Addiction is a chronic, complex medical condition that’s characterized by the repeated misuse of substances even in the face of potentially harmful consequences. It can cause long-term changes in the way the brain responds in situations involving reward, stress, and self-control that make it difficult to stop using.1
The complicated and far-reaching consequences of addiction affect each person differently, but it is a treatable disorder just like other chronic medical conditions such as diabetes or cancer. Research has shown there are many effective treatments that warrant positive outcomes for addiction, which may include residential treatment programs. 5,12,13
Clinicians take a whole-person approach when assessing a person to determine the appropriate level of care and treatment plan. Treatment is provided along a continuum of care intensity, where a person enters at the level that is most appropriate for their individual needs and can move up or down in intensity as their recovery evolves. This can include inpatient, partial hospitalization, outpatient, or residential treatment programs.2, 5, 6
If you or a loved one are considering treatment, this article will:
- Define residential drug and alcohol treatment.
- Explain the differences between inpatient and residential treatment programs.
- Discuss the levels of residential care, services provided, and length of stay.
- Review what to consider when selecting a residential treatment program.
What is Residential Treatment?
Residential treatment provides 24-hour supervision and structured care within a safe, non-hospital environment.3 In contrast to outpatient treatment, people remain in the facility and do not return home or to work during treatment. Residential treatment programs typically include counseling and other behavioral health services, and many also support co-occurring mental health disorders, depending on the level of care and a person’s needs.2, 3, 5
Residential treatment is appropriate for people who: 3, 6
- Have recurring issues with substance misuse.
- Have severe substance use disorders (SUDs).
- Have co-occurring mental health disorders and/or other medical conditions.
- Do not require medically managed services.
Examples of residential treatment include: 3, 5
- Short-term residential treatment programs lasting 3-6 weeks.
- Long-term residential treatment programs lasting 6-12 months.
- Sober living homes.
- Therapeutic communities (TCs).
The 24-hour supervision found in residential treatment can provide a safe place for people to recover with ample support from staff and peers.3 While some residential treatment centers may provide a certain level of medical monitoring, it is typically not to the extent of medically managed intensive inpatient treatment that serves subacute and acute addiction and mental health disorders.2
What Are the Differences Between Inpatient and Residential Treatment Programs?
While inpatient and residential treatment programs may seem very similar, they typically offer different levels of care. Both can play an important role in a person’s recovery. Some of the ways in which inpatient and residential treatment programs differ include: 2, 3, 4, 5
- Setting: Inpatient treatment is typically provided in a hospital or specialized treatment facility. Residential treatment programs are not offered in a hospital setting, but rather a group living, or communal home-like environment.
- Medical management: Inpatient treatment offers 24/7 medically monitored or managed care that focuses on stabilizing a person. Residential treatment generally provides access to medical staff and clinically managed care without 24/7 monitoring to focus on ongoing recovery.
- Length of the program: Inpatient treatment is not typically for long-term care, but short-term, acute care. Residential treatment can be open-ended, lasting from a few months to a year. Length of stay may also depend on a person’s progress as determined by the team at the treatment facility.
Levels of Residential Care
The levels of residential care are designed to meet the different needs that people have and often seeks to prepare a person to transition into a lower level of care.2, 7 This continuum of care also allows treatment to be intensified if a person isn’t progressing at their current level of treatment.7
To be placed in the appropriate level of care, an addiction treatment professional will conduct a thorough assessment of an individual’s needs, including: 2
- Substance use history.
- Physical health.
- Mental and emotional health.
- Motivation to change.
- History of relapse.
- Current living situation.
- Support structure.
The American Society of Addiction Medicine (ASAM) has defined 5 levels of care that fall along this continuum. Where a person is placed will depend on the needs identified in their assessment. The 5 levels are:2
- Early intervention.
- Outpatient services
- Intensive outpatient/partial hospitalization services.
- Residential/Inpatient services.
- Medically managed intensive inpatient services
The specific levels of residential care include:2, 8
- Level 3.1: The least intense type of residential care, which provides a minimum of 5 hours of clinical treatment weekly.
- Level 3.3: Moderately intense care that has counseling staff available 24 hours a day.
- Level 3.5: The most intense type of residential care and can include therapeutic communities or dual diagnosis residential treatment programs. This level involves counseling staff that is available around-the-clock.
While medically managed detoxification is completed in an inpatient setting, some residential facilities offer certain types of detox services.4, 9 At the residential level, detox may include 24-hour support, including peer and social support, but not necessarily medically supervised detoxification (although they may offer this service to a certain level of intensity). 4 This level of care is appropriate for mild to moderate withdrawal symptoms, or for people who do not have medical or mental health conditions that may complicate the withdrawal process.9
What Services are Included in Residential Treatment Programs?
The types of services that are offered and the settings in which they are provided can vary widely.5 Individualized care allows treatment to be tailored to meet a person’s unique needs, which takes into account the substances being used and psychiatric, social, emotional, and legal factors.1, 5
Personalized care can also include treatment that serves specialized groups, such as: 5
- LGBTQ+ people.
- People with co-occurring disorders.
- People who are homeless.
Residential treatment programs offer an array of services that can be combined to help address substance use disorder and improve a person’s ability to function in daily life.1, 5 These may include:1, 3, 5
- Detoxification: Clinically managed detox in a residential facility typically offers 24-hour supervision that’s characterized by peer and social support. If a person needs more intensive medical care, they may be referred to an inpatient or detox facility.4
- Behavioral therapy: Often used in group and individual settings to help people learn healthy coping skills, manage stressors, and develop positive hobbies. Counseling sessions may occur in both group and individual settings and include cognitive behavioral therapy (CBT), family therapy, or other therapeutic practices.
- Medication-assisted treatment (MAT): This includes the use of medication in combination with other therapies to help people recover.14
- Support groups: People may be strongly encouraged or required to attend support group meetings during treatment. This offers an opportunity to connect with others and develop a strong support network, which may ease the transition back to daily life after treatment is complete.15
How Long is a Stay in Residential Treatment?
The length of time a person spends in residential treatment varies depending on different factors, including:1, 5, 11
- The level of care determined by clinicians.
- A person’s specific physical, psychological, and medical needs.
- The type of substances being used.
- The severity of a person’s substance use disorder.
- Prior attempts at treatment.
- Co-occurring mental health disorders.
- Issues with detox.
- Legal issues.
Certain types of residential treatment programs are more likely to be associated with specific time frames, such as:3, 4, 11
- Short-term residential treatment programs, which can last between 30 and 90 days.
- Long-term residential treatment, or therapeutic communities, which commonly involve stays between 6 and 12 months.
Studies have demonstrated that although longer periods of treatment may demonstrate improved outcomes, any treatment length can be beneficial.5 Attending a drug or alcohol residential treatment program can be effective in helping a person abstain from using substances and gain the skills needed to live a healthy, productive life free from compulsive substance use.5
When to Choose a Residential Treatment Program
Those who enter residential treatment programs typically demonstrate a need for a greater level of supervision and structure than what’s found in an outpatient program. At the same time, they may demonstrate that they don’t need the medical focus and constant monitoring that characterizes many intensive inpatient programs.
People seeking admission to residential programs are commonly facing an acute substance use and/or mental health disorder that warrants 24-hour care. Residential treatment may also be recommended after completing inpatient treatment to support sobriety while preparing to live independently.3, 6, 16
When choosing a residential treatment program, there are several different factors to consider in determining the type of support a person needs for a successful recovery. Taking time to learn about the program and contacting the treatment facility will help in making appropriate treatment choices. Some factors to consider are:6, 11
- Accreditation: Check to see if the facility is accredited by the Commission on Accreditation on Rehabilitation Services (CARF), which seeks to promote the quality of health and human services providers.17
- Staffing: Check if the facility offers medical supervision and what type of credentials the staff holds.
- Treatment methods: Check that the facility offers treatment that aligns with the level of care needed.
- Cost: The cost of residential treatment programs varies depending on amenities, services, and type of treatment. Check to see if the facility accepts your insurance plan, or if they offer financing options or scholarships.
- Location: Some people prefer to seek treatment close to home, while others may want to be farther away. Be sure to check what the facility’s visitation policies are and if they allow regular visitation.
- Amenities: Amenities vary depending on the treatment facility but can include private rooms, pool access, chef-prepared meals, massage, and more. Luxury amenities may impact the cost.
- Specific populations: Some residential treatment programs are for specific populations, such as men/women, LGBTQ+, adolescents, veterans, or people who are homeless.
- Treatment for co-occurring mental health disorders: Treatment that addresses
co-occurring SUDs alongside a person’s other mental health disorders (e.g., depression or anxiety disorders) may result in better outcomes than just treating one without the other(s).11
If you are considering residential treatment, American Addiction Centers (AAC) can help. Our facilities are located across the country and provide treatment along the continuum of care. Call a caring admissions navigator today to learn about treatment options and verify your benefits at (877) 232-9895.