Explainer 05 · Free
Detox, residential, PHP, IOP
These are not marketing tiers. They are defined levels of care with different staffing, different intensity, and prices that differ by an order of magnitude. Being placed at the wrong level is one of the most common and most expensive mistakes in this process — in both directions.
There is a standard framework here. Most clinicians and nearly all insurers describe levels of care using The ASAM Criteria, which sorts treatment into a ladder from occasional outpatient sessions up to hospital-based care, and matches a patient to a rung based on how severe their situation is.
You do not need the numbering. You need to know what each rung actually is, and which mistakes happen at each one.
| Level | What it actually is | The common mistake |
|---|---|---|
| Withdrawal management ("detox") |
Medical stabilisation while the substance leaves the body. Days, not weeks. Can range from monitoring in a residential setting up to full hospital care depending on what is being withdrawn from. | Treating it as treatment. Detox addresses the physical crisis. It does very little about why the person uses. Discharge from detox straight home is the highest-risk transition in the whole process. |
| Residential / inpatient | Living at the facility, 24-hour staffing, structured programming most of the day. Intensity within this band varies a lot — from low-intensity supportive housing with clinical hours up to medically monitored care with nursing on site. | Assuming all residential is the same. Ask specifically what medical coverage exists overnight, and how many clinical hours per week are actually delivered versus how many are on the brochure. |
| PHP (partial hospitalization) |
Full-day programming, roughly 20+ hours a week, but the person sleeps elsewhere — at home or in structured housing. | Underrating it. For the right person PHP delivers close to residential clinical intensity at meaningfully lower cost, and keeps them connected to real life. It is often the correct answer where residential was sold. |
| IOP (intensive outpatient) |
Typically around 9 to 19 hours a week, several sessions, designed to fit around work or school. | Using it as the first and only step for someone with a dangerous use pattern and no sober housing. IOP assumes a survivable home environment. |
| Outpatient | Weekly or twice-weekly individual or group therapy, plus medication management where relevant. | Stopping here after a residential stay without any bridge in between. The step down from 24-hour structure to one hour a week is very steep. |
The single most important thing on this page
Detox is not treatment. If the plan being described to you is "seven days of detox and then we'll see," that is not a treatment plan. Ask what comes immediately after, at what level, at which facility, on what date, and who books it. Get that answer before admission, in writing, because the person will not be in a state to arrange it themselves on day seven and the window closes fast.
Where does medication fit?
Medications for opioid and alcohol use disorder — buprenorphine, methadone, naltrexone and others — are not a separate level of care. They can accompany any of the rungs above, and for opioid use disorder in particular the evidence for them is strong.
What matters practically is that not every program is willing to use them. Some are philosophically abstinence-only and will taper a patient off medication that was working, or decline to start it. That is a legitimate question to ask directly, and the answer should be specific rather than a general statement about supporting all pathways.
"Do you start and maintain buprenorphine or naltrexone on site, and will you continue a medication he arrives on?"
Listen for whether they distinguish between continuing and starting, and whether "we support MAT" turns into "we taper everyone off before discharge" two sentences later.
Why "30 days" is a marketing number
The 28- or 30-day program is a historical and commercial convention, not a clinical finding. Nothing about the biology of recovery resolves on day 30.
In practice, length of stay is driven by two things: what the insurer authorizes, and what the program's model is built around. Neither is the same as what a particular person needs. The useful question is not "how long is your program" but:
"What was your average length of stay at this level last year, and what typically ends it — clinical readiness or the authorization?"
Very few facilities will answer the second half honestly, and the way they handle the question tells you a great deal. A program that acknowledges the tension is being straight with you.
What good placement looks like
- An assessment happens before a level of care is recommended — not a level recommended before anyone has assessed the person.
- The recommendation is explained in terms of the person's actual situation: what they are withdrawing from, what else is going on medically and psychiatrically, what they go home to.
- There is a named next step with a date, not "we'll discuss discharge planning later."
- The program is willing to say the answer is somewhere else. A facility that recommends a different level, or a different provider, when that is what the assessment shows, has just demonstrated more than any badge could.
And if a facility recommends the most expensive rung on the ladder within ten minutes of a phone call, before anyone has assessed anything: that is a sales conversation. You are allowed to say you will call back, and then call somewhere else.
Next: the questions a weak program cannot answer well. Read the questions explainer →
The paid guide
The Family Field Guide includes a one-page level-of-care comparison you can fill in per facility, plus the step-down planning worksheet — the questions to settle before admission rather than during discharge. This page stays free either way.