Information on Partial Hospitalization for Substance Abuse

Created On Friday, 10, March 2017
Modified On Friday, 17, September 2021

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Partial hospitalization or PHP is a treatment process where a patient usually stays at a hospital no more than 20 hours per week. Typically, this is during the day, and patients do not stay overnight. Partial hospitalization programs provide a mix of outpatient care, individual counseling, and group counseling with medical services. The benefit of being at the hospital is access to nurses and doctors for any clinical care. For example, this could include medical detox or a form of withdrawal management.

Partial hospitalization is also used as a form of aftercare support when someone has completed inpatient drug rehabilitation. PHP would be considered a step-down program or the individual would attend a partial hospitalization program because they relapsed and need the help. There are various therapies offered through partial hospitalization, and the programs are usually tailored to the needs of the patient. PHP is also beneficial for someone who needs medical attention during detox, or they have not successfully completed detox and need medical help.

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Partial hospitalization programs are similar to intensive outpatient programs, but there are some differences. For example, the main difference is the amount of time the person spends in the program. Partial hospitalization programs are usually 20 hours of programming per week, while an intensive outpatient program usually provides nine hours per week. Partial hospitalization programs are more likely to provide medical services, whereas intensive outpatient programs are less likely to offer these services.

Additionally, partial hospitalization programs offer at least five days of treatment each week but may even provide up to seven days per week. Overall, the program's length varies based on individual needs, but the typical amount of time someone spends in a PHP is 14 to 21 days. Some of the service components include individual therapy, group therapy, family meetings, medical services, drug screening, employment, and education assistance.

When is Partial Hospitalization the Best Treatment Option to Consider?

Partial hospitalization is a good option for someone who needs a high level of care but can remain clean outside of rehabilitation. For example, outpatient treatment requires the patient to attend treatment daily, but they do not live at the facility. Someone who attends a PHP may have already completed a hospital or residential treatment program but feel they may relapse. Once someone has completed inpatient rehabilitation, aftercare support is a good option, and partial hospitalization programs benefit recovering addicts who need extra help.

Partial hospitalization programs are also a good option for someone who has a hard time motivating themselves to continue treatment. Also, addicts with co-occurring disorders often attend partial hospitalization programs for the added support. Addicts that are not making optimal recovery progress in an intensive outpatient program usually attend a PHP program. Some patients enroll directly into partial hospitalization programs aftercare completing an inpatient hospital or residential program, which is known as a step-down.

Other patients seek out partial hospitalization programs as a step up from treatment, which is common for someone who experiences a relapse. Certain patients benefit from partial hospitalization treatment programs, while others benefit from standard outpatient care. PHPs are designed for patients whose addiction isn't completely out of control or have not struggled with addiction for a long time. PHP's are a good option because they do not have to spend weeks isolated from their families. Partial hospitalization programs are designed for those who want intensive treatment but can still have the freedom and responsibility of an outpatient treatment center.

The Benefit of Partial Hospitalization and Preventing Overdose

Partial hospitalization programs have many benefits and offer identical resources to most residential treatment. The benefits are in the recovery process and helping people who may fear relapse while preventing overdose. The process of leaving a residential rehabilitation center is not easy for some people if they do not have any aftercare available. Unfortunately, there is still a risk of relapse and an increased risk of overdose. Partial hospitalization offers extra support for someone who may have relapsed or is in fear of relapsing.

Overdose is responsible for countless deaths every year and is responsible for countless emergency room visits because of non-fatal overdose. According to the Centers for Disease Control, drug overdose deaths in 2019 rose 4.6% to 70,980, including 50,042 opioid overdoses. Per the National Institute on Drug Abuse, in 2018, the data shows that every day 128 people in the United States die after overdosing on opioids.

The opioid crisis has been responsible for countless deaths across the United States. Per NIDA, roughly 21 to 29% of patients prescribed opioids for chronic pain misuse them. Between 8 and 12% develop an opioid use disorder, and an estimated 4 to 6% who misuse prescription opioids transition to heroin. Roughly 80% of people who use heroin first4 misused prescription opioids. However, among 38 states with prescription opioid overdose death data, 17 states saw a decline between 2017 and 2018. In 2018, more than 67,300 Americans died from a drug-involved overdose, which includes illicit drugs and prescription opioids.

Additionally, per the National Institute on Drug Abuse, drug overdose deaths rose from 38,329 in 2010 to 70,237 in 2017. In 2018, it decreased for the first time to over 67,300 deaths and then rose again in 2019. Partial hospitalization programs are excellent options to consider when making a transition back to society. If an addict struggles with chronic relapse before residential rehabilitation, they will benefit from follow-up treatment within a partial hospitalization program.

How Do Partial Hospitalization Programs Operate?

A partial hospitalization program typically begins with an assessment, whether a person has completed residential treatment or is attending a PHP as a treatment option. Licensed clinicians do the assessment, and other treatment team members document the medical history and perform a physical. The assessment process helps develop an individualized treatment plan, which outlines goals for the person to meet while in treatment and discharge and relapse prevention. Most partial hospitalization programs operated from Monday to Friday on an outpatient basis.

Many programs will drug test at the outset of the program and conduct random drug testing during the program. A significant benefit of partial hospitalization programs is medication-assisted treatment for severe withdrawal. Medical detox helps patients that are struggling with opioid addiction, severe alcoholism, and addiction involving prescription drugs. Detox is an essential part of treatment and cannot be avoided. Detoxification prepares the patient for further rehabilitation and counseling by treating the initial drug cravings.

Partial hospitalization programs also employ several types of therapy, whether individually or as part of a group. The therapy is designed to help people commit to their treatment plan, change patterns of behavior, adjust maladaptive thoughts, build relapse prevention, and other recovery skills. More importantly, it improves the important areas of their lives, such as family relationships, social life, employment, and educational success.

Some of the common therapies include cognitive behavioral therapy, which helps identify self-destructive behaviors and thinking patterns that influence addiction. The individual also learns how to recognize the people, places, and things that lead to them to use drugs and then learn how to better deal with them. Contingency management is also used, which is the process of giving rewards to patients when they complete certain goals, such as a negative drug test. The purpose of reward-based therapy is to help the patient reinforce recovery-oriented behaviors.

Motivational enhancement therapy or motivational interviewing is also administered, which is used during individual therapy. The process is designed to help patients overcome their resistance to get clean and engage in treatment. The most recognized form of therapy is the 12-step approach, and PHP uses this therapy to introduce patients to 12-step programs. Group therapy is a significant part of treatment and provides patients with the opportunity to share their insights and learn from others' experiences.

Individual therapy is also important, and the sessions between patients and counselors provide opportunities for individuals to process their emotions in a healthy way. Family counseling is also offered to help family members and close friends that are affected by substance abuse. Some partial hospitalization programs offer fitness and nutrition therapy, such as recreational activities and nutritional education.

Are There Differences Between Inpatient, Partial Hospitalization, and Intensive Outpatient Programs?

Inpatient or residential rehabilitation requires that the patient lives in a residential facility during treatment. Inpatient programs provide 24-hour care and support and offer lengthy rehabilitation. Partial hospitalization and intensive outpatient programs also provide in-depth treatment, but they are outpatient, and the patient does not live at the facility or center. The primary difference is the amount of time the patient spends in treatment.

Intensive outpatient programs are not time-consuming, which is why they are a popular option for someone who is still working. The program allows for a more variable time frame, making it easier for a person to schedule treatment around work and family life. For example, an intensive outpatient program may require the patient to spend two to four hours per day for three to five days per week. Partial hospitalization programs require the patient to spend four to six hours per day for three to five days per week.

Partial hospitalization programs are a step up from intensive outpatient programs and a step down from inpatient or residential treatment. Day programs like a PHP or IOP are effective as a step down from 30-day short-term residential rehabilitation programs. Also, partial hospitalization or even an intensive outpatient program is usually a more affordable option for someone when compared to residential rehabilitation.

According to a Substance Abuse Intensive Outpatient Programs Study: Assessing the Evidence, intensive outpatient programs, and even partial hospitalization programs are an important continuum of addiction care. The programs are effective as inpatient treatment for most individuals seeking rehabilitation.

Partial hospitalization programs provide an easy transition from inpatient to outpatient services and are ideal to transition from inpatient rehabilitation. PHP bridges the gap and provides effective aftercare, such as life skills training and sober living skills. Also, the affordability of a partial hospitalization program makes health insurance dollars go further.

Are There Alternatives to Partial Hospitalization Programs?

Alternatives to partial hospitalization programs are inpatient rehabilitation centers. The purpose of residential treatment is for the addict to live at the facility for a set time while attending daily counseling, therapy, and other aspects of residential treatment for the addiction. Residential rehabilitation is either long-term or short-term, and programs provide everything onsite to help the addict and their family.

Long-term residential treatment typically lasts three to six months, whereas short-term programs last three to six weeks. Overall, rehabilitation is well-rounded and is helps treat the addiction from a physical, mental, and spiritual approach. Lengthier programs have the ability to provide more resources. Residential treatment centers also offer traditional and non-traditional approaches to treatment. For example, experiential therapy, nutritional therapy, or holistic rehabilitation are common non-traditional approaches.

The treatment process with an inpatient treatment program is much of the same as a partial hospitalization program. The patient begins with an assessment, followed by detox, counseling or therapy, and aftercare support. Partial hospitalization programs are usually a step down from residential treatment, acting as aftercare support, and further relapse prevention.

Common Terminology with Partial Hospitalization Programs

Term Definition
Partial Hospitalization PHPs or day programs provide intensive treatment for behavioral health issues without requiring the patient to stay overnight. Partial hospitalization programs tend to provide longer treatment than a standard outpatient center.
Inpatient Hospitalization inpatient is similar to partial hospitalization, but the patient is staying overnight for the time they spend during treatment. Programs provide the same medical services and treatment methodologies as a partial hospitalization program.
Outpatient Treatment outpatient help requires the patient to meet at the treatment center at a scheduled time during the week and then return home after therapy. The programs tend to have built-in accountability that requires the patient to report drug use. Also, random drug tests are done to ensure accountability.
Intensive Outpatient Treatment IOPs are not as time-consuming as a partial hospitalization program and require fewer hours per week. However, intensive outpatient treatment provides more rehabilitation and counseling within a shorter time than a standard outpatient program.
Inpatient Rehabilitation residential treatment programs require the patient to live at the facility during their therapy and treatment. These programs provide all the necessary amenities and services of a home, making it easier for them to focus on treatment without outside distractions.
Behavioral Therapy one of the common and core treatment methods used to help treat addiction. Behavioral therapies include cognitive behavioral therapy or dialectical behavioral therapy. Behavioral therapy is used in conjunction with other forms of treatment to treat addiction.
Individual Counseling a counseling process where the patient works closely with the therapist one on one. The counseling process helps the patient delve deep into the underlying issues surrounding the addiction. Individual therapy also helps the patient set goals and discuss progress with a professional that knows them and their history.
Group Therapy a common form of therapy that gives the individual an opportunity to work closely with others in a group setting who are struggling with similar issues. One therapist usually runs group therapy sessions, and everyone is working towards common therapeutic goals.
Support Groups are less formal settings than a group therapy session. Support groups provide a safe environment for a recovering addict to be in while they stay connected with other sober people. Also, support groups are for family members of addicts to connect with other people who have experienced addiction with another person.
Dual Diagnosis Treatment is a term that refers to someone that is suffering from a mental health disorder and a substance abuse problem at the same time. Partial hospitalization programs commonly treat dual diagnosis.

CONTRIBUTORS TO THIS ARTICLE

Marcel Gemme, DATS - Author

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Marcel Gemme has been helping people struggling with addiction for over 19 years. He first started as an intake counselor for a drug rehabilitation center in 2000. During his 5 years as an intake counselor, he helped many addicts get the treatment they needed. He also dealt with the families and friends of those people; he saw first-hand how much strain addiction puts on a family and how it can tear relationships apart. With drug and alcohol problems constantly on the rise in the United States and Canada, he decided to use the Internet as a way to educate and help many more people in both those countries. This was 15 years ago. Since then, Marcel has built two of the largest websites in the U.S. and Canada which reach and help millions of people each year. He is an author and a leader in the field of drug and alcohol addiction. His main focus is threefold: education, prevention and rehabilitation. To this day, he still strives to be at the forefront of technology in order to help more and more people. He is a Licensed Drug and Alcohol Treatment Specialist graduate with Honours of Stratford Career Institute. Marcel has also received a certificate from Harvard for completing a course entitled The Opioid Crisis in America and a certificate from The University of Adelaide for completing a course entitled AddictionX: Managing Addiction: A Framework for Succesful Treatment.


Michael Leach, CCMA - Medically Reviewed on September 17, 2021

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Michael Leach is a Certified Clinical Medical Assistant, who has over 5 years of experience working in the field of addiction. He spent his career working under the board-certified Addictionologist Dr. Rohit Adi. His experience includes working with families during their loved one’s stay in treatment, helping those with substance abuse issues find treatment, and teaching life skills to patients in a recovery atmosphere. Though he has worked in many different areas of rehabilitation, the majority of his time was spent working one on one with patients who were actively withdrawing from drugs. Withdrawal and the fear of going through it is one biggest reason why an addict continues to use and can be the most difficult part of the rehabilitation process. His experience in the withdrawal atmosphere has taught him that regardless of what approach a person takes to get off drugs, there are always mental and emotional obstacles that need to be overcome. He believes having someone there to help a person through these obstacles can make all the difference during the withdrawal process.