Program Profile: Intensive Outpatient Program (IOP) and Non-Hospital Residential (NHR) Program

These were community-based, substance abuse treatment programs for recently paroled, substance-dependent individuals. The primary aim of the programs was to treat participants’ substance abuse in the community while reducing their likelihood of reoffending. The program is rated Promising. Program participants were less likely to be convicted of a new crime, when compared with the community comparison group; this was a statistically significant difference.

A Promising rating implies that implementing the program may result in the intended outcome(s).

Program Goals

The Intensive Outpatient Program (IOP) and Non-Hospital Residential (NHR) Program were community-based, substance abuse treatment programs in Northeast Pennsylvania targeting individuals released from prison early on parole. The programs were intended to reduce participants’ substance dependence while reducing their likelihood of recidivating.

Because of prison overcrowding, many states have developed early release initiatives, such as IOP and NHR, for drug- and alcohol-dependent individuals. By providing individuals with early parole to a community-based, substance abuse treatment facility, program participants could complete their sentences in a community setting, which had the dual benefit of reducing jail crowding and providing the individual with needed treatment.

Target Population/Eligibility

Individuals with substance abuse or dependence disorders were eligible to be released on parole to one of the two programs if they had served at least half of their minimum sentences, had between 6 months and a year remaining on their prison terms, met DSM-III-R criteria for substance abuse or dependence, did not have a primary co-occurring psychiatric disorder, and volunteered to participate. Inmates who met these criteria were evaluated by a clinical evaluator and a psychiatrist to determine which program (IOP or NHR) would be most appropriate. Final approval was needed from the public defender, district attorney, and presiding judge.

Program Components

The IOP program required participants to attend an average of 10 hours of substance abuse treatment over 3 days. Treatment consisted of one individual counseling session and approximately 9 hours of group work, including educational sessions, therapeutic counseling, and relapse prevention.

The NHR program offered 2 hours of individual counseling, 6 hours of facilitated group counseling, 6 hours of social rehabilitation (community meetings, self-help meetings, etc.) and 6 hours of skill development (education, work skills, exercise, etc.). The required length of treatment for both IOP and NHR programs was 6 months. All released individuals were assigned to a parole officer (PO) who was required to be in contact with the released individual at least once a month. The PO was responsible for monitoring the status of the individual they were assigned to and for serving as an active member of the treatment team. The PO also served as a representative of the court system and conveyed to the released person that noncompliance with the program could lead to a parole violation.

Program Theory

These programs were based on research showing a strong association between substance abuse and criminal activity (ADAM 2000). The programs also applied a 12-step theoretical framework (Zanis et al. 2003). 

Study 1

Zanis and colleagues (2003) used a quasi-experimental design to test the impact of the Intensive Outpatient Program (IOP) and Non-Hospital Residential (NHR) programs on recidivism outcomes for individuals recently released from an urban jail in Northeast Pennsylvania. Individuals with substance use or dependence disorders were eligible to be released on parole to one of these two types of programs if they had served at least half of their minimum sentences, had between 6 months and a year remaining on their prison terms, met DSM-III-R criteria for substance abuse or dependence, did not have a primary co-occurring psychiatric disorder, and volunteered to participate in the project. Inmates who met these criteria were evaluated by a clinical evaluator and a psychiatrist to determine which program — IOP or NHR — would be most appropriate. Approval was needed from the public defender, district attorney, and presiding judge.

The treatment group (n = 495) was composed of individuals released from jail on early parole to one of two community-based programs, with approximately 57 percent (269 individuals) participating in the NHR program and 41 percent (192 individuals) participating in the IOP program. The comparison group (n =74) was composed of individuals who had volunteered for these programs, met all eligibility requirements, and were approved to participate, but who had been placed on a waiting list and were subsequently paroled directly to the community without receiving treatment. Individuals in the comparison group received standard parole services, including monitoring and referrals to community-based service providers.

The treatment group was 91 percent male; the race/ethnicity of the group was 74 percent African American, 14 percent Hispanic, and 12 percent white. The average age was 31 years. The comparison group was 90 percent male; the race/ethnicity of the group was 77 percent African American, 14 percent white, and 10 percent Hispanic. The average age was 30 years. No statistically significant differences were found between the two groups on any of the following characteristics: age, gender, race, years of education, longest amount of time spent at one job, marital status, substances of abuse/dependence, and Global Assessment of Functioning score.

Recidivism was measured as any new conviction during the 24-month period following parole from jail (parole violations were not included in this definition). Data was obtained from the district attorney’s central repository database. A chi-square analysis was used to determine whether there was a statistically significant difference in the proportion of individuals who were reconvicted in each group (treatment and control). No subgroup analysis was conducted.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Following are CrimeSolutions-rated programs that are related to this practice:

Adult Reentry Programs

This practice involves correctional programs that focus on the transition of individuals from prison into the community. Reentry programs involve treatment or services that have been initiated while the individual is in custody and a follow-up component after the individual is released. The practice is rated Promising for reducing recidivism.

Evidence Ratings for Outcomes

Crime & Delinquency - Multiple crime/offense types

Rehabilitation Programs for Adults Convicted of a Crime

This practice includes programs that are designed to reduce recidivism among adults by improving their behaviors, skills, mental health, social functioning, and access to education and employment. They may become participants in rehabilitation programs during multiple points in their involvement with the criminal justice system. This practice is rated Promising for reducing recidivism among adults who have been convicted of an offense.

Evidence Ratings for Outcomes

Crime & Delinquency - Multiple crime/offense types

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?