When families hear “rehab,” most picture 28 days away from home. That is one option among several, and not always the right one.7 Treatment runs from a weekly counseling appointment to 24-hour hospital care, and no single level suits everyone.3 A clinical assessment should decide where your loved one starts.
Choosing a level because a bed is open tonight, or because a call center only offers one kind of program, can backfire. Your loved one may end up with more care than they need, or too little.
What are the levels of addiction treatment?
The American Society of Addiction Medicine (ASAM) numbers the settings from Level 1, the least intensive, to Level 4, the most, with decimals for the steps in between.1
| Level of care | Where they live | Typical intensity | Often a fit when |
|---|---|---|---|
| Outpatient (ASAM Level 1) | At home | Regular sessions, often one to three times a week, depending on the program3 | A stable home, reliable transportation and supportive family or friends; or ongoing care after a higher level3 |
| Intensive outpatient, IOP (Level 2.1) | At home | Medicare covers it when the care plan calls for at least 9 hours a week4 | Stable, substance-free home; can keep working or studying; needs more than weekly therapy |
| Partial hospitalization, PHP (Level 2.5) | At home or in recovery housing | Medicare covers it when the care plan calls for at least 20 hours a week; usually 4 to 8 hours a day5 | Needs daily structure but not 24-hour care; often a step down from residential |
| Residential (Level 3) | At the program | 24-hour live-in care | No stable living situation, little family support, or unable to stop using in other treatment3 |
| Hospital inpatient (Level 4) | In a hospital | 24-hour medical and nursing care | Severe withdrawal or serious medical or psychiatric problems that need a hospital23 |
Hours vary by state, program and plan. ASAM now calls PHP “high-intensity outpatient,” since it isn’t delivered in a hospital.2
Detox isn’t a level of its own. In the current ASAM Criteria, withdrawal care is built into several levels, so it can happen in an outpatient clinic, a residential program or a hospital, depending on risk.2 It gets someone through withdrawal and can prepare them for treatment, but it isn’t treatment by itself.3 More on medical detox. Stopping alcohol after long, heavy drinking, or coming off benzodiazepines too fast, can cause seizures, so read about withdrawal risks and involve a doctor before they quit.712
Medication can be part of care at any level: buprenorphine, methadone and naltrexone are FDA-approved for opioid use disorder, and medication combined with counseling has been shown to improve survival.6 For alcohol, the approved options are acamprosate, disulfiram and naltrexone.67 The guide to addiction medications explains each one.
Who decides which level of care is right?
A trained clinician, after looking at the whole person. ASAM describes its criteria, now in a fourth edition released in 2023, as the most widely used standards for this.2 They cover six areas: intoxication and withdrawal, physical health, mental health, substance use-related risks, the recovery environment, and person-centered factors such as barriers to care and the person’s own preferences.9 The goal is the least intensive level where someone can be treated safely and effectively.2
Sam and Dana both drink heavily every day. Sam has a supportive partner, a steady job and no history of withdrawal problems; an assessor suggests IOP plus medication for alcohol use disorder. Dana has had a withdrawal seizure before, lives alone and has untreated PTSD. Her assessor recommends medically managed withdrawal, then residential care, then PHP while she lives in recovery housing.
Tell the assessor what you’ve seen, with dates, amounts and any past withdrawal, and ask how they reached their recommendation. Your insurance plan makes its own separate call on what it will pay for.2 See getting an assessment and the Insurance & Costs section.
Does treatment have to happen in a set order?
No. A common path runs from detox to residential, then PHP, IOP and outpatient care, but plenty of people skip steps, start in IOP, or step back up after a setback. Under the ASAM Criteria, people are reassessed as they go.1
The part families can push on is the handoff. Before your loved one leaves any program, the next appointment should already be booked. A gap is riskiest after a stretch without opioids, such as detox, because using again then carries a higher overdose risk; SAMHSA says people in that position should have naloxone on hand.8 When discharge gets closer, read how to plan for life after rehab.
Which level of care might fit your loved one?
This won’t diagnose anyone or replace an assessment. It shows which options are likely to come up, so you can ask better questions.
What might an assessment look at first?
InteractiveDo they drink heavily every day, take benzodiazepines regularly, or have a history of withdrawal seizures or DTs?
See possible outcomes
- Start with a medical check before they stop An assessment will likely look at medically managed withdrawal first, then the next level of care. A clinician decides where that happens.
- Look for care that treats both conditions A program that treats substance use and mental health together is usually needed.
- More structure may come up When home isn’t safe or supportive, assessors often discuss residential care, or PHP or IOP paired with recovery housing.
- A higher level may be discussed If outpatient care wasn’t enough, an assessor may suggest PHP or residential for a while, then a step back down.
- Outpatient care or IOP is often where assessments start With a stable home and no risky withdrawal, many people begin with outpatient counseling or IOP while living at home. If opioids or alcohol are involved, ask about medication.
What should we ask about the recommended level?
Questions about the level of care
Finding a program once you know the level
SAMHSA’s FindTreatment.gov says good programs use FDA-approved medication for alcohol or opioid use and include family members in treatment.3 Its confidential, anonymous treatment locator lists state-licensed facilities and lets you filter by treatment type, services and payment accepted.310 From there, learn how to vet a program before anyone signs.
What else should we read about treatment?
In this section
Frequently asked questions
What's the difference between inpatient and residential treatment?
People use the words interchangeably, but ASAM draws a line. Inpatient (Level 4) means hospital care with full medical oversight. Residential (Level 3) is less intensive, and most of it happens in residential programs rather than hospitals.2
Is sober living a level of care?
No. Recovery housing is a substance-free place to live, not a treatment program. ASAM’s criteria may recommend it alongside outpatient-level care, which includes IOP and PHP.1 See how to check a sober living home.
Where can we get a free or low-cost assessment?
Start with their primary care doctor, your state’s substance use agency, or the free, confidential SAMHSA National Helpline at 1-800-662-4357. It gives referrals around the clock and can point uninsured callers to state-funded programs.11
Sources
- American Society of Addiction Medicine — The ASAM Criteria, 4th Edition (2023). asam.org/asam-criteria/asam-criteria-4th-edition — accessed Oct 2026
- American Society of Addiction Medicine — ASAM Criteria FAQ. asam.org/asam-criteria/criteria-faq — accessed Oct 2026
- SAMHSA, FindTreatment.gov — What to Expect: Treatment. findtreatment.gov/what-to-expect/treatment — accessed Oct 2026
- Medicare.gov — Mental Health Care (Outpatient): Intensive Outpatient Program Services. medicare.gov/coverage/mental-health-care-outpatient-intensive-outpatie… — accessed Oct 2026
- Medicare.gov — Mental Health Care (Outpatient): Partial Hospitalization. medicare.gov/coverage/mental-health-care-outpatient-partial-hospitaliz… — accessed Oct 2026
- SAMHSA — Treatment Options for Substance Use Disorder (updated August 2025). samhsa.gov/substance-use/treatment/options — accessed Oct 2026
- NIAAA — Treatment for Alcohol Problems: Finding and Getting Help (updated February 2025). niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol… — accessed Oct 2026
- SAMHSA — Opioid Overdose Reversal Medications (OORM). samhsa.gov/substance-use/treatment/overdose-prevention/opioid-overdose… — accessed Oct 2026
- American Society of Addiction Medicine — The ASAM Criteria. asam.org/asam-criteria — accessed Oct 2026
- SAMHSA — FindTreatment.gov treatment locator. findtreatment.gov/ — accessed Oct 2026
- SAMHSA — National Helpline. samhsa.gov/find-help/helplines/national-helpline — accessed Oct 2026
- FDA — FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class, Drug Safety Communication (September 23, 2020). fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning… — accessed Oct 2026