Partial Hospitalization Programs (PHP): What Are They, and Are They Effective?
Partial hospitalization programs, or PHPs, are outpatient treatment programs that help people end an addiction for the long-term. A PHP involves intensive daytime programming for people who have completed an inpatient treatment program or those who are entering treatment but don’t require inpatient care. Here’s what you need to know about partial hospitalization programs.
Partial Hospitalization Programs and the Continuum of Care
The continuum of care is a leveled protocol for addiction treatment. People in recovery enter the continuum at the level of care best suited to address needs and move along the continuum as they complete each level. The American Society of Addiction Medicine identifies four levels in the continuum of care: 1
Level 1: Outpatient
Level 1 is outpatient treatment, which is the least restrictive of the levels and involves living at home and attending up to nine hours of programming each week at an outpatient treatment center.
Level 2: Intensive Outpatient
Level 2 is intensive outpatient treatment and consists of two sub-levels. The partial hospitalization program is the most intense level, involving 20 or more hours of programming each week. Intensive outpatient treatment is the lower level, consisting of nine or more hours of programming each week.
Level 3: Clinically Managed Inpatient
Level 4: Medically Monitored Inpatient
Level 4 is medically monitored inpatient treatment, and it’s the most intensive and restrictive of the levels. It involves around-the-clock nursing care and daytime care under the supervision of a physician.
Entering or continuing through the continuum at the partial hospitalization program level provides strong support while you work on developing a sober lifestyle and resolving issues that underlie the addiction.
Partial hospitalization programs aren’t for everyone. Entering treatment at the PHP level generally requires that you have:
- A safe and stable place to live
- A high level of intrinsic motivation to recover
- Good physical and mental health, aside from the addiction
- Reliable transportation to the treatment center for daily programming
- A high level of support at home and in the community
Four Stages of Treatment for Recovery from Addiction
Regardless of the level at which you enter treatment, you’ll move through four stages during the course of rehab, according to the Substance Abuse and Mental Health Services Administration:2
The more engaged you are in your treatment plan, the better your chances of successful recovery. People who don’t stay in treatment for an adequate period of time are at a high risk of relapsing. During the first phase of treatment, which typically takes place in a detox program, care providers focus on getting you engaged and excited about treatment.
In early recovery, beginning after detox, clients get into a routine that supports abstinence. During early recovery, clients learn to resolve problems, develop a healthy lifestyle and make important changes in patterns of thinking and behaving.
During the maintenance phase, clients put to work the skills and strategies learned and continue to learn in treatment. They work on developing a strong support system at home and in the community, and they continue to work through their problems and improve emotional functioning.
The last phase of treatment is about sustaining recovery through involvement in the community, participating in a support group, engaging in a healthy lifestyle and finding new interests and enjoyable hobbies.
Detox: The First Step of a Partial Hospitalization Program
The first step of treatment is detox, which is the process of allowing all traces of drugs or alcohol to leave the body so that brain function can begin to return to normal. During medical detox, medical professionals provide medications as needed to reduce the intensity of withdrawal symptoms and prevent or treat dangerous symptoms.
Complementary therapies are used during detox in high-quality treatment programs help engage clients in treatment and improve wellbeing. These therapies often include restorative yoga, meditation, acupuncture or massage. Motivational interviewing is a therapy used to help you identify and solidify your own intrinsic reasons for wanting to recover from your addiction.
During detox, a range of assessments help care providers determine the level of care you need, and they guide the development of a highly individualized treatment plan that’s designed to address your unique needs, issues and challenges.
Once detox is complete, you’ll begin your partial hospitalization program.
What to Expect in a Partial Hospitalization Program
Detox addresses the physical dependence on drugs or alcohol, but it does little to treat the addiction, which is far more complex. Your PHP will involve 20 hours or more sessions each week, which typically adds up to four to six hours, five days a week. Sessions will involve a variety of traditional and complementary therapies, classes and interventions that are designed to help you improve your life on all fronts and remove the need to use drugs or alcohol to cope.
Traditional therapies typically used in PHPs include cognitive-behavioral therapy, acceptance and commitment therapy and dialectical behavior therapy. These therapies help you address a range of issues and develop healthier thought and behavior patterns.
Complementary therapies used in PHPs may include mindfulness meditation, art or music therapy, horticultural therapy or a daily yoga practice. These therapies help increase self-awareness, self-confidence and self-esteem and provide a way to express difficult emotions and experiences and look at old problems in new ways.
Psychoeducational classes help individuals better understand addiction and how it develops and progresses. They offer information about a range of addiction-related topics, including how recovery occurs and how to prevent relapse.
Provided as needed, other interventions may include educational or vocational assistance, legal help, housing assistance or medical or mental health care.
Through these therapies, classes
- Identify and replace dysfunctional ways of thinking and behaving
- Address complex underlying issues, which often include chronic stress, a history of trauma or a co-occurring mental illness
- Develop coping skills for negative emotions, stress, cravings and other relapse triggers
- Find purpose and meaning in a life of sobriety
- Learn to have fun without drugs or alcohol
- Repair damaged relationships and improve the functioning of the family system
- Develop a healthy lifestyle
- Develop healthier relationship and communication skills
During treatment, you’ll learn a great deal about yourself, and you’ll gain perspective and clarity that will promote a successful recovery.
The Goals of Partial Hospitalization Programs
Different partial hospitalization programs offer different types of programming, but all PHPs have the same overarching goals, according to the Substance Abuse and Mental Health Services Administration.
The goals of a PHP include helping clients:
- Achieve abstinence
- Change dysfunctional thought and behavior patterns
- Create a new, non-using lifestyle
- Address a broad range of needs and problems
- Facilitate participation in a community-based support group
- Develop a strong support system outside of treatment
- Improve problem-solving, coping and decision-making skills
According to the National Institute on Drug Abuse, the recommended duration of PHP treatment is 90 days. 3 Anything less is of limited effectiveness.
Once you complete the PHP, you’ll step down to intensive outpatient treatment, then outpatient treatment. By the end of treatment, you’ll have the arsenal of tools, skills, and strategies to fly solo in recovery. A comprehensive aftercare plan will include participation in a support group to help you stay mindful in recovery.
Partial Hospitalization Programs Work and It Can Work for You
According to an article published in Psychiatric Services,