Before you say yes to residential treatment.
Residential treatment is the loudest option in the substance use system. For some people it is empirically the right starting point. For many others, it is not. This walkthrough helps you think through factors a thoughtful clinician would consider, so you can have a more informed conversation with one.
About a dozen plain-language questions, one screen at a time. You can stop and back up whenever.
Everything runs in your browser. We do not see, save, or share your answers.
Every clinical claim links to public guidance from SAMHSA, NIDA, or NIAAA.
Byline: AvoidRehab Editorial Team. Clinically reviewed by licensed clinicians with expertise in substance use disorder. Published 2026-05-02. Last reviewed 2026-05-03.
What this walkthrough covers
The walkthrough is organized around five plain-language sections. It produces one of six possible "things to consider" outcomes, each tied to specific answers, never to a calculated score. It does not diagnose, prescribe a level of care, or claim clinical validity.
- Section 1: What is actually happening physically. Substance, frequency, duration, withdrawal history. Drives the question of whether medical detox is medically necessary. Drawn from SAMHSA TIP 45 and TIP 63.
- Section 2: Is there an immediate crisis. Suicidality with plan or intent, active psychosis or mania, pregnancy with active use, or acute medical instability. These route to emergency care, not rehab.
- Section 3: What is home and daily life like right now. Stable housing, active use in the home, domestic violence, day-to-day functioning, support system. Drawn from SAMHSA TIP 42.
- Section 4: What has been tried, what is wanted. Prior treatment, current goal (abstinence, moderation, or harm reduction), readiness to change. Drawn from SAMHSA TIP 35 and NIDA Principles.
- Section 5: What does the math say. Insurance, time off work, caregiving obligations, transportation. Real-world feasibility factors that determine which treatment will actually be attended.
The six possible outcomes
Based on a user's answers, the result page surfaces one of six framings. None of them are prescriptions; all are starting points for a conversation with a licensed clinician.
Medical or psychiatric emergency
Suicidality with plan or intent, active psychosis or mania, or acute medical instability. Routes to 988, 911, and the SAMHSA National Helpline at 1-800-662-HELP.
Withdrawal management is the right first step
Alcohol with prior withdrawal seizure or DT history, long-term benzodiazepine use, or daily illicit opioid use. Days of supervised withdrawal management, not weeks of residential.
A 24-hour structured setting may fit
Daily-life functioning, subacute psychiatric symptoms, or a destabilized recovery environment. Could mean residential treatment, or a recovery residence (sober-living house) paired with outpatient.
IOP or PHP deserves a hard look first
Significant use plus environmental complexity, or prior outpatient that was not enough. Intensive outpatient (9 to 19 hours per week) or partial hospital (20+ hours), often paired with medication.
Outpatient plus medication may be enough
Mild-to-moderate use with a workable environment. Weekly counseling and the right medication: buprenorphine, methadone, or naltrexone for opioids; naltrexone, acamprosate, or disulfiram for alcohol.
This may not require formal treatment at all
Use that does not meet typical clinical thresholds, or readiness that is not where formal treatment lands well. Brief intervention, harm reduction, peer support, and individual therapy are all on the spectrum.
For pregnancy with active substance use, the walkthrough routes to a perinatal-specific outcome: methadone or buprenorphine is standard of care for opioid use disorder in pregnancy, and abrupt cessation can cause fetal distress. This is drawn from SAMHSA TIP 63.
Frequently asked questions
Is the AvoidRehab Decision Walkthrough a clinical assessment?
No. The walkthrough is an educational tool, not a clinical assessment, screening instrument, or diagnostic test. It does not score users, produce a number, or compare answers to a population. Its purpose is to surface factors a thoughtful clinician would consider, so a person can have a more informed conversation with one.
How long does the walkthrough take?
About five minutes. It is roughly a dozen plain-language questions across five sections, one screen at a time, with the option to stop and back up.
Are my answers stored or shared?
No. The walkthrough runs entirely in your browser. State persists only in the URL hash on your own device. No answer set is sent to a server, logged, attributed, or retained.
What sources does the walkthrough use?
Every clinical claim traces back to publicly available federal guidance: SAMHSA Treatment Improvement Protocols (TIP 35, 42, 45, 63), NIDA Principles of Effective Treatment, and NIAAA Rethinking Drinking. Public-domain instruments referenced include CIWA-Ar, COWS, AUDIT, DAST-10, PHQ-9, and the Columbia C-SSRS. The full bibliography is at /decide/sources.html.
Is this affiliated with the ASAM Criteria or any proprietary level-of-care framework?
No. The AvoidRehab Decision Walkthrough is independent. It is not affiliated with, endorsed by, or derived from the ASAM Criteria, the LOCUS, the CALOCUS-CASII, or any other licensed level-of-care system. The five-question structure and six outcomes are AvoidRehab's own.
Does the walkthrough tell me whether I need rehab?
No. The walkthrough never prescribes a level of care. It surfaces factors and frames them as things to consider with a licensed clinician. The result page returns one of six outcome categories ranging from medical or psychiatric emergency to outcomes where formal treatment may not be needed at all.
Is the walkthrough appropriate for adolescents?
No. The walkthrough is built for adults. For anyone under 18, the appropriate first step is a pediatric or adolescent substance use specialist.
What should I do with my result?
Bring it to a licensed clinician. The provider prep PDF on each result page is a one-page printable checklist designed to make that first conversation more productive. Download the provider prep PDF.
Related reading
If you would rather read than walk through it, these articles cover the same ground:
- Outpatient vs Residential: how to think about it. The comparative-outcomes evidence in plain language.
- PHP vs IOP. The two outpatient options most often mistaken for each other.
- Medical detox vs at-home withdrawal. Three settings for withdrawal management, and how to choose.
- ASAM Criteria 4th edition. How clinicians decide what level of care fits.
- Medication for opioid use disorder. Why buprenorphine and methadone are first-line.
- The full map of evidence-based alternatives.
- Questions to ask any program before signing.
- Methodology behind this walkthrough and the full bibliography.