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Importance of Finding a Strong Partial Hospitalization Program
People may either transfer or “step down” into a PHP program from an inpatient program or “step up” from a relatively less intensive, standard outpatient program. In other cases, people may enroll in a PHP as their initial entry into treatment.
What Are PHPs?
A partial hospitalization program is a hospital-based form of outpatient drug rehabilitation. These programs offer services comparable to a residential inpatient program, including access to mental health care sevices, if needed; however, they do not require the person to stay at the program full-time.1 Different partial hospitalization programs may be tailored to meet the needs of adolescents or adults.
The American Society of Addiction Medicine (ASAM) recommends that PHPs provide 20 hours of programming per week, while IOPs provide 9 hours per week.
The key difference between a PHP and an intensive outpatient program (IOP) is the amount of time the person spends in the program. The American Society of Addiction Medicine (ASAM) recommends that PHPs provide 20 hours of programming per week, while IOPs provide 9 hours per week.2 PHPs also offer medical and psychiatric services, while IOPs may be less likely to offer these services.3
PHPs tend to offer at least 5 days of treatment each week but may in some cases go up to 7 days per week. The length of a program varies based on individual needs, but the typical amount of time someone will spend in a program is 14 to 21 days.1
PHP Treatment Components
Some of the services that PHPs may include are:2,4
- One-on-one therapy.
- Group therapy.
- Family meetings.
- Medical services.
- Treatment of comorbid (i.e., co-occurring) mental health disorders.
- Medication management.
- Drug screening.
- Employment and educational assistance.
Who Should Participate?
Partial hospitalization may be a good fit for people who:4
- Need a high level of care but can remain clean outside of a rehab center.
- Have already completed a hospital or residential treatment program but feel at imminent risk of relapse.
- Have a hard time motivating themselves to continue treatment.
- Have a co-occurring disorder (e.g., anxiety or depression in addition to a substance use disorder).
- Live in environments where they are at risk for using drugs and have little support.
- Are not making optimal recovery progress in an IOP.
People may enter PHPs in a variety of ways. Some people enroll directly into them while others are admitted after they complete a hospital or residential program, which is known as “step down.” And still others seek partial hospitalization as a “step up” form of treatment. This is common when someone experiences a relapse while enrolled in a less intensive form of outpatient program or is at risk of relapse because of a major life change or mental health symptoms.
What Should I Expect?
A PHP program typically begins with a diagnostic interview performed by one of the licensed clinicians.8 Another member of the treatment team will take a medical history and perform a physical. As part of this intake examination period, the patient will also be evaluated for any significant mental health issues that might need additional treatment attention as well as undergo alcohol and drug screening.8
A multidisciplinary team of mental and medical health providers will use the information from these assessments to develop an individualized treatment plan, with input from the patient and their family. The plan outlines goals for the person to meet while in treatment as well as a discharge and relapse prevention plan.
Most programs meet Monday through Friday, from anywhere between 8:00 a.m. and 5:00 p.m. Most days are structured around several group meetings, with occasional one-on-one sessions with a therapist or physician.
A multidisciplinary team of mental and medical health providers will use the information from these assessments to develop an individualized treatment plan, with input from the patient and their family.
Many programs will drug test at the outset of the program, then conduct random drug testing during the program.2,4
Medication management is also a core part of most PHPs. A nurse or other medical professional will supervise a patient’s use of treatment medications, such as methadone or buprenorphine.4
Partial hospitalization programs employ several types of therapies on an individual and group level. Therapy is designed to help people commit to their treatment plans; adjust maladaptive thoughts and change patterns of behavior that support continued drug use; build relapse prevention and other recovery skills; and improve important areas of their lives, such as their social lives, family relationships, and employment/education.4
Common therapies used include:5,6
- Cognitive behavioral therapy (CBT): This type of therapy helps people identify self-destructive thinking patterns that can negatively influence their behavior. A recovering user learns how to recognize the people, places, and things that lead them to use drugs and how to better deal with these.
- Contingency management: Programs that use contingency management give rewards to patients when they complete certain goals, such as submitting a negative drug test. The rewards help reinforce recovery-oriented behaviors.
- Motivational enhancement, or motivational interviewing: Mostly used in individual counseling early on, this therapy helps patients overcome their resistance to get clean and engage in treatment.
- 12-step facilitation therapy: PHPs that use this form of therapy introduce patients to 12-step programs such as Alcoholics Anonymous and encourage them to regularly attend meetings as part of their long-term recovery efforts.
What To Look For
Things to look for in a PHP include:
- Positive online reviews. Read about other people’s experiences with the program and see what they had to say about it.
- Quality staff. Find out as much as you can about the background of the staff: their training, experience, and approach to treatment.
- Programs close by will be easier to get to, increasing your chances of attending each day.
- High staff-to-patient ratio. A higher ratio means more staff will be available to give you more personalized attention.
- If the program is accredited, it is expected to meet and adhere to certain standards and maintain a certain level of quality. Accreditations to look for include certifications from a state substance abuse agency, The Joint Commission, the Commission on Accreditation of Rehabilitation Facilities (CARF), and the National Committee for Quality Assurance (NCQA).
- Different programs use different approaches to treatment. Some are heavily based on the 12 steps of Alcoholics Anonymous, while others are more secular and focused on evidence-based therapeutic interventions. Many incorporate both into their treatment programming.
How Much Does a Program Cost?
The cost of a PHP is determined by:
- Location: Programs set in desirable areas, such as near the beach, will usually cost more than programs in other areas.
- Amenities: PHPs that feature more amenities, such as private rooms, spa services, and chef-prepared meals, will also likely cost more than programs with fewer amenities.
- Length of stay: Cost will go up along with your duration of stay.
- Insurance coverage: The amount your insurance will cover will affect how much you pay.
On average, partial hospitalization tends to be cheaper than inpatient because you don’t live at the program and don’t have to bear the cost of room and board. However, PHPs are often more expensive than standard outpatient programs because you spend several hours in therapy each day, and many programs serve lunch.
Payment options for PHP include:
- Payment plan or sliding scale, in which the rehab facility adjusts the cost based on your ability to pay. Ask any programs you’re considering if they offer these options.
- Health care credit cards.
- Crowdfunding sites, such as GoFundMe.
- Borrowing from friends and family.
Treatment may seem expensive, but it might not seem as bad when you consider the long-term costs of not getting help.
Medicare and Medicaid
Medicare does cover partial hospitalization. However, not all programs accept payment from Medicare, and those that do must first meet certain requirements. The program must be offered through a hospital outpatient department or community mental health center.7
Medicare will not cover:7
- Support groups (though it does cover group therapy).
- Testing or training for job skills.
Medicaid coverage for substance abuse rehabilitation varies by state. Visit your state’s Medicaid website for more information.
- National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: Treatment Settings.
- Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
- Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
- American Psychiatric Association. (2010). Practice Guideline for the Treatment of Patients With Substance Use Disorders: Second Edition.
- National Institute on Drug Abuse. (2019). DrugFacts: Treatment Approaches for Drug Addiction.
- National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: Behavioral Therapies.
- Medicare.gov. Your Medicare Coverage: Mental health care (partial hospitalization).
- Nebraska Department of Health and Human Services. (n.d.) Adult Substance Use Disorder Day Treatment Adult ASAM Level 2.5.