Key Takeaways
- Choosing a level of care isn’t about “how bad things are.” It’s about safety, stability, and what kind of support your loved one needs to heal in real life, not just get through today.
- Substance use and mental health symptoms can change quickly, so the “right” option is often the one that can meet current needs and adjust as your loved one stabilizes, rather than a one-size-fits-all plan.
- A quality assessment looks at more than substance use. It considers withdrawal risk, mental health symptoms, medical needs, daily functioning, and the strength of the support system at home, aligning with the multidimensional approach described in the ASAM Criteria.
- You don’t have to figure this out alone. A trauma-informed, integrated evaluation can bring clarity, reduce fear, and help your family take the next step with confidence.
Overview: Care Matters, But the Right Level of Care Matters Even More
When someone you love is struggling, “getting help” can feel like the only goal. And you’re right to prioritize care. The sooner support is in place, the sooner your loved one has a chance to breathe again.
But here’s the part families don’t always hear: the right level of care can make treatment feel possible. The wrong level can create unnecessary stress. Too little support can leave your loved one trying to manage serious symptoms with willpower alone. Too intensive a setting can feel overwhelming when a person is stable enough to stay connected to home, work, or family.
The goal isn’t to pick the “highest” level of care. It’s to match support to clinical need, so your loved one can engage, stabilize, and build real skills that last.
At The Blanchard Institute, our approach is grounded in whole-person care and family involvement. You’ll see that commitment reflected across our treatment programs and our belief that families deserve guidance, not guesswork.
First, Take a Breath: You’re Not Supposed to Know This Automatically
If you’re overwhelmed, you’re not doing it wrong. This is complicated. Treatment systems have their own language, and families often get handed acronyms like PHP and IOP while their hearts are still racing.
A helpful starting point is this: levels of care exist because people need different intensities of support at different times. The same person may move between levels as they stabilize. That flexibility is a strength, not a failure.
What “Level of Care” Actually Means
A level of care is the intensity and structure of treatment, including how often sessions happen, how much clinical monitoring is provided, and whether someone lives at home while receiving services.
Broadly, levels of care range from:
- Detox/Withdrawal Management (live-in or at home detox support)
- Residential treatment (live-in, highly structured support)
- Partial Hospitalization Program (PHP) (intensive day treatment while living at home)
- Intensive Outpatient Program (IOP) (structured treatment multiple days per week)
- Outpatient therapy (regular sessions with more independence)
SAMHSA describes outpatient care as ranging from standard appointments to more intensive outpatient or partial hospitalization services, depending on need and coordination required (SAMHSA’s overview of treatment types).
The Real Question: What Does Your Loved One Need Right Now?
Families often ask, “Is it bad enough for residential?” A more helpful question is:
“What level of support is needed for safety and progress this week?”
Clinicians typically consider several domains when recommending a level of care. The ASAM Criteria is a widely used clinical framework that describes a multidimensional assessment approach to match people to appropriate services and intensity (ASAM Criteria FAQ).
Even if you never use the term “ASAM” again, the idea is simple: the decision should be based on the full picture, not one symptom.
Here are factors that often shape the recommendation:
- Safety risks (self-harm, overdose risk, medical instability)
- Withdrawal potential and need for monitoring
- Mental health symptoms (panic, depression, trauma responses, psychosis)
- Ability to function day-to-day (work, parenting, basic self-care)
- Home environment and support (safe housing, reliable transportation, supportive relationships)
- History of relapse or repeated crises
- Motivation and readiness, including ability to engage in treatment consistently
If you’re not sure how to weigh these factors, that’s exactly what a professional assessment is for. Our admissions process is designed to help families get clarity without shame or pressure.
Residential Treatment: When 24/7 Structure Is the Safest Option
Residential care (sometimes called inpatient residential treatment) provides a highly structured environment with round-the-clock support. This option is often considered when symptoms are severe, safety is a concern, or the home environment can’t reliably support recovery right now.
Residential may be appropriate when your loved one:
- Can’t stay safe without close supervision
- Has repeated relapses despite outpatient care
- Lives in an environment where substances or triggers are unavoidable
- Needs intensive stabilization before stepping down to outpatient care
- Has co-occurring symptoms that make daily functioning very difficult
Residential treatment can offer breathing room. It removes the constant “white-knuckling” and gives the nervous system a chance to settle.
If your loved one is exploring substance use treatment, our addiction programs page can help you understand how care is structured and what support can look like over time.
Partial Hospitalization Program (PHP): Intensive Day Treatment With Home as the Base
PHP is sometimes described as “day treatment.” It provides a high level of therapeutic structure during the day, while allowing your loved one to return home in the evenings.
In federal guidance for partial hospitalization services, Medicare describes PHP as a structured outpatient psychiatric program that requires at least 25 hours per week of therapeutic services in the plan of care, and it’s intended for people who need more than traditional outpatient but don’t require 24-hour inpatient care (42 CFR §410.43; see also Medicare’s PHP overview).
PHP may be a fit when your loved one:
- Needs intensive support but can remain safe at home
- Is stepping down from a higher level of care and needs structure to stay stable
- Has significant symptoms that impact daily life
- Benefits from frequent therapy, skills work, and clinical coordination
PHP can be especially helpful for families who want strong clinical support while keeping the person connected to home routines that matter. Our treatment programs give structured, evidence-based care. We also offer supportive housing options for those in PHP with us.
Intensive Outpatient Program (IOP): Structured Support That Fits Into Real Life
IOP offers more structure than weekly therapy, with treatment scheduled multiple days per week. It’s often used as a step-down from PHP or as a starting point when symptoms are serious but stable enough for home-based living, or in our supportive housing community.
One practical way to understand intensity is time. For example, a payer-facing overview of ASAM levels of care describes Intensive Outpatient Services (ASAM Level 2.1) as more than 9 hours of service per week for adults (Humana’s ASAM Levels of Care overview).
IOP may be a fit when your loved one:
- Needs consistent support several days per week
- Can stay safe at home but struggles with coping skills and relapse triggers
- Needs continued clinical accountability while rebuilding work, school, or family roles
- Benefits from group therapy, individual therapy, and recovery skills practice
For many people, IOP hits a sweet spot. It provides meaningful structure while allowing a person to practice recovery skills in the settings where life actually happens.
Families often benefit from support alongside IOP. That’s why we emphasize connection and education through family support programs and community-based support groups and workshops.
Outpatient Therapy: Steady Support With More Independence
Traditional outpatient therapy typically means meeting with a therapist (and sometimes a psychiatrist or medication provider) on a schedule that fits your needs. SAMHSA describes this as outpatient care that can look like standard appointments, with frequency depending on what’s clinically appropriate (SAMHSA’s treatment types).
Outpatient therapy may be a fit when your loved one:
- Is medically stable and not at immediate risk
- Has a supportive home environment
- Can manage daily responsibilities with some structure
- Needs ongoing help for anxiety, depression, trauma, or relapse prevention
- Benefits from consistent check-ins rather than intensive programming
Outpatient care can also be an important step after higher levels of care. Recovery is a long game. Continued support helps the gains from intensive treatment hold up over time.
If you’re trying to understand what ongoing care can look like, our treatment programs and support groups and workshops offer a helpful map of options.
A Simple Comparison Table for Families
| Level of Care | What It Feels Like Day-to-Day | Often Helpful When | Key Family Consideration |
| Residential | Live-in, structured days, high supervision | Safety concerns, unstable symptoms, unsafe environment | Your loved one may need a full pause from daily life to stabilize |
| PHP | Intensive day programming, home at night | Needs high structure but can be safe at home; often 25+ hours/week in plan of care (42 CFR §410.43) | Home support matters because evenings are outside program hours |
| IOP | Several sessions/week, builds skills while living life | Needs consistent structure; often 9+ hours/week for adults in Level 2.1 framing (Humana ASAM overview) | Transportation, schedule support, and accountability help a lot |
| Outpatient | Weekly or periodic appointments | Stable symptoms, strong support, ongoing growth | Encourage consistency and celebrate steady progress |
For a more detailed comparison, visit our Levels of Care page.
How to Tell When It’s Time to Move Up a Level of Care
Sometimes families try outpatient first, hoping it will be enough. That hope comes from love. It’s also okay to adjust when reality says more support is needed.
Consider a higher level of care when you notice:
- Safety concerns, including self-harm thoughts, overdose risk, or inability to care for basic needs
- Escalating use, more frequent intoxication, or dangerous withdrawal patterns
- Repeated relapses despite effort and support
- Severe mental health symptoms that interfere with daily functioning
- A home environment that can’t reliably support recovery right now
You don’t need to prove that things are “bad enough.” You only need enough information to make the next safe decision.
That’s where a professional assessment can change everything. Our admissions process is built to help you talk through options and understand what support fits best.
How to Tell When Stepping Down Might Be Appropriate
Stepping down can feel scary. Families sometimes worry, “What if we remove structure too soon?” That concern makes sense.
In well-coordinated treatment, stepping down is often a sign of progress, not a risk. The timing depends on stability, coping skills, and support systems.
A step-down may be appropriate when your loved one:
- Is consistently using coping skills in real situations
- Has improved mood stability and fewer crises
- Has stronger accountability and support at home
- Can manage urges or symptoms without constant clinical intervention
- Is engaged in ongoing recovery support
This is why continuity matters. A thoughtful plan often includes family education and community support through family support programs and ongoing connection through support groups and workshops.
Why “Support at Home” Can Change the Recommendation
Two people can have similar symptoms and need different levels of care because of what happens outside the therapy room.
A safe, stable home with supportive family members can make PHP or IOP realistic. A chaotic, triggering environment may make residential treatment the safer option, even when symptoms look similar on paper.
This isn’t a judgment on your family. It’s just reality. The environment either supports healing or adds stress.
If your family is trying to rebuild trust, communication, and healthy boundaries, our family support programs can be a practical next step, alongside clinical care.
What to Do Next: A Grounding Checklist for Families
When you’re overwhelmed, simple steps help.
Here’s a practical way to move forward today:
- Prioritize safety first. If you’re worried about immediate danger, seek urgent help right away.
- Write down what you’re seeing. Sleep changes, mood swings, substance use patterns, missed responsibilities, withdrawal signs.
- Notice what makes symptoms worse. Stress at work, relationship conflict, isolation, certain environments.
- Consider the home support reality. Can your loved one be safe overnight? Is substance access limited?
- Reach out for a professional assessment. A clinical recommendation can take the weight off your shoulders.
You can start with our admissions process and explore services across North Carolina through our locations page.
A Final Word for Families
You’re trying to help someone you love through something complex, emotional, and often scary. That effort matters.
The right level of care can bring relief, structure, and hope, not just for your loved one, but for your whole family. You don’t need a perfect plan. You need a supported one.
When you’re ready, The Blanchard Institute is here to help you find a path forward that fits your loved one’s real needs, with care that respects the whole person. You can learn more about how we approach treatment at The Blanchard Institute and explore our full continuum through treatment programs.
FAQs
How do I know whether my loved one needs residential treatment or can start with PHP/IOP?
Start with two questions: Is your loved one safe at home, and can they reliably engage in treatment? Residential treatment is often considered when safety is a concern, symptoms are severe or unstable, or the home environment can’t support recovery right now. PHP and IOP can be strong options when your loved one needs significant structure and clinical support but can remain safe at home and tolerate time outside the program. A professional assessment is the best way to sort through the gray areas, because symptoms can overlap and families shouldn’t have to carry the burden of “getting it right” without guidance. If you’re ready to talk through options with a team that understands both substance use and mental health concerns, our admissions process is a clear place to begin.
What’s the difference between PHP and IOP in everyday life?
Think of PHP as more intensive day treatment, with a larger time commitment and more frequent clinical contact, while IOP is still structured but typically fits more easily around work, school, or family responsibilities. Medicare’s description of partial hospitalization includes a plan of care requiring at least 20 hours per week of therapeutic services (42 CFR §410.43), which gives you a practical sense of why PHP can feel like a major reset for someone who needs a lot of support quickly. IOP is often used when a person needs consistent therapy multiple days per week and accountability, but doesn’t require the intensity of PHP. Many people step down from PHP to IOP as they stabilize, and that progression is often part of a thoughtful plan, especially when family support is included through resources like family support programs.
Can someone be in the “wrong” level of care, and what does that look like?
Yes, and it’s more common than people talk about. When the level of care is too low, you might see repeated crises, ongoing relapse, missed sessions, escalating symptoms, or a loved one who simply can’t follow through because their nervous system is overwhelmed. When the level of care is too intense, you may see shutdown, increased anxiety about participation, or a sense of discouragement that makes engagement harder. The goal isn’t to force a person into a box. It’s to match care to need and adjust as symptoms change. This is one reason clinicians use multidimensional frameworks like the ASAM Criteria, which emphasize individualized recommendations based on a full assessment rather than a single symptom.
What can families do while we’re deciding on a program?
You can do more than you think, even before treatment begins. Focus on safety, connection, and clarity. Keep notes about patterns you’re seeing, especially around sleep, mood, substance use, withdrawal symptoms, and daily functioning. Reduce avoidable triggers when possible, and try to communicate with calm, direct language rather than fear or anger (hard, yes, but it helps). Most importantly, don’t try to solve everything through late-night internet research. A professional conversation can reduce confusion quickly. Families also benefit from education and support of their own, which is why many people lean on resources like support groups and workshops and structured guidance through family support programs. When your family is supported, your loved one often feels that stability too.
Sources
- American Society of Addiction Medicine (ASAM). (n.d.). The ASAM Criteria, Third Edition. ASAM Criteria overview
- American Society of Addiction Medicine (ASAM). (n.d.). ASAM Criteria FAQ. Clinical assessment and placement guidance
- Substance Abuse and Mental Health Services Administration (SAMHSA). (2023). Treatment Types for Mental Health, Drugs and Alcohol. SAMHSA treatment types
- Electronic Code of Federal Regulations. (Current). 42 CFR §410.43 Partial hospitalization services: Conditions and limitations. Federal PHP requirements
- Medicare.gov. (n.d.). Mental health care: Partial hospitalization. PHP overview
- Humana. (2025). ASAM Levels of Care (PDF). IOP/OP hour thresholds overview