An Interview with Anna McDonald, Houston North Intensive Outpatient

Helping people struggling to overcome addiction is Anna McDonald’s passion. “A good day is when I know I have done my job well, when I see a client who at one time was very hesitant about treatment begin to realize that there is hope for another way of life, that it’s obtainable.” Knowing that she’s helped someone gain the tools for lasting sobriety “is the best gift.”

The Road to Right Step

For the first 10 years of her life, Anna lived in Alaska, moving to Texas when her dad retired. After attending San Jacinto College, she’s one class short of her A.A.S., is a level 3 licensed chemical dependency counselor-I and is close to becoming fully licensed as an LCDC. How Anna got into the field is a story laced with rich experience. She worked as the program coordinator of an intensive outpatient program (IOP) for a nonprofit treatment center in the area whose clients were mostly criminal justice referrals ordered into treatment as a condition of probation. There, she also taught offender education classes such as DWI education, drug offender education and parenting classes. Looking for greater opportunities, Anna found her current job through networking. At The Right Step, as a program coordinator at the North Houston IOP, Anna facilitates groups, does individual counseling and case management, and works with UDS results.

Why Choose an Intensive Outpatient Program (IOP)

Intensive outpatient treatment is a good choice for those who have commitments to work and/or school and don’t require a higher level of care. It allows time for clients to be with their family members, which is especially helpful for those who can’t be away from their work/family responsibilities for a 30- to 90-day residential addiction treatment program. IOP lasts six weeks. Many of The Right Step clients have dual diagnosis, or substance abuse and a co-occurring mental health disorder, most commonly bipolar disorder or depression and substance abuse. Many clients abuse drugs to medicate those disorders. Once they’re able to regulate the symptoms of bipolar or depression, they’re better able to focus on their sobriety. Some people confuse intensive outpatient treatment with AA, or think that IOP means AA. IOP is in between residential addiction treatment and AA. “You get the education and learn coping skills and relapse prevention like you do in residential, and have regular meetings like in AA,” Anna explains. “There’s also the family component in IOP, as in residential. But you don’t stay there. You go home with your family and tend to your work/school responsibilities.” After the six-week IOP, clients graduate into the aftercare program where they attend process groups and check in with other graduates in a kind of fellowship in the aftercare meeting. “We recommend clients attend at least one year of aftercare, but they are free to continue as long as they want,” Anna says.

How Intensive Outpatient Addiction Treatment Works

Clients come to meetings four days a week for three hours a day, attending either morning or evening groups. Three of the days are group meetings, 1-1/2 hours of chemical dependency (CD) education, such as teaching relapse prevention and new ways to cope with stress. Clients learn that by controlling their thoughts, they can control their behavior. And by changing their feelings, they can change their behavior. There’s also 1-1/2 hours of process groups, where clients complete assignments; for example, they may do a goodbye letter to alcohol or 10 triggers in the past to use. Process groups allow peers to answer questions. Let’s say someone shares something and a group member may say that you’re rationalizing, using a defense mechanism. “You’re in denial.” Hearing it from a peer, the IOP client is more likely to accept the comment. There’s also an adolescent program, which is two hours (compared to three for adults), four days/week. The first hour is chemical dependency education, followed by a process group. Adolescents attend family group with adults. “The teaching format with adolescents is a little different,” Anna continues. “We do a lot of games and interaction, as well as teach drug refusal skills.”

Why Is IOP Beneficial?

Residential treatment isn’t necessary or practical for everyone. Some people have family or work responsibilities and can’t be away for the 30 to 90 days of residential treatment. It could be financial reasons that prevent them from going into residential treatment. At the same time, AA is not enough for them. They need the structure and discipline that they’d get with IOP. IOP works for all of these reasons. In IOP, random drug tests are conducted twice weekly. Clients are also required to attend three 12-step meetings each week. “We keep them very busy.”

All in – Family Group

The family program is an educational outlet and is mandatory for IOP participation. Someone that is supportive of the client’s recovery has to be present one day a week. Many times, the family is in great need of education about addiction. If clients go through treatment and their environment at home hasn’t changed, they’re more likely to relapse. In family group, clients do activities like making a concerns list and then sharing it with the group. “Initially, family members may be reluctant to share what they’ve written, but they’re encouraged by hearing other family members (it’s a multi-family group) open up and share in this safe environment,” Anna says. Another rule is that family members and clients refrain from talking about the concerns list for one day afterward. “We find that the more a client has family involved, the more successful the client will be at maintaining sobriety.”

What to Look for in an IOP

In Anna’s estimation, positive regard for counselors is the top thing to look for in an IOP. “Finding counselors who genuinely care about clients is vital,” she comments. “The mark of a good counselor is the number of clients who attend the aftercare program and who continue their recovery efforts.” Anna says that getting the most out of the intensive outpatient treatment experience means “being open to learn.” Clients who are closed off to the help being offered or are defensive throughout treatment probably won’t find IOP works for them. “You can only get out of the treatment experience what you’re willing to put in.” IOP is affordable and includes aftercare for as long as the client wants to participate in it.

Scroll to Top