Levels of care

Treatment comes in levels. Most programs use a national guide called the ASAM Criteria. Its current version is the 4th edition, published in 2023. The idea is simple: you get the amount of care you need now, and you move up or down as that changes. [1][2]

The levels, from most care to least

Inpatient (Level 4).Hospital-level care with doctors and nurses around the clock. For serious medical or psychiatric danger.
Residential (Level 3).You live at the program. Staff are there 24 hours. At the higher levels, a doctor oversees withdrawal and medical needs.
Withdrawal management ("detox").This is no longer its own separate level. It happens inside the levels that have medical staff. Detox alone is not treatment. It should lead to a next step. [3]
High-intensity outpatient (Level 2.5).This used to be called partial hospitalization, or PHP, and many programs still use that name. At least 20 hours of treatment a week, and you go home at night. [2][4]
Intensive outpatient, or IOP (Level 2.1).9 to 19 hours a week. [2]
Outpatient (Level 1).Regular counseling and medical visits, fewer than 9 hours a week. [2]

Sober homes are not treatment

A sober home, also called a recovery residence or sober living, is housing. It is a place to live without alcohol or drugs while you go to treatment or after you finish. The national standard (NARR) describes four types:

Level I, peer-run:residents run the house together. Oxford Houses are an example.
Level II, monitored:a house manager and house rules.
Level III, supervised:trained staff and weekly structured recovery programming.
Level IV, clinical:treatment is provided on site, so it should be licensed as treatment. [5]

A sober home is housing, so it has no treatment to bill your insurance for. Many sober homes are connected to an outpatient program, often an IOP, and that program bills your insurance for treatment. Insurance pays for treatment, not rent. If a home gives you free rent for going to a certain program, that is a red flag. If a sober home itself bills your insurance, it should have a treatment license. [6][12][8]

What good care looks like

Someone assesses you before deciding your level, and explains why.
You can see a written plan, and it changes as you change.
Your rent is a separate agreement from your treatment. It does not depend on your insurance, and you don't have to attend a certain program to keep your room. In California, this is required when the treatment program owns or runs your housing. Any rent they cover has to be paid back under a written plan. [6]
You can leave. You can choose a different program.

Red flags

Free rent, free flights, cash, gifts, or phones, if you go to a certain program. [6][7]
The program and the sober home won't tell you whether they have the same owner. In California, a treatment program has to report to the state if its owners have a financial interest in a sober home. You can ask them directly. [14]
Pressure to move to another state, or to a specific city, fast.
Questions about your insurance before anyone asks about your health.
Being moved between programs or levels without a clear reason, or being sent back to detox after each relapse to start over.
Urine tests many times a week with no one explaining why or going over the results. In one Florida case shown to a grand jury, a provider billed one patient's insurance more than $600,000, mostly for drug tests, in seven months. [7]
Being told you will lose your housing if you leave a certain program. In California, a program that offers you housing can't make it depend on using its services. [6]
Being asked to sign over your food stamps, cash aid, or Medicaid. Arizona bans this for licensed sober homes. [8]

Are levels the same everywhere?

Partly. The ASAM levels are a national standard, and many states use them. California requires every licensed residential program to hold a DHCS or ASAM level-of-care designation. [9] Pennsylvania switched all licensed treatment programs to ASAM in 2018. [10]

What differs is everything around the levels: what the state calls each program, what staff it requires, and how it licenses them. Florida's licenses use its own names, like "day or night treatment with community housing." [11] Sober homes differ the most. Arizona requires them to be licensed, Florida certifies them voluntarily, and California does not license housing-only homes at all. So the same name can mean different things in different states. Ask what the program is licensed for.

General information only. This is not legal or medical advice. Rules vary by state, county, and city. Last verified November 2026.

Sources

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