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Treatment Settings

There are a number of treatment settings typical for the treatment of patients with substance abuse disorders. They fall into two main categories. Those that are not specific to a particular drug of abuse, for example, intensive outpatient treatment; and those that specialize in a particular class of drug and a treatment that has been developed for that class, for example, opioid dependence and the use of methadone maintenance treatment. Below is a general description of each treatment mode. To find treatment services available at Johns Hopkins, please contact the programs listed below each type of treatment or review our list of treatment programs.

Intensive and Standard Outpatient Treatment

Intensive outpatient treatment is distinguished from outpatient counseling by the amount of time the patient spends in the program --- usually nine or more hours a week of treatment. A patient in an intensive outpatient program (IOP) will have an individual treatment plan based on an assessment of their particular needs. The treatment is provided by a variety of professionals including nurses, counselors, physicians, psychologists, therapists, and social workers. Individual counseling is part of the treatment but the emphasis is on group therapy. Patients often enter an IOP from a more intensive level of service such as an inpatient or residential setting or a partial hospitalization program. Intensive outpatient treatment can last from a few weeks to several months, when the patient can move to standard outpatient counseling as they are stabilized. IOP programs vary in how they are organized – for example, some might operate in the early evening for two hours each weeknight (to accommodate people who work), while others may operate three to four hours per day, three days per week. 

Johns Hopkins Programs

Partial Hospitalization

A partial hospitalization program (PHP) is one in which a patient stays in the hospital no more than 20 hours a week , usually during the day. Patients do not stay overnight. A PHP provides a mix of outpatient individual and group counseling in a setting with medical services. Nurses and physicians are available for clinical car, such as medically supervised withdrawals. Patients often enter a PHP after being an inpatient, and the PHP is used as a step-down in the intensity of services provided. In other cases, a person may be admitted to a PHP because they have relapses in their drug use and more intensive services are needed to restabilize the person. Staff in partial hospitalization program assess the patient and generate a treatment plan. Treatment often includes classes about drug use are well as therapies. 

Johns Hopkins does not currently have any partial hospitalization substance abuse programs.

Inpatient Treatment

Inpatient substance abuse treatment is used on a short-term basis particularly for medically supervised withdrawal, also known as detoxification or ‘detox’. Trained medical professionals are on-site 24 hours a day. A physician (or in some cases a physician’s assistant or nurse practitioner) typically sees each patient on the inpatient unit every day, seven days per week.  Other professionals such as social workers and occupational therapists are also available.  Withdrawal from some drugs, such as opioids, sedative-hypnotics, and alcohol, which produce physical dependence, can produce a great deal of distress and discomfort. In some cases, it can be dangerous to abruptly stop using a drug. Detoxification can occur in either an inpatient or an outpatient setting. It often involves giving some medication in decreasing doses over time until the person is drug free. When done on an inpatient basis, detox usually lasts just a few days.  In an outpatient setting it can last weeks or months.

Johns Hopkins Programs

Residential Treatment

Residential treatment is also a level of service that has 24-hour supervision but does not have the same level of medical monitoring and staffing associated with inpatient treatment.  Individuals who do not have significant medical problems but who need constant supervision, are good candidates for residential treatment.  The length of time that a person stays on a residential unit can vary considerably, with some stays lasting as little as a few days or a week, and others lasting many months. Residential programs are staffed 24-hours a day and provide groups and counseling. A physician may see patients on an intermittent basis after admission (e.g., once per week if no medical issues), and in some cases non-complicated medical problems and withdrawals can be managed on a residential unit. 

Johns Hopkins Program

Opioid Treatment Program

An opioid treatment program (or OTP) is a specially licensed clinic that provides both medication (typically methadone or buprenorphine) and non-pharmacological services for the treatment of opioid dependence. It is staffed by counselors, nurses, a medical director, and other professionals. These programs are typically open six or seven days per week, and patients receive a supervised dose of medication every day. OTPs can provide a range of services, such as individual and group counseling, primary medical care, vocational counseling, couples therapy, HIV testing, counseling and treatment for other drugs of abuse besides opioids. 

Johns Hopkins Programs

Office-Based Opioid Treatment

Office-Based Opioid Treatment (OBOT) is provided to opioid dependent persons through a physician’s office. Special legislation in the United States (passed in the year 2000) allows certain physicians to prescribe certain opioid agonist medications for the treatment of opioid dependence. At the present time, only buprenorphine (or buprenorphine/naloxone) can be prescribed in this way and treatment can only be provided by physicians. Ideally the physician practicing OBOT can readily refer patients to coordinated services in the.  The patient receiving office-based opioid treatment does not need to go to the doctor’s office each day to receive Buprenorphine, as is the case with a clinic-based opioid treatment program. The patient receives a prescription that is filled at the local pharmacy providing up a month of medication. 

Johns Hopkins Programs

Opioid Treatment Program

An opioid treatment program (or OTP) is a specially licensed clinic that provides both medication (typically methadone or buprenorphine) and non-pharmacological services for the treatment of opioid dependence. It is staffed by counselors, nurses, a medical director, and other professionals. These programs are typically open six or seven days per week, and patients receive a supervised dose of medication every day. OTPs can provide a range of services, such as individual and group counseling, primary medical care, vocational counseling, couples therapy, HIV testing, counseling and treatment for other drugs of abuse besides opioids. 

Johns Hopkins Programs

Office-Based Opioid Treatment

Office-Based Opioid Treatment (OBOT) is provided to opioid dependent persons through a physician’s office. Special legislation in the United States (passed in the year 2000) allows certain physicians to prescribe certain opioid agonist medications for the treatment of opioid dependence. At the present time, only buprenorphine (or buprenorphine/naloxone) can be prescribed in this way and treatment can only be provided by physicians. Ideally the physician practicing OBOT can readily refer patients to coordinated services in the.  The patient receiving office-based opioid treatment does not need to go to the doctor’s office each day to receive Buprenorphine, as is the case with a clinic-based opioid treatment program. The patient receives a prescription that is filled at the local pharmacy providing up a month of medication. 

Johns Hopkins Programs

 

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