Detox, residential, PHP, IOP, outpatient, sober living. It can be a lot to navigate for the first time, especially during a crisis. So here it is, in plain language.
Looking for care8 minute read
You are trying to help someone you love, which can be one of the most tender and upsetting moments in a person's life. We are here to help.
What you probably need right now is someone to explain how this actually works. Most program websites are built to get you to call, but not necessarily to teach you anything. So the learning part is on us.
This page is the map. No programs are named in it, so nobody is selling you anything. We hope that once you know how the levels work, you will know what to look for and what to ask.
You can hire someone to help you decide
You do not have to do this alone. Some people help families pick a level and find a program for a living. You will hear them called case managers, care navigators, or therapeutic consultants. For a teenager, educational consultants.
A good one figures out what your person needs, lays out real options, tells you the truth about your insurance, and makes the calls so you do not make twenty. Then stays with you between levels, because that is where things fall apart.
You pay them by the hour or a flat fee, usually a thousand to a few thousand for placement. Ask what they charge, how many options they will show you, and whether they have been to these places themselves.
If you can afford one, it is money well spent. If not, keep reading. This page covers most of what they would tell you.
The levels, from most support to least
Care is sorted by how much structure someone needs. More structure means more hours, more eyes on them, and more money. You want the lowest level that is still safe, then you step down as they get steadier.
How much structure each level gives
DetoxAround the clock · 3 to 7 days
ResidentialAround the clock · 30 to 90 days
Partial hospitalization · PHP25 to 30 hours a week
Intensive outpatient · IOP9 to 12 hours a week
Virtual PHP or IOPSame hours, remote
Outpatient therapyAbout 1 hour a week
Most supportLeast support
Not levels of care, but part of the picture
Case managementSomeone you hire to help you choose a level, find programs, and coordinate the moves between them. Their fee is separate from whatever a program costs.
Sober livingHousing with rules, not treatment. Most often used after residential, alongside PHP, IOP, or outpatient therapy.
Hours and lengths vary by state, program, and insurer. Treat this as the shape of the system, not a rulebook.
Level one
Detox, or withdrawal management
What it is
Getting a substance out of the body safely. Nurses and doctors on site. Medicine for the symptoms. Watched around the clock.
How long
Three to seven days, usually.
Who it is for
Anyone whose withdrawal could turn dangerous. Coming off alcohol or benzos can kill you. Never do it alone at home.
Worth knowing
Detox is not treatment. It only makes someone stable. If nobody can tell you what happens next, there is no plan.
If they say hospital level, check
The scale runs 1-WM to 4-WM. Only 4-WM is a real hospital. A 3.7-WM has nurses and a doctor, but cannot do what a hospital does. So ask three things. Which level are you? Are nurses here all night, or on call from home? If someone has a seizure at three in the morning, what can you do before the ambulance gets here?
Level two
Residential, sometimes called inpatient
What it is
Living there full time. Therapy one on one and in groups. Doctors and psychiatrists. Someone else runs the schedule.
How long
30, 60, or 90 days. That number usually comes from insurance, not from what your person needs. Ask where it came from.
Who it is for
People who need to get away from their environment to make any progress. Or who tried outpatient and could not hold on.
Worth knowing
The building matters less than the people in it. A beautiful place where staff keep quitting is worse than a plain one where nobody leaves.
Level three
Partial hospitalization, or PHP
What it is
Treatment most of the day, most days. You sleep somewhere else. Usually five or six hours, five days a week.
How long
Two to four weeks, usually.
Who it is for
People coming down from residential. Or people who need real structure but have a safe place to sleep.
Worth knowing
Lots of people do PHP while living in a sober living house. The two get sold together. Ask which parts you are paying for.
Level four
Intensive outpatient, or IOP
What it is
Therapy a few times a week, about three hours each time. Built so someone can keep working or stay in school.
How long
Eight to twelve weeks.
Who it is for
People who need a real schedule and someone checking on them, but who are steady enough for an ordinary week.
Worth knowing
Families skip this because it sounds like less. It is where a lot of the real work happens, and it has to survive a normal week. That is the hard part.
Level five
Virtual PHP and IOP
What it is
The same schedule, over video, from home. Groups, one on one sessions, check-ins. Just not in a room.
How long
Eight to twelve weeks for IOP, a few weeks for PHP.
Who it is for
People who cannot get to a building. No car. A job with no give. Little kids at home. Nothing good nearby. For a lot of families this is treatment or nothing.
Level six
Outpatient therapy
What it is
Seeing a therapist, often a psychiatrist too. Usually once a week.
How long
As long as it helps. Months or years is normal.
Who it is for
Most people, eventually. Plenty of people start here and never need more.
Worth knowing
Who the person is matters more than where they trained. Meet two or three before you pick. Switch if it is not working. Nobody good will mind.
Not a level of care
Sober living and transitional housing
What it is
A shared house with rules. Curfew, drug tests, chores, house meetings. It is housing, not treatment.
How long
Months, often longer. Longer is usually better.
Who it is for
People leaving residential who are not ready to go home. Or anyone whose living situation is part of the problem. Usually paired with PHP, IOP, or therapy.
Worth knowing
Nobody watches these houses closely, so quality is all over the place. Ask who runs it day to day. Ask to see it.
How people usually move through it
Most people go down the list. Detox, residential, PHP, IOP, then therapy. Almost nobody goes in a straight line, and going back up a level is not failing. What matters is that the next step got planned before the last one ended.
The single most useful question
"What happens on the day this ends?" Ask before anyone goes anywhere. A real answer means they thought about your person. A vague answer tells you plenty.
What to ask any program
You are allowed to interview them, and the good ones expect it.
Are you licensed here? What is the number so I can look it up?
Who exactly will work with my person, and how long have they been here?
What does an ordinary Tuesday look like?
What is the total cost, everything in, in writing?
What has insurance agreed to cover? What if they stop?
Who does well here? Who does not?
That last question is the best one on the list. A program that can name who it is wrong for knows exactly what it does well.
What a good program does
Most people in this field are good at this, and a good program is easy to spot. They give you time to decide, put costs in writing, let you walk the place, ask what is going on before they ask about insurance, and tell you to go call two other programs.
If you run into the opposite, that is worth noticing:
Pressure to decide today, or a bed that will be gone by tonight
Anyone offering to pay for a flight, a bus ticket, or your deductible
Not letting you tour before admission
Costs that never show up in writing
Anyone talking you out of calling other programs
Being asked about insurance before being asked what is going on
That last one tells you the most. The order someone asks their questions in tells you what they care about.
How to check a program yourself
All free, and you can do it in an afternoon without talking to anyone.
Your state licensing or behavioral health department, for the license and any complaints
Your insurance provider directory, which also shows what is in network
If this is an emergency, do not wait
Call or text 988 for the Suicide and Crisis Lifeline, any time, day or night. If someone is in immediate physical danger, call 911.
One last thing
There is no perfect answer, and waiting for one costs time you may not have. Learn enough to ask real questions. Notice when an answer is thin. That is enough to choose on purpose instead of choosing whoever came up first.
That is most of it. The families who do well are the ones who stayed involved and kept asking.
About this page. Treatment Tour Collective is a creative agency. We work in behavioral health every day, which is how we learned all of this, but we are not clinicians and this is not medical advice. No program paid to be part of this page, and no program is named in it.
Levels of care follow the framework used across the field, including the ASAM criteria for substance use care. Definitions and typical lengths vary by state, by program, and by insurer, so treat the timelines here as a starting point rather than a rule.
