What is inpatient residential rehab?
Residential rehab gives you a safe, substance-free place to live while you focus fully on recovery. Staff are on site 24 hours a day. Your days are filled with structured treatment, and your basic needs, such as meals and a place to sleep, are covered.
Providers place people in care using The ASAM Criteria, guidelines from the American Society of Addiction Medicine (ASAM). The fourth edition, published in 2023, describes three residential levels:
- Level 3.1 – Clinically Managed Low-Intensity Residential: a structured home-like setting with lower-intensity treatment. It often helps people practice recovery skills, find work or get ready to live on their own.
- Level 3.5 – Clinically Managed High-Intensity Residential: the most common type of "rehab." It offers daily, intensive therapy and 24-hour staff. In the fourth edition, it also includes the clinically managed withdrawal care once called Level 3.2-WM.
- Level 3.7 – Medically Managed Residential: for people who need daily medical or nursing care, including withdrawal management, along with treatment.
The third edition also had a Level 3.3 for people with cognitive challenges. The fourth edition removed it and expects all levels to adjust care for those needs.
Wondering if residential care is the right fit? Call (877) 847-2855 to talk through options and check your insurance benefits. It's free and confidential.
Who is residential treatment for?
A clinician recommends residential care after an assessment. It is often a good fit if you:
- Have tried outpatient treatment and kept returning to use
- Live in a home where drugs or alcohol are present, or where you don't feel safe
- Have a moderate to severe substance use disorder
- Have a co-occurring mental health condition, such as depression, anxiety or PTSD (see dual diagnosis treatment)
- Need distance from daily triggers, people or places tied to your use
If you are still dependent on alcohol, benzodiazepines or opioids, you may need detox first, or a Level 3.7 program that provides withdrawal care on site. Withdrawal from alcohol and benzodiazepines can be life-threatening and needs medical supervision.
Some residential programs focus on specific groups, such as veterans, women, young adults or pregnant women. These programs can address needs that general programs may not, like military trauma, parenting or safe care during pregnancy. If one of these fits you or your loved one, ask about it when you compare options.
Residential care can also make sense when someone has been through a crisis, such as an overdose or a hospital stay, and needs a safe place to keep stabilizing. In that case, a hospital social worker can often help arrange a direct transfer.
What does a typical day look like?
Every program is different, but most follow a steady routine. Our guide to what happens in rehab goes deeper.
| Time | Typical activity |
|---|---|
| Morning | Wake up, breakfast, medication, morning meditation or check-in group |
| Late morning | Group therapy, such as cognitive behavioral therapy (CBT) or relapse prevention |
| Midday | Lunch and free time |
| Afternoon | Individual therapy, education sessions, family sessions, or activities like exercise or art |
| Evening | Dinner, peer support meetings (such as 12-step or SMART Recovery), reflection time |
Throughout your stay, you'll also meet with a case manager to plan what comes next. Many programs offer medication-assisted treatment (MAT), which pairs FDA-approved medications with counseling.
How long does residential rehab last?
Many programs advertise 28- or 30-day stays, and longer programs of 60 or 90 days are common. Your stay should be based on your progress and clinical needs, not just a set number of days.
The National Institute on Drug Abuse (NIDA) reports that staying in treatment long enough is critical, and that most people need at least three months of total treatment to significantly reduce or stop drug use. That total often includes a residential stay plus step-down outpatient care. See how long rehab lasts for more.
How does residential rehab compare with other levels of care?
| Level of care | ASAM level (4th ed.) | Where you sleep | Typical intensity | Best fit |
|---|---|---|---|---|
| Hospital inpatient | 4 | Hospital | 24-hour physician and nursing care | Severe medical, psychiatric or withdrawal needs |
| Medically managed residential | 3.7 | Facility | 24-hour nursing, daily medical oversight | Needs medical care plus intensive treatment |
| High-intensity residential | 3.5 | Facility | Daily therapy, 24-hour staff | Moderate to severe SUD, unstable home |
| Low-intensity residential | 3.1 | Facility | Structured living with fewer therapy hours | Building skills for independent living |
| Partial hospitalization / high-intensity outpatient | 2.5 | Home | About 20 or more hours a week | Stable home, needs daily structure |
Does insurance cover residential treatment?
Under the Affordable Care Act (ACA), substance use disorder services are an essential health benefit for Marketplace and most individual and small-group plans. The Mental Health Parity and Addiction Equity Act (MHPAEA) generally requires that plans not limit these benefits more strictly than medical and surgical care.
Coverage for residential care usually depends on:
- Medical necessity, often assessed with ASAM Criteria
- Prior authorization and ongoing reviews during your stay
- In-network vs. out-of-network status, which can greatly change your costs
- Your deductible and out-of-pocket maximum
Plans differ by state, employer and plan type (HMO, PPO or EPO). Medicaid coverage for residential care varies by state. Medicaid has long limited payment to larger mental health and addiction facilities, but many states now use federal waivers to cover residential treatment. Costs vary widely by program, setting and length of stay. Learn more about the cost of rehab.
How do you choose a good residential program?
Look for:
- A current state license for residential substance use treatment. Check your state's health or behavioral health agency.
- Accreditation from The Joint Commission or CARF (Commission on Accreditation of Rehabilitation Facilities).
- Licensed clinical staff, such as counselors, therapists, nurses and an addiction medicine physician or psychiatrist.
- Evidence-based care, including therapy approaches like CBT and access to medication.
- Family involvement and a clear plan for aftercare.
Be cautious of red flags:
- Patient brokering: recruiters paid per admission. Kickbacks for referrals to treatment facilities and recovery homes are illegal under the federal Eliminating Kickbacks in Recovery Act of 2018 and many state laws.
- Free flights, travel or gifts to attend an out-of-state program.
- "Free rent" sober homes tied to attending a specific outpatient program.
- Promises of guaranteed success or "100% covered" care before anyone checks your benefits.
- Pressure to admit immediately without a clinical assessment.
Our guide on how to choose a rehab lists more questions to ask.
What happens after residential treatment?
Leaving residential care is a big change, so most people step down gradually. Common next steps include partial hospitalization, intensive outpatient care, standard outpatient therapy, ongoing medication, and sober living homes. Peer support groups and recovery coaching can help you stay connected.
A good program will start planning your aftercare soon after you arrive. To compare residential programs that fit your needs and insurance, call (877) 847-2855 to reach our admissions helpline. It's free and confidential.
