Levels of care

The right level of care is the one matched to the diagnostic picture, not the brochure tier.

A note on language

We say “guest” rather than “patient” for a reason. The treatment field uses a vocabulary that can obscure what is actually clinically distinct from what is marketing. ASAM Criteria — the framework published by the American Society of Addiction Medicine — defines five formal levels of care, from Level 1 (outpatient, less than nine hours per week) through Level 4 (medically managed intensive inpatient). Most published guidance uses a more granular vocabulary built around these levels: medically supervised detoxification, residential or inpatient treatment, partial hospitalization (PHP), intensive outpatient program (IOP), standard outpatient, and medication-assisted treatment. We use the latter vocabulary on this page because it is what guests and families actually encounter when researching options.

More important than the label is the clinical match. The two-day Peninsula intake uses the full ASAM Criteria across six dimensions to determine which level is appropriate — and to identify the modality combinations within that level that fit the specific guest's profile.

Six levels of care

From medically supervised detox to continuing support.

Glass of water on a bedside table, medically supervised detox
01.

Medically supervised detox

Typical duration: 3–10 days · ASAM Level 3.7 / Level 4

Medically supervised detoxification stabilizes the body during withdrawal from alcohol, opioids, benzodiazepines, or other substances with significant physical dependence. Required for alcohol, opioid, and benzodiazepine dependence where withdrawal can be dangerous (alcohol and benzodiazepine withdrawal carry seizure and delirium-tremens risk; opioid withdrawal is rarely life-threatening but is medically managed for comfort and dignity). The detox clinician is a board-certified addiction medicine physician on site daily, supported by RN-level nursing for vital-sign monitoring and protocol-driven medication management.

Read more →

Closed wooden door of a private residence
02.

Residential treatment

Typical duration: 30–90 days · ASAM Level 3.5 / 3.7

Residential treatment is the structural core of recovery for adults with moderate-to-severe substance use disorder, significant co-occurring conditions, or environments where outpatient continuity is not feasible. At Peninsula, the residence operates at a six-bed maximum with master's-and-above clinicians at 1:1 or 1:2 ratios. The clinical week integrates the evidence-based spine (CBT, DBT, MI, EMDR, MAT) with integrative supplements (somatic experiencing, equine-assisted psychotherapy, mindfulness-based relapse prevention, nutrition psychiatry) selected to the guest's profile from the two-day intake.

Read more →

Fountain pen on a desk, intensive outpatient scheduling
03.

Intensive outpatient program (IOP)

Typical duration: 2–4 months · ASAM Level 2.1

IOP delivers structured clinical work at nine to twenty hours per week, allowing the guest to maintain professional and family commitments while receiving substantial therapeutic engagement. Particularly appropriate as a step-down from residential treatment, as a primary level for guests whose clinical severity does not require residential, and as the structure for executives whose role does not pause. Peninsula offers IOP with the same clinical depth as residential — master's-level clinicians, evidence-based protocols, integrative modalities.

Read more →

Quiet window seat in daylight, standard outpatient care
04.

Standard outpatient

Typical duration: 3–12 months · ASAM Level 1

Standard outpatient at less than nine hours per week is the continuing-care floor that follows higher-intensity treatment, and the appropriate primary level for guests with mild substance use disorder, stable home support, and the capacity to engage clinical work as part of ongoing life. Peninsula's outpatient track integrates with the residential and IOP work — the same clinician who knows you during residential continues during outpatient, providing meaningful continuity that fragmented in-network care typically cannot.

Read more →

Stethoscope on a clinical desk, medication-assisted treatment
05.

Medication-assisted treatment (MAT)

Integrated across all levels · FDA-approved pharmacotherapy

MAT integrates FDA-approved medications (buprenorphine, naltrexone, methadone for opioid use disorder; acamprosate, naltrexone, disulfiram for alcohol use disorder) with behavioral therapy. The evidence base for MAT in opioid use disorder is overwhelming; refusal to use MAT on ideological grounds is malpractice in 2026. Peninsula offers MAT integrated across residential, IOP, and outpatient levels — never as a sole intervention but never refused when clinically indicated.

Read more →

Open journal and pen, mutual-help and continuing support
06.

Twelve-step and community recovery support

Ongoing · Adjunctive across all levels

Twelve-step facilitation (TSF) — Alcoholics Anonymous, Narcotics Anonymous, and the broader twelve-step framework — has accumulated outcomes data showing comparable effectiveness to CBT and MI in randomized trials for alcohol use disorder when integrated with clinical work. Secular alternatives — SMART Recovery, LifeRing, Refuge Recovery — offer evidence-based options for guests for whom the spiritual framework is not the right fit. Peninsula integrates community recovery support as adjunctive to clinical work, not as a replacement.

Read more →

Quick Answer

Seven levels of care exist, and the right one is a clinical decision rather than a price decision. Seven levels exist, from medically supervised detox down to continuing outpatient support, and the correct one is the least intensive level that is clinically sufficient — a principle written into the ASAM Criteria, the standard most US clinicians and insurers use.

In practice: detox handles the days when stopping is physically dangerous, residential handles the case where the home environment is part of the problem, and structured outpatient handles the far more common case of a life that is still functioning and needs to keep functioning. A programme that recommends the same level to everyone who calls is describing its inventory, not your situation.

On This Page

What is the ASAM Criteria, and what does it decide

Four empty ceramic dishes in a row, levels of care compared

The ASAM Criteria is the assessment standard that decides which level of care you need — developed by the American Society of Addiction Medicine and used by most US treatment programmes and insurers to justify what they approve.

It works across six dimensions, and each one can move the recommendation up or down independently:

  1. Acute intoxication and withdrawal potential. Is stopping physically dangerous? This dimension alone decides whether detox comes first.
  2. Biomedical conditions. Pregnancy, liver disease, cardiac history, chronic pain — anything that changes how withdrawal or medication will behave.
  3. Emotional, behavioural and cognitive conditions. Depression, trauma, anxiety, ADHD. Untreated, these are the most common reason a first attempt does not hold.
  4. Readiness to change. Not a character test — a description of where the person actually is, which changes what the first weeks should contain.
  5. Relapse and continued-use potential. History of previous attempts, and what happened in them.
  6. Recovery environment. Whether home supports recovery or undermines it. This is the dimension that most often decides residential versus outpatient.

Why it matters to you: if a programme cannot tell you which dimension drove its recommendation, the recommendation was not clinical. Asking that question directly is the fastest way to tell an assessment from a sales call.

How to choose between residential and outpatient

Row of stones decreasing in size, stepping down levels of care

It depends on two things: whether home supports stopping, and whether outpatient has already been tried and failed. Residential is indicated when the environment is the problem; outpatient is indicated when the life around the person is intact and worth protecting. That is close to the whole rule, and everything below is detail on it.

What residential actually buys

Distance. Twenty-four-hour clinical presence, no access to the substance, and a break from the routine that maintained the pattern. For someone whose home contains the supply, or the person supplying, that distance is not a luxury — it is the mechanism.

What outpatient actually buys

Practice under real conditions. Skills learned in a residence sometimes fail on first contact with the office, the commute and the evening that used to end a particular way. Structured outpatient builds those skills where they have to work, which is why it holds well for people whose lives are still running.

The mistake in both directions

Choosing residential for the reassurance of it, when nothing in the assessment indicates it, buys thirty days away and a return to an unchanged evening. Choosing outpatient when withdrawal is medically risky, or when home is where the problem lives, is the version that ends in an emergency department. Both errors come from deciding before the assessment.

6 questions that decide your level of care

Two facing armchairs in a quiet consulting room

These are the six questions our clinicians ask on the first call, and they map directly onto the ASAM dimensions above. You can answer them for yourself before you speak to anyone.

1. What are you taking, and for how long

Substance and duration decide whether medical supervision is required before anything else. Alcohol and benzodiazepines past a few months put this question first.

2. What else is on the list

Combinations change the risk profile completely. Alcohol with a benzodiazepine, or an opioid with gabapentin, is a different situation from either alone — and it is the most commonly under-reported answer at intake.

3. What happened the last time you stopped

Previous withdrawal is the best available predictor of the next one. Seizure, hallucination or a hospital visit moves the recommendation immediately.

4. What does home look like

Not whether it is comfortable, but whether it supports stopping. This single answer decides residential versus outpatient more often than any other.

5. What is untreated underneath

Depression, trauma, ADHD, chronic pain, insomnia. If the substance was solving something, the plan has to solve it too, or the plan is a countdown.

6. What are you protecting

A licence, a company, a marriage, custody. These are not obstacles to treatment — they are constraints the plan must be built around, and they are the reason many people call us rather than a facility that expects them to disappear.

What insurance pays at each level

Brass balance scale, cost and coverage by level

Most plans cover assessment, withdrawal management, outpatient and structured outpatient in-network; the private-residential premium generally is not covered. Federal parity law requires plans that cover substance use treatment to do so on terms comparable to medical and surgical benefits, which is why cover is usually wider than people assume.

Where approval is routine

Medically supervised withdrawal has clear clinical justification and is rarely contested. Intensive outpatient and high-intensity outpatient are approved when the assessment documents the dimensions requiring them — which is another reason the assessment matters.

Where you pay the difference

Private rooms, setting and amenities sit outside what a plan reimburses. A plan may authorise a standard residential rate while the difference to a private programme remains yours.

The number to establish first

Not the daily rate — your out-of-pocket maximum for the plan year and how much of it is already spent. That figure caps your exposure for in-network care and frequently changes which level is financially realistic. The full breakdown is in does insurance cover rehab, and carrier-specific detail is on the insurance pages.

How to decide, in three steps

Three steps, and the order matters. Every avoidable harm we see comes from doing step two or three before step one.

Private gate opening onto a path
  1. 1

    Establish the medical facts

    What you take, how much, how long, and what else is on the list. This is what decides whether stopping is a medical risk, and it takes about ten minutes on the phone.

  2. 2

    Get the six dimensions assessed

    A clinician works through the ASAM dimensions with you and names the one driving the recommendation. If nobody names a dimension, you have had a sales call, not an assessment.

  3. 3

    Choose the least intensive sufficient level

    With the assessment in hand the choice usually makes itself — and it is more often outpatient than people expect. Reassessment is scheduled at the start, not left to a crisis.

Begin with step one — (844) 595-3264

Frequently asked questions about levels of care

How long does each level of care last? +

Medical detox is measured in days — typically three to seven, longer for benzodiazepines. Residential is commonly 28 to 45 days. High-intensity outpatient runs around 20 hours a week for several weeks; intensive outpatient is 9 or more hours a week and often continues for two to three months. Continuing outpatient support has no fixed end. These are ranges rather than rules: the ASAM dimensions decide when a step down is appropriate.

Do I have to start with detox? +

Only if stopping is physically risky for you. Detox is indicated by the first ASAM dimension — withdrawal potential — which mainly applies to alcohol, benzodiazepines and Z-drugs, and to opioids where medication will be started. For stimulants and most prescription medicines, treatment begins at the level the other five dimensions indicate. Detox on its own is also not treatment; it is the step that makes treatment possible.

Can I keep working through treatment? +

For intensive outpatient, usually yes — schedules are built around working hours precisely for this. High-intensity outpatient is harder but is done, often with a reduced load for several weeks. Residential is not compatible with working, which is exactly why the level should be decided clinically rather than defensively: many people who assume they must disappear for a month do not need to.

What is the difference between PHP and IOP? +

Hours and intensity. Partial hospitalization — which ASAM now calls high-intensity outpatient — runs around 20 or more clinical hours a week. Intensive outpatient runs 9 or more. Both are outpatient in the sense that you sleep at home. The choice between them turns on medical and psychiatric stability and on how much structure the week needs. We compare them directly in PHP or IOP — how to choose.

What happens if the level turns out to be wrong? +

It is adjusted. Levels of care are meant to move in both directions, and stepping up is not a failure — it is the system behaving as designed. What matters is that reassessment is scheduled rather than triggered by a crisis, and that the criteria for stepping up or down were explained to you at the start. If you are unsure where you currently sit, a clinician will tell you on the phone: (844) 595-3264.

Is medication part of every level? +

No, and it depends on the substance rather than the level. Opioid use disorder has three FDA-approved medications; alcohol use disorder has approved options too. For stimulants, sedatives and gabapentinoids there is no approved medication, and the treatment is behavioural or is the taper itself. Medication can accompany any level of care where it is indicated, including outpatient.

How do I know a programme is assessing rather than selling? +

Ask which ASAM dimension drove the recommendation, and what would change it. A clinical answer names a dimension and a threshold. A sales answer describes the facility. Ask also who performs the assessment and whether they also carry an admissions target — the answer is usually honest when the question is direct. You are welcome to put those questions to us first: (844) 595-3264, answered by a clinician rather than a call centre.

What happens after the intensive phase ends? +

The weeks after any step down carry elevated risk, so continuing care is arranged before the phase ends rather than after. In practice that means scheduled therapy, medication management where it applies, and a specific plan for a bad week — a named person and a defined action, not general encouragement to stay in touch.

Sources for this page

Send this to someone who needs it:

Medical Disclaimer

This page is information, not medical advice, and it does not create a clinician–patient relationship. Do not start or stop any medication, or attempt withdrawal, without a qualified physician. If you are physically dependent on alcohol or a benzodiazepine, stopping abruptly can be dangerous. For free, confidential help 24/7 call the SAMHSA National Helpline on 1-800-662-HELP. In an emergency call 911, or 988 for the Suicide & Crisis Lifeline.

Begin the conversation

The level of care is best determined clinically.

A self-assessment can be a useful first step — Peninsula offers anonymous, clinician-developed screenings — but the level-of-care decision is made through clinical assessment, not from a brochure. A twenty-five-minute call with our admissions clinician is enough to know whether Peninsula is the right fit, or to recommend somewhere we believe is better-matched.

Call (844) 595-3264 Confidential self-assessment