Duke IOP documentary with endowment information from Jennifer Segura on Vimeo.

Abuse and dependence on alcohol and other drugs, and the associated risk taking behaviors, are the most life-ruining or lethal threats faced by American adolescents and young adults. Yet most parents cannot get treatment for these young people in crisis. The most recent government data show that, from 2002 to 2007, available treatment fluctuated between 5.9 and 8.1 percent of the total number in need (SAMSHA, 2008). Treatment is even less available for those who have both a substance abuse and a psychiatric disorder.

Who are we?

We are a group of substance abuse experts with extensive experience. We provide intensive outpatient substance abuse and psychiatric rehabilitation services for high school and college students. We provide state of the art counseling and medication services. Our program was the first substance abuse treatment program for young people in a department of psychiatry in America. Despite limited resources, our program has survived and has saved the lives of many young people and has saved the future productivity of many more. The substance abuse counselors are experienced and dedicated people. It is through their efforts that approximately two-thirds of the young people who enter the program achieve a state of sobriety and thereby establish a healthy life direction without hospitalization or residential treatment.

What is the program’s purpose?

Our program attempts to bring a young person into a state of sobriety which leads to clear thinking and safe living during the time the patient is in an IOP. We attempt to achieve this sobriety so that the young person and his or her family can turn to a healthier new direction in life. The period of sobriety gives the young person the opportunity to mobilize abstract thinking and rise above the concrete thinking of only the here and now caused by drugs and alcohol. The ability to use abstract thinking allows the young person to begin planning healthier scenarios for their future life. Our program attempts to achieve this goal without placing the young person in a costly hospital or residential treatment program.

Why do we do this work?

Abuse of alcohol and other drugs intensifies the danger of an already dangerous period of life. Adolescence and young adulthood are the most dangerous ages in human life. Young people are risk takers, and risk taking with a clouded brain is a terrible combination. Seventy-five percent of deaths of young people are due to trauma (such as accidents, suicide, and homicide), and most trauma is associated with intoxication. Deaths due to trauma associated with alcohol and other drugs account for many more deaths than infections, cancer, and all other causes of death combined in young people.

If alcohol and drugs do not cause death, they cause a permanent fixation in concrete thinking leading to an inability to achieve educational and personal goals needed to succeed in life.

Another reason we do this work is because, years ago, some of us have had our own near-death experiences with drugs and alcohol. We have devoted our lives to helping others avoid such terrible problems.

Why is our program unique?

The United States Department of Health and Human Services has defined this type of intensive outpatient program as the most cost effective type of program to help people with drug and alcohol problems. Yet, this type of program is rare. Few professional groups attempt to achieve the goal of sobriety and re-establishment of life direction for young people without placing them in a hospital or residential treatment program. To achieve the goal of sobriety, while keeping a young person in a normal situation at home, or in college, requires an extraordinary amount of work by treatment staff and families.

The extensive experience of the substance abuse counseling specialists combined with this remarkable devotion to young people and their families is a rare combination. As well, supervision by very experienced adolescent addiction psychiatrists is very rare.

Duke faculty member, Paul Nagy, is the author of the comprehensive review of IOPs for the United States Department of Health and Human Services (Nagy, 1994, 2006). He knows our program well and he lists some characteristics of our program which distinguish it from any others:

  • Length of time in operation and experience of staff.
  • Capacity for evaluating and treating co-occurring psychiatric disorders.
  • Family centered nature of the program.
  • Integrated and reliable referral networks.
  • Established relationships with other providers for continuing or increasing care after completion of our Intensive Outpatient Program.
  • Flexibly and individualized programming.

What is our success rate?

Approximately two-thirds of the young people achieve sustained sobriety from the program. Approximately one-third do not and have to be referred to a hospital or residential treatment. Often they come back to our program after they have achieved stability in this higher level of care.


Trends in Substance Use, Dependence or Abuse Treatment Among Adolescents: 2002 to 2007. (2008). Rockville, MD: US Department of Mental Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment.

Forman, R. and Nagy, P. (2006). Substance abuse: Clinical issues in intensive outpatient treatment, Treatment Improvement Protocol (TIP). Series 47. SAMHSA/CSAT, No SMA 06, 4182. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment.

Nagy, P. (1994). Intensive outpatient treatment for alcohol and other drug abuse. (DHHS Publicaion No. (SMA) 94-2077). Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment.