The Vestibule Intensive Outpatient Program (VIOP)

This short film is seen by every single Above and Beyond intake patient at the end of their initial assessment. Please give it a watch as it is short (6 minutes) and is one of the more prominent of our many "distinguishing characteristics". It is self-explanatory in offering our clients enough information about which program of support to choose (either SMART Recovery or AA) to make their "informed consent" so that their initial treatment plan can be written around it. Then, after they have attended one of each meeting they can revisit the topic with their counselor and finalize which support modality they will adopt somewhat more permanently.

Technical Specs of the Copyrighted VIOP

Recognizing the individual differences in philosophical orientation of patients in a general population, hospital-based CD [Chemical Dependency] units "match" patients to highly contrasted therapeutic approaches. These "tracks" are based on differential diagnosis between subsets of alcohol dependence (DSM-III-R). Administrative rationale for the two-track Vestibule Intensive Outpatient Program (VIOP) is provided along with clinical guidelines for running Rational Emotive Behavior Therapy groups. The VIOP is incorporated into a community-based, two-track system with continuing outpatient follow-up provided in both A.A. and REBT/S.M.A.R.T. Recovery meetings for the first year following graduation.

At present, the majority of American outpatient addiction care is based on the 12-step program of A.A. Statistics have shown that the majority of patients continue their addictions during the year following discharge. Client receptivity to the central concepts of the 12-step program is predictive of treatment outcome. Ideally, patients with a secular or humanistic orientation would select institutions where non-spiritual and non-religious methods are employed, either as a matter of personal preference or on the advice of a referring professional, but these services are only sparsely available (other than our Vestibule Program, S.M.A.R.T. Recovery and a handful of other low profile Harm Reduction support modalities). VIOP is a means for any 12-step inpatient, outpatient, or intensive outpatient program to immediately diversify its theoretical basis for addiction care, and to clinically accommodate those patients who give early indicators that the 12- step approach will not lead to a satisfactory outcome. This paper will specifically deal with the intensive outpatient model, although the principals contained herein will vary only slightly from the other two.

Transition to the two-track VIOP system is accomplished through systematic staff development with administrative support and encouragement. On-site consultation with qualified S.M.A.R.T. Recovery consultants, along with Rational Emotive Behavior Therapy supervision is highly recommended in order to benefit from in-service training in clinical methods. The material presented here includes:

  1. Conceptual Backdrop
  2. Guidelines for Differential Diagnosis
  3. Demographic Considerations
  4. Competitive Conditions
  5. The Solution
  6. Operations
  7. Common Problems in VIOP
  8. Clinical Protocol
  9. Conducting the Daily REBT/ S.M.A.R.T. Recovery Group Sessions
  10. The Role of the Family in VIOP
  11. Suggestions for Rational Milieu Therapy
  12. A.A./ S.M.A.R.T. Recovery VIOP Outpatient Follow-up and Alumni Support

The required readings in the VIOP are Rational Recovery from Alcoholism: The Small Book, by Jack Trimpey, LCSW, and Rational-Emotive Therapy with Alcoholics and other Substance Abusers by Albert Ellis, Ph.D., John F. McInerney, Ph.D., Raymond DiGuiseppi, Ph.D. and Raymond Yeager, Ph.D., of the Institute for Rational-Emotive Therapy, New York. It is assumed that therapists are already familiar with Bill Wilson's "Big Book" (Alcoholics Anonymous) and the program of Alcoholics Anonymous.

Conceptual Backdrop for VIOP: A philosophical dichotomy has been present throughout history, and its division continues today in our pluralistic American society. Aristotelians (rationalists) and Platonists (supernaturalists) hold fundamentally different premises, and therefore, require different psycho-emotional management. Addicts themselves represent a cross section of the general population, as reflected in their viewpoints on matters such as politics, religion, philosophy, psychology, education, economics, and chemical dependency. Indeed, values and perceptions concerning all of the above vary widely from country to country and from culture to culture. Although the physiology of addiction may be fairly uniform between social and ethnic groups, the philosophical underpinnings are not. Therefore, we have defined two subsets of Alcohol Dependence (DSM-III-R) that must be differentiated as part of the diagnostic protocol. It's called Differential Diagnosis. Its purpose is to identify traits of personality and philosophy that will promote, for any given person or group of persons, a high degree of success in one program as distinct from a high probability of failure in another.

Subtype 1: Aristotelian, without theistic beliefs:REBT/ S.M.A.R.T. Recovery

Subtype 2. Platonic, with theistic beliefs: A.A.