In crisis right now? Call or text 988 (Suicide and Crisis Lifeline) or call 911.
Methodology

How the AvoidRehab Decision Walkthrough works.

The walkthrough is an educational framework. It is not a clinical assessment, and it is not derived from any proprietary level-of-care system. Here is exactly what it is, what it draws on, and what it deliberately does not do.

By AvoidRehab Editorial Team. Clinically reviewed by licensed clinicians with expertise in substance use disorder. Last reviewed: May 2026.
TLDR
  • The walkthrough is an educational tool that helps users think through factors a thoughtful clinician would consider before residential rehab.
  • Every clinical claim traces back to publicly available federal guidance: SAMHSA TIPs 35, 42, 45, and 63; NIDA Principles of Effective Treatment; NIAAA Rethinking Drinking.
  • It does not diagnose, prescribe a level of care, or claim clinical validity.
  • It is not affiliated with, endorsed by, or derived from the ASAM Criteria or any other proprietary level-of-care framework.
  • The decision logic, structure, and category names are AvoidRehab's own.

What the walkthrough is

The AvoidRehab Decision Walkthrough is a self-paced set of plain-language questions that surface the factors a thoughtful clinician would consider before recommending residential treatment. It produces one of six "things to consider" outcomes, each tied to the specific answers a user gave. The walkthrough does not assume that residential treatment is wrong: for some people it is empirically the right starting point. It assumes that the decision should be driven by clinical factors, that residential length of stay should be tied to clinical progress rather than a fixed calendar, and that the system tends to default to residential when other options would fit better.

It is built for two readers: a person trying to figure out their own next move, and a family member trying to think through someone else's situation. Both are stressed, both have short attention spans, and both deserve plain language.

What it is not

  • Not a diagnosis. The walkthrough never tells you that you have a substance use disorder. Diagnosis is the work of a licensed clinician using DSM-5-TR criteria.
  • Not a level-of-care prescription. The walkthrough never tells you "you need IOP" or "you do not need rehab." It surfaces factors and frames them as things to discuss.
  • Not a validated screening instrument. The walkthrough is educational. It has not been studied, validated, or normed against any clinical population.
  • Not a substitute for a clinician. The most important thing a user can do with the walkthrough is bring its output to a licensed provider and have a real conversation.
About proprietary frameworks 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. We do not reproduce ASAM's six-dimension structure, level numbering, or decision rules. The five questions and the six outcomes in this walkthrough are AvoidRehab's own.

Source basis

Every clinical claim in the walkthrough traces back to one of the following publicly available sources. Most are free to download from federal agencies. The two clinical instruments referenced (CIWA-Ar and the C-SSRS framing) are public-domain or freely licensed.

SAMHSA Treatment Improvement Protocols (TIPs)

  • TIP 45: Detoxification and Substance Abuse Treatment. The federal reference for which substances require medical detox and which do not. Drives the alcohol and benzodiazepine pathways in the walkthrough, and the explicit note that stimulant and cannabis withdrawal do not require medical detox.
  • TIP 42: Substance Use Disorder Treatment for Persons With Co-Occurring Disorders. Covers the psychiatric crisis flags, environmental factors, and treatment-planning considerations.
  • TIP 63: Medications for Opioid Use Disorder. Drives the medication-first framing for the opioid pathway. Buprenorphine and methadone are first-line treatment.
  • TIP 35: Enhancing Motivation for Change in Substance Use Disorder Treatment. Drives the readiness-to-change question, the goal question, and the treatment of motivational interviewing as evidence-based.

NIDA

  • Principles of Effective Treatment (research-based guide). The framing that duration of engagement, not residential intensity, is the strongest predictor of outcome comes directly from NIDA's published principles.

NIAAA

  • Rethinking Drinking. Drinking-level thresholds (low-risk, heavy) come from NIAAA's public Rethinking Drinking materials.

Public-domain or freely licensed clinical instruments

  • CIWA-Ar (Sullivan et al., 1989, Br J Addict). The walkthrough does not score users on CIWA-Ar. It uses CIWA-Ar's symptom domains (prior seizure, prior DTs, tremor) to flag for the user that these symptoms matter to a prescriber.
  • COWS (Wesson & Ling, 2003, J Psychoactive Drugs). Used as background framing for the opioid pathway, not as a scored instrument.
  • AUDIT (WHO). Referenced for self-assessment in the minimal-treatment outcome.
  • DAST-10 (Skinner, 1982). Background reference for non-alcohol substance screening.
  • PHQ-9 (Pfizer / Spitzer). Not directly used in the walkthrough; cited in the source library for clinicians who want to follow up on co-occurring mood concerns.
  • C-SSRS (Columbia Lighthouse Project). The walkthrough uses only the core ideation framing (with vs without plan or intent) for the crisis question. It is not scored.
  • WHO mhGAP Intervention Guide v2.0. Background reference for crisis routing.

The five questions, in our voice

The walkthrough is organized around five plain-language questions, named by AvoidRehab. They map loosely to factors the source documents discuss, but the structure, naming, and flow are ours.

  1. What is actually happening physically? Substance, frequency, duration, withdrawal history. Drives the detox-or-not question. Drawn from TIP 45 and (for opioids) TIP 63.
  2. Is there an immediate crisis? Suicidality with plan or intent, active psychosis or mania, pregnancy with active use, acute medical instability. Drawn from TIP 42 and the C-SSRS ideation framing.
  3. What is home and daily life like right now? Stable housing, active use in home, domestic violence, support system, plus a separate question on whether daily-life functioning and any subacute psychiatric symptoms would let outpatient appointments actually be attended. Drawn from TIP 42 (treatment-planning factors and co-occurring disorders) and TIP 35.
  4. What has been tried, what is wanted? Prior treatment, current goal, current readiness. Drawn from TIP 35 and NIDA Principles.
  5. What does the math say? Insurance, time off work, caregiving obligations. Drawn from TIP 42's treatment-planning framework, applied to real-world feasibility.

The six outcomes

Based on a user's answers, the result page surfaces one of six "things to consider" frames. Each is tied to specific input flags, not a calculated score:

  1. Right now, this looks like a medical or psychiatric emergency. Triggered by suicidality with plan or intent, active psychosis or mania, or acute medical instability. Routes to 988, 911, and SAMHSA's National Helpline. Acute hospital-level needs are deliberately separated from residential treatment needs.
  2. Withdrawal management is the right first step. Triggered by alcohol with prior withdrawal seizure or DT history (or current severe pattern), long-term benzodiazepine use, or daily illicit opioid use without current medication. Result page describes three settings (at home with daily check-ins, a short residential withdrawal program, or a hospital), not a binary detox-vs-outpatient framing. For the opioid pathway, leads with medication induction (buprenorphine, methadone) followed by IOP or PHP, per TIP 63.
  3. A 24-hour structured setting may be a better fit than outpatient. Triggered when nothing rises to an emergency, but daily-life functioning, subacute psychiatric symptoms, or recovery environment makes outpatient unrealistic. Distinguishes residential treatment from a recovery residence (sober-living house) paired with outside outpatient. Length of stay is framed as tied to clinical progress, not a fixed calendar. Drawn from TIP 42 and TIP 45.
  4. Intensive outpatient or partial hospital deserves a hard look before residential. Triggered by significant use plus environmental complexity, or by prior outpatient that was not enough. Mentions PHP alongside IOP and recovery residences as an add-on. Frames the comparative-outcomes evidence from NIDA.
  5. Standard outpatient plus medication may be enough. Triggered by mild-to-moderate use with a workable environment. Leads with medication for opioid use disorder (TIP 63) and FDA-approved medications for alcohol use disorder.
  6. This may not require formal treatment at all. Triggered by use that does not meet typical clinical thresholds, or by readiness that is not where formal treatment lands well. Validates harm reduction, peer support, and brief intervention as legitimate alternatives.
One more outcome variant Pregnancy with active use routes to a perinatal-specific result that flags methadone or buprenorphine as standard of care for opioid use disorder in pregnancy and warns against abrupt cessation. Drawn from TIP 63.

What we deliberately do not calculate

The walkthrough does not score users. It does not produce a number, a percentile, or a comparison to a population. It does not store answers anywhere. The only state it keeps is in the URL hash on the user's own device, so that a result page is reproducible if shared.

What changes when we update this

The walkthrough's logic, copy, and source citations are version-controlled. When SAMHSA, NIDA, or NIAAA publish updated guidance, we revise. Substantive changes to logic or copy are noted on the sources page with a date.

Privacy

The walkthrough runs entirely in the user's browser. No answers are sent to a server. The site uses anonymous, aggregate analytics (page views, generic outcome counts) only. No individual answer set is logged, attributed, or retained. The full privacy policy is at /about/privacy.

Limits and caveats

  • The walkthrough is built for adults. It is not appropriate for adolescents under 18.
  • It is built around US treatment options (insurance categories, SAMHSA helpline, levels of care). The clinical logic generalizes, but the system-level recommendations do not.
  • It assumes the user can answer honestly. If the user is being assessed by someone else (court, employer, family pressure), the answers will skew, and the walkthrough's output will reflect that skew.
  • It does not capture every clinically relevant factor. A licensed evaluator using a structured interview will catch nuances this tool will not.

Bottom line

The walkthrough's purpose is one specific thing: to help a person who is being pointed toward residential treatment ask better questions before committing. The answer to "do I need residential?" is rarely yes-or-no, and the people selling fixed-length residential programs have a financial reason to push toward yes. For some people residential is the right starting point. For many others, structured outpatient with the right medication is. A few minutes of structured thinking, grounded in publicly available federal guidance, is the cheapest tool we know of to make that decision well.

The next move after this walkthrough is always the same: take what came up, bring it to a licensed clinician, and have a real conversation. The provider prep PDF is built for that conversation.