There are different levels of care for substance use and co-occurring disorders. The highest level of intensive outpatient therapy is Partial hospitalization programs, or PHP.
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Partial Hospitalization (PHP)
Levels Of Care
What is PHP
Calling an intensive outpatient level of care “hospitalization” can be confusing. Partial hospitalization programs gained popularity in the 1970s to help psychiatric patients receive care at a hospital while living in their communities. Because patients were living at home and receiving treatment at a hospital during the day, they were considered partially hospitalized. Eventually, this model was adopted for treating alcohol and substance use disorders.
PHP, or intensive outpatient therapy programs are treatment programs which treat multiple behavioral health conditions, including substance use, co-occurring disorders, mental health disorders and eating disorders. These programs differ from residential care because they do not provide detoxification or round the clock medical supervision. IOP and inpatient residential do share several things in common, primarily structured therapies and services to help you recover.
The intensity of the different levels of care depends on the number of clinical hours you receive structured treatment. Most PHP programs provide a minimum of twenty hours of clinical care a week, five days a week, and this takes place over a minimum of two weeks. In addition, most PHP programs will offer housing where you may stay during your treatment. This is in comparison with an IOP program where you typically live at home or another setting and travel to and from treatment independently.
You can expect to spend less than nine or more hours per week in treatment and can usually select from day, night or weekend programs. Outpatient programs offer flexible services for less than nine hours per week which may be individual therapy and a group therapy session, such as an alumni group if it is offered through a treatment center. At Crystal Lake, our clinical staff is proud of our carefully developed PHP program. We make sure that our program follows evidence-based guidelines to ensure the highest quality treatment for each individual situation. We are committed to delivering the same quality of service as you would receive in an inpatient or residential program.
The PHP program at Crystal Lake Healing has been carefully developed to deliver therapeutic services tailored to your unique needs. Some of these services include:
- One-on-one therapy
- Group therapy
- Family therapy
- Substance use disorder education
- Relapse prevention
- Treatment for co-occurring disorders
- Nutrition and wellness
- Structured activities
- Access to medical care
Where is PHP in the continuum of care?
The ASAM levels of care have been developed to guide the recovery process through series of stages along an effective continuum of care. Partial Hospitalization Programs (PHP) are the most intensive level of care for Intensive Outpatient Programs (IOP’s) as defined by the ASAM. They are a bridge between inpatient residential care and a lower level of care in IOP.
If you’ve completed an inpatient program, PHP is a great way to transition back to your daily activities and continue to have structure and access to treatment staff 24/7. If you don’t require detox or round the clock medical supervision, PHP is an ideal starting point for your recovery.
What are the Differences Between PHP and IOP Treatment?
The primary difference between PHP and IOP treatment is the intensity of services. PHP acts as a bridge between inpatient residential care and IOP. The intensity of services simply means how much time you’ll spend in clinical therapy per week. For PHP, the quality of services such as individual and group therapy, educational groups, and discharge planning is equivalent to an inpatient residential program. Many people transition to IOP at the same facility they completed PHP treatment.
At Crystal Lake Healing, we are committed to offering superior care on your recovery journey. Below are some of the key differences and similarities between PHP and IOP.
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Intensive Outpatient Services(IOP)
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Partial Hospitalization Program(PHP)
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Average Length of Treatment
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Varies
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Two weeks – 3+ months
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Average Weekly Commitment
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9 or more hours per week
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Twenty or more hours per week, not to exceed 24.
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Stay at Facility?
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No
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Varies
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Day/Evening Programs?
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Yes
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Typically, no
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Can I work?
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Yes
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Typically not until treatment level is complete
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Is therapy offered?
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Yes, individual, group, family
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Yes, individual, group, family
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Dual diagnosis treatment
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Depends on the facility
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Depends on the facility
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Psychiatric/Medication Services?
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Depends on the facility
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Depends on the facility
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As you can see, there are many similarities between the two levels of care. The goal for each level of care is the same, to provide you with the skills, tools, and insight to live a full life in recovery.
Do I need to (or can I) start at PHP?
Yes, you can start at PHP. While most people enter PHP directly from inpatient treatment, this is not always the case. For some, PHP is the starting point for recovery. While many factors determine this clinical decision, the primary factors are medical and psychological stability. Speaking with your doctor or an addiction professional can help assess whether you are ready for PHP.
Admission to the PHP program at Crystal Lake Healing will be based on our clinical assessment team’s input. When you contact us, we will ask your permission to share your information with our team of addiction and medical professionals. Our clinical team will review your information and make an informed recommendation for the best level of care for you. If you need to attend detox and/or residential treatment before joining our PHP, we will make these arrangements for you so your transition to PHP at Crystal Lake will be smooth.
Who is a partial hospitalization program best for?
Partial hospitalization programs are well-suited to you if you are physically and psychologically stable to join a program with a lower intensity of services than detox or residential programs. The structure and therapy offered in a PHP are equivalent to those provided in an inpatient setting. PHP’s benefit is that you will have a stable environment with continued access to staff and daily structure to aid your recovery.
Our skilled admissions counselors are ready to help you find the correct level of care for your substance use of co-occurring disorders. When you call, our representatives will have a conversation with you to understand your needs. A clinical team will review your information and decide if PHP is the best program for you to start. Should you need to attend detox and/or residential before admission to Crystal Lake Healing, we will work to make these arrangements for you, so your transition to our PHP is seamless.
Who May Not Benefit From A Partial Hospitalization Program (PHP)?
If you need medical care or detox or are experiencing acute psychiatric symptoms, a PHP program is typically advised against until you are physically and mentally stable. If you are experiencing withdrawal or acute psychiatric symptoms, seek medical attention immediately.
What is the goal of PHP?
Most PHP’s share the same goal, to provide you with the therapy, education, and skills you can use to enjoy a lifetime of recovery. From providing you with an accurate diagnosis and medications for any co-occurring disorders to relapse prevention planning, the goal is your recovery.
Therapy is an essential part of the treatment process. You may have tried in the past to quit using drugs or alcohol and found yourself in a stressful situation that caused you to resume using. Stress, loneliness, and trauma can all trigger a return to substance use. Therapy can help these triggers in a few ways. The first is by exploring your life experiences, which may contribute to uncomfortable emotions, and the second is working with your therapist to learn how to manage difficult emotions. These new skills can provide you with a foundation to take new action in your life.
Education is a vital part of PHP. While topics may vary from facility to facility, you can generally expect to learn about the impact of substances on the brain and short- and long-term health impacts from substance use. You may also learn how addiction impacts the individual and the family and learn about recovery pathways, including 12-step fellowships, SMART Recovery, and Recovery Dharma.
The skills you will learn in therapy generally focus on several areas such as mindfulness, interpersonal relations, emotion regulation, and tolerating distressing situations. These skills all help you by focusing on acceptance and making changes.
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ACCEPTANCE |
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Mindfulness |
Staying present and experiencing life and situations in the moment, without judgment. |
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Tolerating Stress |
Learning to accept stress and discomfort without making situations or emotions worse. |
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CHANGE |
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Emotional Regulation |
Understanding your emotions and finding solutions to help change them. |
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Interpersonal Effectiveness |
Skills in this area will teach you how to build and maintain relationships, ending destructive ones, and decreasing loneliness. |
If you have a co-occurring disorder, treating and managing your disorder’s symptoms will benefit your recovery. Some people who suffer from depression or other mental health conditions engage in self-medicating. For example, if you struggle with depression and experience symptoms, you may use drugs or alcohol to change the depression. While this may provide temporary relief, it is not a long-term solution. In fact, depression may be made worse by using substances.
At Crystal Lake, we are an integrated treatment center, and we will treat your substance or alcohol use disorder and co-occurring mental health disorder(s). We realize that mental health disorders and substance use disorders are related yet separate conditions. This is why we utilize a holistic approach to care, as we have seen the benefit of wholly treating you.
What Is Offered In A Partial Hospitalization Program?
Each PHP program will structure the treatment day differently. The primary goal is to provide comprehensive addiction and mental health services. This is achieved through therapeutic activities such as:
- Individual therapy
- Group therapy
- Family therapy
- Life skills
- Expressive therapies
- Substance and alcohol use disorder education
- Relapse prevention
- Wellness and nutrition
You can expect to be in treatment or clinical setting for at least twenty hours a week while in PHP. Crystal Lake provides a structured schedule and includes a variety of groups or sessions throughout the day. In addition to our clinical facility, you will live in our brand-new, luxury residences during your treatment. We know the benefit of providing a stable supervised environment for people in early recovery. Living at our residences is an excellent way to begin building friendships and your recovery network.
A typical day at Crystal Lake Healing will consist of:
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6:30 AM |
Wake-up |
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7:00-8:00 AM |
Breakfast (self-prepared) / Medication (if prescribed) |
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8:00-8:30 AM |
Transport to clinical building |
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9:00-10:30 AM |
Motivation and Inspiration Time |
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10:30 AM – 12:00 PM |
Morning groups |
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12:00-1:00 PM |
Lunch – catered lunch provided & Medication (if prescribed) |
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1:00-4:00 PM |
Afternoon Groups |
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4:00-4:30 PM |
Return to residences |
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5:00-6:30 PM |
Dinner (self-prepared) / Medication (if prescribed) |
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6:30-8:30 PM |
12-Step Meeting |
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8:30-11:00 PM |
Free-time / Medication (if prescribed) |
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11:00 PM |
Lights Out |
Weekends provide leisure time and community outings, as well as weekly grocery shopping. You will be provided a budget and do not need to pay out of pocket for groceries unless you exceed the budgeted amount. If you attend spiritual services, these are available to you on Sundays. There is also a weekly house meeting for clients where the community meets more informally than a clinical group. During the weekends, you will continue to attend 12-step meetings on Zoom or in-person.
Is there therapy in PHP?
PHP programs offer individual, group, and family therapy sessions for you as you begin the recovery process. Our comprehensive treatment program has several options available, including:
- “Talk Therapy” or individual and group counseling
- Medication management
- Evaluation for co-occurring disorders
- Treatment for mental health diagnoses such as anxiety, depression, or trauma
- Expressive therapy
- Family therapy
- Relapse prevention planning
The modalities we utilize are well suited to treating substance and alcohol use disorders and co-occurring mental health issues.
Cognitive Behavioral Therapy (CBT)
Cognitive-behavioral therapy is used in many therapeutic programs. It is very effective in substance use and dual diagnosis treatment. This is because it works and even shows benefits in as little as 5 – 20 sessions. CBT teaches you to skills to help change your emotions by looking at your thoughts and personal beliefs. In addition to working well with substance use disorders, this is an effective therapy if you have post-traumatic stress disorder, major depression, or anxiety. Working with a CBT therapist can help you learn new skills to help you in your recovery.
Dialectical Behavioral Therapy (DBT)
Dialectical behavioral therapy is a form of CBT that can help you manage difficult emotions and situations. Dialectical means that two things that seem like opposites can both be true. For example, you have a substance use disorder, and you can still stay sober. This type of therapy is used to treat many conditions, including bulimia, suicidal depression, bipolar disorders, borderline personality disorder, and substance/alcohol use disorders. To help you make lasting change in your life, DBT will teach you skills in four key areas: mindfulness, interpersonal relationships, emotion regulation, and how to tolerate stressful situations without using drugs or alcohol.
Dual Diagnosis Treatment
The most effective approach when treating co-occurring disorders is to treat both simultaneously. Many people with a substance use disorder also have a mental health diagnosis. Over a third of the 20.3 million Americans with a substance use disorder may also have a co-occurring mental health disorder. If you’ve been diagnosed with a substance use disorder and a mood, personality, anxiety, or trauma disorder, an integrated therapeutic model can help you recover.
Expressive Therapy
Expressive therapy utilizes creativity to explore challenging areas in your life. Unlike talk therapy, expressive therapy encourages the expression of thoughts, feelings, beliefs, or memories through creative activities such as art, dance, storytelling, poetry, and music. A core principle of this therapy is that there is no right or wrong in creative expression, which means there isn’t a right or wrong way to paint or write. The process, meaning, and creative outlet are the primary goals of this type of therapy. Expressive therapy can help with various disorders, including anxiety, low self-esteem, trauma, and substance or alcohol use.
Family Support Program
We offer family therapy sessions at your request. Substance use and mental health are disorders that impact entire families. Family therapy can improve how you communicate, resolve family problems, and be a safe space for you and your family to work through difficult emotions. Involving your family in your treatment is your choice; we will not engage in family sessions without your approval. It is highly recommended, however, as you will be on the recovery journey together.
Motivational Interviewing
Motivational interviewing is a therapeutic modality designed to help you resolve uncertainties around recovery. The goal is to help you find your motivation for sobriety. This method has been used successfully with people managing physical health issues, such as heart disease, asthma, and obesity, that require lifestyle change to address. It works well with substance use disorders because it recognizes change is difficult. You may have doubts about whether you are genuinely ready or capable of enacting positive change in your life, and this technique can help you through your doubts to find your motivation for change.
The Benefits of PHP
There are many benefits of attending a PHP program. These programs help you build a foundation in recovery, develop healthy relationships, and receive treatment for co-occurring disorders in a supervised setting, yet encourages personal responsibility. PHP can help you learn to manage free-time without using drugs or alcohol and develop a support network of people in recovery when you attend outside meetings.
Access to medical services: Crystal Lake Healing will provide access to medical care should you have concerns or require treatment for physical illnesses.
Medication management: Your clinical team may prescribe medications for co-occurring disorders. While in PHP, your clinical team can monitor you for adverse reactions, ensuring you are on the most beneficial medications for your diagnosis.
Individual therapy: Throughout PHP, you will have access to an individual therapist who will work with you on your personal treatment goals.
Group therapy: Time spent in group therapy can help you share your thoughts and feelings and begin to connect with others who have similar experiences. You will also learn new skills such as stress management or relapse prevention.
Aftercare planning: Together with your treatment team, you can begin aftercare planning. In addition to your therapist, your team includes a case manager. Your case manager will be an invaluable resource for your discharge and aftercare planning. They will be able to help you with things such as returning to work, school, or home, finding a halfway house, or finding a therapist and/or doctor. Should you be returning home, your case manager will ensure you have appointments set before discharge, so your transition home includes a plan for your ongoing treatment.
What happens after PHP?
When you complete PHP, many people wonder what the next steps are. For some, it is returning home. For others, it is residing at a halfway house while engaged in outpatient treatment. Some say recovery is what happens after you leave treatment. If you think of PHP as school, your next step is going to be out in the world so you can take the skills you’ve learned in the classroom and continue them in your daily life.
At Crystal Lake Healing, we work closely with you to ensure you have a solid plan of action for your recovery. Your discharge plan may include:
- Therapy Appointment
- Doctor’s Appointment (psychiatric/medical)
- IOP arrangements at Crystal Lake
- Resources for halfway housing (we will transport you locally to halfway)
- A plan for support meetings, such as AA, NA, Recovery Dharma, SMART Recovery
The most important part of a discharge plan is that you have a voice and a choice in what your aftercare will look like. We will make recommendations that you can review to ensure the next steps support your new life in recovery. Ultimately, you are the expert on yourself, and we respect your ability to be an active participant in what happens for you after PHP.
Sources
Wikipedia. Intensive Outpatient Program
https://en.wikipedia.org/wiki/Intensive_outpatient_program
Frontiersin. Psychiatric Acute Day Hospital as an Alternative to Inpatient Treatment (2020)
https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00471/full
Healthline. Expressive Therapy
https://www.healthline.com/health/depression/expressive-therapy
Psychology Today. Motivational Interviewing
https://www.psychologytoday.com/us/therapy-types/motivational-interviewing
ASAM Continuum. What are the ASAM levels of care?
https://www.asamcontinuum.org/knowledgebase/what-are-the-asam-levels-of-care/
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Medical Disclaimer: Crystal Lake Healing uses fact-based content about recovery treatment, addiction medicine, and behavioral health conditions in order to improve the quality of life for those struggling with drug and alcohol addiction or mental health disorders. While the information provided is researched and reviewed by licensed medical professionals, it is not intended to replace professional medical guidance, diagnosis, care, or treatment. This information should not be used as a substitute for advice from a qualified healthcare provider and/or your physician.
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