In today’s clinical world, in the midst of an opiate crisis, medical and recreational use of marijuana, it appears that substance abuse treatment centers are popping up all over. We are seeing commercials on TV, on the radio, many promising to be “unique, and individualized” which are words that obviously are attractive to those seeking this type of care. However, there has been a huge shift in this type of care and it is important to do research for not only what treatment center you or your loved one chooses, but the level of care they choose. So how do you decide whether to start with an assessment for outpatient counseling or inpatient substance abuse treatment? I have worked in all levels of substance abuse treatment so I have been able to observe firsthand the benefit and individual appropriateness of each level of care

Often, loved ones of those seeking treatment for substance abuse, believe that residential treatment is the first stop. However, there are other options that may be appropriate and helpful before placing yourself or a loved one in that exact level of care. I will break down what each level of care means, and provide some details for the expectations of each.

Detoxification is identified as physical and mental assistance in the removal of substances from one’s life. What this means, is that if you are drinking alcohol daily or using substances such as benzodiazepines (Xanax, Klonopin, Valium, etc.) that you would require this level of care to safely allow your body to go through this process. Since this is not solely a physical process, it is important to have the emotional support while doing so, which is offered at residential treatment programs. If one is using opiates such as heroin, Percocet, Oxycodone, etc. there are options for medication assisted therapy that can also be treated on an outpatient basis. 

The next highest level of care that follows detox, is often residential treatment. Residential treatment is effective in stabilizing the individual, but that is pretty much where it ends. Residential programs are often structured to keep clients busy through long days of groups, lectures, activities, etc. Most residential treatments are based on a 21-28 day model, however, with private insurance companies, the stays often are closer to 10-14 days. The greatest benefit aside from the education, is the time away from one’s natural environment. However, there is generally limited access to the outside world which can make it difficult to communicate with loved ones throughout the course of treatment. Very little “deep” clinical work is able to be accomplished given the short stay. However, inpatient treatment can focus on firming up an aftercare plan which bolsters commitment to recovery, anticipates relapse triggers, involves family and loved ones and strengthens the scaffolding necessary to support healthy recovery. The good news is that this can also be done on an outpatient basis as well. 

Partial hospitalization (often 20 hours or less), intensive outpatient (often 9 hours or less), and outpatient counseling are all types of therapy that you are able to attend while living at your home or perhaps a sober living home. PHP and IOP are in group settings and often contain general education on addiction, coping skills, understanding your mental health, etc. You will also probably be provided drug screens regularly to ensure this level of care remains appropriate for you based on your ability to sustain sobriety. It is important to also research the type of foundation your program is built upon. Examples include 12-step fellowship and SMART recovery. Outpatient counseling can include groups also, but less often. Outpatient counseling can simply be 1:1 therapy with the therapist of your choice

It is important to note that one can start their treatment process in an outpatient setting and that this is often the best place to start so that your therapist can help you decide if you would benefit from IOPO/PHP/Inpatient or Detox. You do not have to begin at detox/residential unless you are using substances at a rate that would require you to do so, you can’t stop or danger is a high risk.  If you feel that perhaps your substance use is concerning you or your loved ones, you can begin the process here. If you are continuously unsuccessful in remaining sober at this level of care, then a higher level of care is often recommended. 

Being that a large majority of my clinical experience has been in substance abuse treatment settings, I believe it can be important to consult with a trusted treatment provider. Contacting an individual therapist that specializes in addiction can be helpful as they are able to assess and assist in treatment placement. They often have previous experience either working in or working alongside treatment centers that they find to be trustworthy and reputable. They can often point you in a direction based on the information provided in the discussion and an objective assessment.


Lauren Barrett, MA, LPC, LCADC is a Licensed Professional Counselor and Certified Alcohol and Drug Counselor with a private practice located in Audubon, NJ. She is also an associate at Jeremy Frank Associates in Bala Cynwyd, PA. She specializes in substance abuse treatment, trauma and other mental health issues.