What is a PHP? A Partial Hospitalization Program (PHP) is a type of outpatient treatment program that has been found effective in treating addiction. These programs are designed to help people who can benefit from structured treatment but who do not need medical assistance or supervision 24 hours a day. PHP programs can be modified or customized to fit the requirements of the patient, and treatment can be delivered at varying care levels.
The treatment in this sort of program is intensively focused on the patient’s recovery, and it takes place in an environment that fosters the patient’s transition out of addiction and into a responsible, productive life. PHP programs are an alternative to residential or inpatient treatment options, and they may be more intense than other outpatient treatments.
What Is the PHP Treatment Model?
A Partial Hospitalization Program might make use of a number of different therapies to achieve its goals. Among the options commonly employed by these programs are:
Individual therapy
Addiction counselors or other health professionals consult with the patient to explore the triggers and causes of drug or alcohol use. The goals of this type of therapy are to address the patient’s denial and the underlying causes of the addiction so that they can focus on the recovery process.
Group therapy
Sessions in group therapy involve an addiction treatment counselor and a group of people who are recovering from addiction. The people in the group are encouraged to discuss emotions, experiences, coping mechanisms, aspirations and anything else that could be related to overcoming drug or alcohol addiction.
Family therapy
In this sort of therapy, members of the patient’s family, along with an addiction therapist, meet together to help the patient see the reality of the situation and to guide him or her to recovery. In some cases, a family member can be an enabling factor or even the cause of the addiction, but family therapy can provide a safe environment to address these issues.
History of Partial Hospitalization Programs
Partial Hospitalization Programs were originally developed in the 1960s with a focus on the treatment of mental illness. They were designed to help people who needed an intensive level of care but who would also benefit from being part of the community. It was also meant to help people who were struggling with mental disorders but who had safe, stable homes to return to the following treatment.
The Medicaid regulations changed in the 1980s, making Partial Hospitalization Programs more viable for health care and recovery centers. The number of partial hospitalization options nationwide increased significantly through the 1990s until restrictions were placed on them. Around that same time, the idea began to take hold that addiction was tied to mental and behavioral illness rather than being simply a question of willpower.
Partial Hospitalization Programs are still primarily designed to help individuals who have mental health issues, but there is significant overlap of this group with those who want to stop using substances or alcohol. The programs developed into a method of helping those people who want to overcome addiction without joining an inpatient program.
Who Can Benefit From a Partial Hospitalization Program?
Partial Hospitalization Programs are often recommended for people who have already gone through inpatient addiction treatment and who can benefit from transitional coaching as they reintegrate into the community. They are also recommended for people who need more structure and supervision than is available in traditional outpatient treatment programs.
On the other hand, a PHP might not be right for people who need constant monitoring or who do not have transportation or housing. Inpatient treatment may be a better option for people who:
- Will be tempted to do drugs if they return to their homes and social circles
- Are homeless
- Are victims of domestic abuse or other violence
- Have learning disabilities or structural brain issues and will not benefit from PHP therapy sessions
- Require 24-hour medical supervision or care following an overdose
- Might become dangerous due to withdrawal symptoms
- Need a methadone treatment program
- Lack community or family support
Primary Functions of Partial Hospitalization Programs
A taxonomy has been proposed for PHP options. Three primary functions of partial hospitalization treatment have been identified.
First, it is an alternative to more restrictive inpatient treatment. Second, it is a supplement to traditional vocational rehabilitation or outpatient treatment. As an outpatient supplement, a Partial Hospitalization Program can provide added intensity periodically throughout the treatment without requiring admission into the hospital or treatment center. Third, a Partial Hospitalization Program can provide an opportunity for functional maintenance while the patient remains part of the larger community.
Variations of Partial Hospitalization Programs
The ways in which medical appointments and therapy can be scheduled and structured might vary widely among different PHP options. They are often flexible enough to change with the needs of the patient. The number and structure of the therapy sessions required might range from as little as two hours each day for three days a week up to eight hours each day for five days a week.
Different Partial Hospitalization Programs might make use of many different types of mental health and other health care professionals. Among those who could be involved are:
- Social workers
- Occupational therapists
- Recreational therapists
- Psychiatrists
- Psychologists
- Nurses
- Pharmacists
- Peer support workers
Most Partial Hospitalization Programs require between four and five days of therapy each week, and each therapy session can range from four to eight hours. The day will have breaks scheduled in to break up intense therapy sessions. Typically, a minimum of 10 hours per week is required, and it is rare for patients to attend therapy sessions for more than 50 hours per week. On average, patients attend treatment for 20 hours a week.
PHP Versus Inpatient Treatment
Inpatient treatment for substance or alcohol abuse requires patients to live in a treatment facility 24 hours a day. Patients in this type of treatment program are separated from their previous lives. This means the patient has barriers between themselves and the outside world of influences, both positive and negative. The idea with an inpatient program is to provide a safe environment so that a patient can focus solely on sobriety and overcoming the issues that led to addiction.
Therapy sessions during inpatient treatment might make use of many of the same techniques and professionals that Partial Hospitalization Programs use. Typically, an inpatient program lasts at least 30 days, and some programs last as long as a year. The length of the program depends on a number of factors, including the patient’s specific plan of treatment, the severity of the patient’s addiction and the patient’s other obligations.
People who are in an inpatient addiction treatment program typically go through the phases of detoxification, hospitalization and residential treatment. All of these components take place while the patient lives at the treatment facility. A Partial Hospitalization Program, by contrast, allows the patient the freedom to move between the treatment facility and the outside community. In a partial hospitalization scenario, the patient shows up to the hospital at scheduled times for therapy and returns home after the session is over.
PHP Versus Outpatient Treatment
Outpatient treatment is a strong option for people who are dealing with substance or alcohol use but who do not meet the diagnostic criteria for inpatient or residential treatment. It can also be useful in providing continued support for patients after they’ve been discharged from an inpatient program.
This type of therapy is less costly than inpatient options and works well for people who have a solid support structure and other obligations outside of therapy. While they are less intensive than inpatient treatment options, many outpatient programs are effective because of their drug education components.
Partial Hospitalization Programs, by contrast, are a high-intensive treatment option. While outpatient addiction therapy might call for only weekly or biweekly sessions totaling less than eight hours of treatment, PHP options usually demand a minimum of 10 therapeutic hours per week.
The popularity of Partial Hospitalization Programs
Nationwide, Partial Hospitalization Programs have grown tremendously in popularity in recent years. This growth might be a reflection of certain benefits offered by partial hospitalization methods over other treatment options. According to the findings of a research study, 2.5 percent of non-disabled adults and 5.4 percent of disabled adults chose PHP options for treatment of addiction. The study covered a group of 32,037 people.
The authors of the study said the low percentages of people choosing PHPs might be due to a lack of public knowledge about the existence or effectiveness of these programs. As they are becoming more popular, though, PHPs are likely to draw increased attention from researchers and addiction patients alike. This sort of therapy has also shown promise in treating eating disorders.
PHP Benefits
A Partial Hospitalization Program can be the ideal way for a patient dealing with addiction to transition from inpatient treatment, which is the most intense and highest level of treatment, to outpatient treatment, where there is significantly less supervision and structure. Generally, PHPs are significantly more affordable than inpatient programs, which means more people can afford to get help.
All forms of addiction treatment were made more widely available to Americans by the Affordable Care Act, and insurance companies are more likely to approve payment for PHP options than they are for inpatient treatment. Because PHPs offer a longer treatment period at a reduced cost, insurance funds are likely to last longer for people in PHP treatment.
These programs also allow people who need addiction treatment but also have another home, work or family obligations to get treatment on terms that don’t demand all of their time or attention. The flexibility of PHPs and the reduced hours they require leave time for the patient to schedule and address other commitments. Participants in Partial Hospitalization Programs also have the chance to develop new or existing support communities with people who are not part of the treatment.
Conclusion
PHPs offer something of a middle ground between inpatient and outpatient addiction treatment options. They are typically utilized by people who have been hospitalized for substance use and who have been discharged following some level of treatment for addiction. They might be effective for people who:
- Have a current diagnosis of a substance or an alcohol use disorder
- Need regular monitoring by medical professionals but are stable enough to spend significant time without supervision
- Are not at risk for self-harm
- Are mental, physically and emotionally capable of going through several hours of intensive therapy at a time for several days each week
- Have symptoms of detox that are moderate or mild and manageable without constant medical oversight
- Are not currently capable of daily functioning but who have sufficient family and community support to avoid relapse
Partial Hospitalization Programs commonly offer detox support, but it is also common for patients to go through detox in an inpatient program and then join a PHP following inpatient treatment. Withdrawal symptoms only rarely rise to the level of threatening the life of the patient, but they can. Withdrawal from a severe addiction to alcohol or benzodiazepines can be life-threatening and may require 24-hour supervision to watch for heart attacks, seizures or other dangerous side effects until the patient has cleared the initial withdrawal period.
PHPs can be a good option for people who are tapering down their alcohol or substance use or who can make use of intensive therapy to alter their behaviors. These programs also act as an effective transition plan between inpatient and outpatient therapy options. People who believe they might benefit from addiction therapy should consider and discuss their options with medical professionals or trusted friends and family so that they can make an informed decision about the treatment option that may be the most effective for them.
