Stepping Stones

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The Intensive Outpatient Program (IOP) for substance use disorders provides treatment in an outpatient setting that is more intensive than traditional outpatient services, but less intensive than partial hospitalization.

The program is designed to meet an individual’s needs. Participants are expected to be able to engage in drug-free leisure activities and attend self-help groups weekly.  Individuals meet with a clinician for a biopsychosocial assessment prior to admission to identify treatment needs and support strengths and concerns. This assessment includes a comprehensive evaluation as well as utilized ASAM placement criteria using Living in Balance, Family Matrix Model and other programs/techniques.  Individuals are taught principles of their chronic disease, basic problem solving techniques, positive communication and expansion of their support systems is emphasized.  Positive coping skills and relaxation skills are also a regular part of the group process. 

Intensive Outpatient Service, IOP (aka “Stepping Stones”) – requires the person to attend group sessions which are three hours in duration, three times per week (9 hours total). Individuals are encouraged to attend twelve-step, Celebrate Recovery, SMART Recovery, or other support group meetings at least weekly.  The Living in Balance is utilized.

Length of stay in each program is determined individually, based on the individuals’ needs included within in the treatment plan goals and tasks. Individuals are staffed at least weekly to determine if the current level of care is the best treatment option available for them. Periodic drug screens are administered and are documented in the medical record. 

SETTING – IOP and Transitional Care are available at the NRVCS Radford Center.

STAFF – IOP Staff are a multi-disciplined team of specialized Master-level clinicians who assess and treat various addictions and who are either in supervision for Licensure as a LPC/LCSW, for Certification as Addiction Counselors, or have that Certification.  Peer Recovery Specialists are also utilized within this program. Staff are knowledgeable and skilled in the areas of bio-psychological disorders of addiction, mental illness, women’s issues, high risk individuals and personality disorders. Staff are able to make referrals to an agency psychiatrist on an as needed basis.


  1. Enrollment Criteria –
  • Acute Intoxication and/or Withdrawal Potential – Assessment for intoxication and/or withdrawal management. Detoxification in a variety of levels of care and preparation for continued addiction services
    • For IOP, no signs of withdrawal or needs can be safely managed.
  • Biomedical Conditions and Complications – Assess and treat co-occurring physical health conditions or complications. Treatment provided within the level of care or through coordination of physical health services
    • For IOP, biomedical conditions won’t interfere with treatment, but may be treated concurrently.
  • Emotional, Behavioral or Cognitive Conditions and Complications – Assess and treat co-occurring diagnostic or sub-diagnostic mental health conditions or complications. Treatment provided within the level of care or through coordination of mental health services
    • For IOP, client will be admitted to a co-occurring capable program
  • Readiness to Change – Assess stage of readiness to change. If not ready to commit to full recovery, engage into treatment using motivational enhancement strategies. If ready for recovery, consolidate and expand action for change
    • For IOP, has variable engagement, low awareness of their SUD, requires almost daily treatment. May require frequent, structured, motivational interventions
  • Relapse, Continued Use or Continued Problem Potential – Assess readiness for relapse prevention services and teach where appropriate. If still at early stages of change, focus on raising consciousness of consequences of continued use or problems with motivational strategies.
    • For IOP, client is experiencing intensification of SUD symptoms despite participation in a lower level of care. High likelihood of continued use.
  • Recovery Environment – Assess need for specific individualized family or significant other, housing, financial, vocational, educational, legal, transportation, childcare services
  • For IOP, environment may unsupportive but client has some skills to cope
  • Exclusion Criteria –

Any of the following criteria is sufficient for exclusion from this level of care:

  • Organic mental disorders which would suggest a poor prognosis for improvement.
  • Personality disorders which would prevent the individual from being able to participate in the group process in a constructive manner.
  • The individual is in danger to self or others and needs a more intensive level of care.
  • The individual has medical issues that prevent beneficial utilization of services or is not stabilized on medications.
  • The individual requires a level of care of structure and supervision beyond the scope of the program.
  • The individual chooses to withdraw from the program.
  • The individual is unwilling to follow the program guidelines and procedures.
  • Release/Discharge Criteria –

All of the following should be achieved before discharge from IOP:

  • Achieved majority of goals and objectives as stated in the treatment plan.
  • Active in twelve-step program, has a sponsor and actively using the group


  • Completed a personal relapse prevention plan.
  • Able to define addiction, recovery and relapse.
  • Actively participates in group to include Living in Balance and Matrix Family Group
  • Has been able to abstain from mood altering drugs.
  • The individual recognizes his inability to control his use.
  • The individual has identified personal triggers for craving and use and developed a basic plan for dealing with these triggers.
  • The individual will identify community resources that may provide assistance for recovery.
  • Therapeutic Discharge Criteria –

Any of the following is sufficient for involuntary discharge from this level of care:

  • Continued deterioration despite treatment interventions.
  • Non-attendance.
  • Failed drug screens without the ability to develop and implement a relapse prevention plan.
  • Cannot, or chooses not, to follow staff direction to the point that further treatment is likely to serve no benefit.
  • Noncompliance with fee agreement.

Any time an individual is discharged from the program for the above reasons, a means should be provided for the individual to re-engage in the program by the staff.  Discussions with supervisors will be documented prior to a contested discharge from the program.