standard criteria for defining how intensive therapy works. It does, however, typically involve the following characteristics:
- Frequency of sessions: It usually occurs more than the usual once-per-week frequency of traditional therapy.
- Length of sessions: Each session lasts about 90 minutes, which is longer than the usual 50- to 60-minute therapy session.
- Treatment duration: Intensive therapy may involve more sessions than standard therapy. It may also combine longer hours and frequent sessions within a compressed time frame, such as one week.
- Settings: Intensive therapy is a significant component of intensive treatment approaches like inpatient rehab and intensive outpatient treatment.
There are no specific requirements for the frequency, duration, or number of sessions in intensive therapy.
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Pros and Cons of Intensive Therapy
Some pros of intensive therapy include:
- More therapist-client interaction: The therapist can uncover more emotional difficulties and underlying factors that contribute to the person’s substance use disorder (SUD) or mental health condition.4
- Effectiveness: Multiple studies have shown intensive therapy’s effectiveness regarding relapse prevention and recovery.5 A higher frequency of sessions was associated with better results in treating anxiety disorders and other mental health conditions.6
- Quicker results: Intensive therapy that occurs within a compressed time frame is ideal for people who want to see an immediate impact.
Some cons of intensive therapy include:
- Higher cost: An increase in number of sessions and a prolonged treatment duration typically correlate with a higher treatment cost.
- Less convenient: Intensive outpatient sessions usually consume more time with more frequent or prolonged sessions.
- Less flexible: People may need to alter their daily lives to accommodate intensive outpatient sessions. This becomes more challenging with inpatient rehab, where people must live in a treatment facility.
Who Benefits from Intensive Therapy?
Intensive therapy can benefit individuals who need to concentrate time and resources to achieve recovery. It’s suited for addressing conditions such as:
- Severe addiction: Inpatient rehab and other intensive treatments are recommended for severe substance use disorder. Intensive therapy is a significant component of these types of addiction treatment.
- Co-occurring disorders (dual diagnosis): This happens when a person has both a substance use disorder and a mental health condition. Treating both conditions is necessary for a full recovery.
- Unstable medical and psychiatric conditions: Intensive treatment settings offer ready access to medical and psychiatric care.
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Intensive Therapy in Addiction Treatment
The American Society of Addiction Medicine (ASAM) defines five levels of care with varying intensities:7
- Early intervention
- Outpatient treatment
- Intensive outpatient treatment (IOP) and partial hospitalization program (PHP)
- Inpatient rehab
- Inpatient hospitalization
The last three levels of care are the more intensive approaches. Intensive therapy is a big part of each of these.
Intensive Outpatient Program (IOP)
Traditional outpatient programs require less than 9 hours of weekly sessions for adults and less than 6 hours for adolescents. Intensive outpatient programs (IOPs) require more: 9 to 19 hours for adults and 6 to 19 hours for adolescents.
IOPs offer medical, psychological, and psychiatric services. These behavioral services often include:7
- Individual counseling
- Group therapy
- Occupational and recreational therapy
- Psychotherapy
- Motivational interviewing
- Motivational enhancement
While a traditional program also has these features, expect intensive outpatient therapy to have more frequent and prolonged sessions.
IOPs are effective despite being less intensive than inpatient rehab and other intensive treatments.
One review that assessed 12 studies spanning from 1995 and 2012 determined that IOPs have comparable results to inpatient rehab.5
Partial Hospitalization Program (PHP)
PHPs have more stringent requirements than IOPs. PHPs require at least 20 hours or more total number of sessions per week for people who need monitoring and management.
PHP behavioral services include:7
- Individual counseling
- Group therapy
- Family therapy
- Occupational and recreational therapy
- Psychotherapy
- Motivational interviewing
- Motivational enhancement
PHPs provide almost the same types of services as IOPs. But, expect the length of sessions and frequency to be higher.
Inpatient Rehab (Residential Treatment)
In inpatient rehab, medical staff provide services in a structured, residential setting and monitor their patients 24/7.
Intensive therapy is a significant component of inpatient rehab. This type of residential treatment also typically involves:7
- Individual counseling
- Group therapy
- Family therapy
- Medications
- Mental health evaluations and treatment
- Motivational enhancement therapy
- Recovery support services
- Additional services for co-occurring disorders
Inpatient Hospitalization
This is the highest level of care. It’s ideal for people whose severe conditions need 24-hour medical and nursing care. It includes intensive medical and psychiatric services.7
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- “Intensive Psychotherapy.” APA Dictionary of Psychology.
- Youn, Soo Jeong, and Luana Marques. “Intensive CBT: How fast can I get better?” Harvard Health Publishing. October 23, 2018
- “Overview – Cognitive behavioural therapy (CBT).” NHS. July 16, 2019.
- Punzi, Elizabeth. “Relationships, Emotions, and Defenses Among Patients with Substance Use Disorders, Assessed with Karolinska Psychodynamic Profile: Possibilities to use Intensive Short-Term Dynamic Psychotherapy in Substance Abuse Treatment.” Alcoholism Treatment Quarterly vol. 37,4 : 481-496.
- McCarty, Dennis et al. “Substance abuse intensive outpatient programs: assessing the evidence.” Psychiatr Serv vol. 65,6 : 718-726.
- Tiemens, Bea et al. “Lower versus higher frequency of sessions in starting outpatient mental health care and the risk of a chronic course; a naturalistic cohort study.” BMC Psychiatry vol. 19, 228 .
- “Overview of Substance Use Disorder (SUD) Care Clinical Guidelines: A Resource for States Developing SUD Delivery System Reforms.” Medicaid Innovation Accelerator Program (IAP). April 2017.
