Drug addiction treatment runs as a sequence, and knowing the sequence removes most of the fear of starting. It begins with a phone call and an assessment, moves through detox if you are physically dependent, and then steps down through partial hospitalization, intensive outpatient, and standard outpatient care over the following year. Each level hands off to the next. This post walks through what happens at each step, how long it takes, and what it feels like from the inside, based on how treatment works at Rockland Recovery and at most programs like it.
Step One: The Call and the Assessment
The first call is a conversation, not an interrogation, and it takes about 20 minutes. An admissions coordinator asks what you are using, how much and how often, how long it has been going on, whether you have been through treatment before and what happened, what your living situation is, and what insurance you have. From that, a clinician recommends a starting level of care, using the American Society of Addiction Medicine criteria, which is the same framework your insurer uses. Admissions verifies your coverage at the same time, so by the end of the call you know what is recommended and roughly what it will cost.
You do not need to know what level of care you need before you call, and you do not need to have decided anything. Many people call to ask questions and start a week later. Some start the next day. Family members can make the first call on someone’s behalf and complete most of the insurance verification before the person ever picks up the phone.
Step Two: Detox, If You Need It
Not everyone needs detox. People who are physically dependent do: daily heavy alcohol use, daily benzodiazepine use, and daily opioid use each produce a withdrawal that should not be attempted alone. Alcohol and benzodiazepine withdrawal can cause seizures and can be fatal. Opioid withdrawal is rarely dangerous on its own but is severe enough that almost nobody finishes it without medical help, and starting buprenorphine during withdrawal is the safest way to begin. Detox takes a few days to a week under medical supervision.
Rockland Recovery does not run detox or residential rehab. When your assessment shows you need either, we refer you to a partner facility in Massachusetts and plan your admission to our program for the day you are discharged. Detox that ends with a list of phone numbers is the standard prelude to relapse. Having the next step arranged before you go in is the point of doing it this way.
Step Three: Partial Hospitalization
Partial hospitalization (PHP) is five to six hours of treatment a day on weekdays while you sleep at home or in sober living. It is the usual starting point after detox and for many people the starting point directly. The first day or two are orientation and the rest of the assessment: a psychiatric evaluation, a medical history, and a treatment plan you help write. Then the schedule starts, and most of it is group therapy, with individual sessions weekly, psychiatric care and medication management as needed, and a case manager for the practical side. Nobody will make you tell your story to a room on day one. Most people spend two to four weeks in PHP.
Step Four: Intensive Outpatient
Intensive outpatient (IOP) is about three hours a day on three to five days a week, for six to twelve weeks, with schedules built so you can work. This is where most of the actual therapy in recovery happens: you practice the skills during the day and test them in real life that evening, then come back and talk about what happened. Group therapy is still the backbone, individual therapy continues weekly, and medication management continues on its own schedule. Our guide to PHP vs. IOP explains how the two intensive levels differ and how to tell which one you need.
| Step | What happens | How long | Where |
|---|---|---|---|
| Call and assessment | Clinical interview, level-of-care recommendation, insurance verification | About 20 minutes, same day | Phone |
| Detox (if physically dependent) | Medically supervised withdrawal; buprenorphine started for opioids | A few days to a week | Partner facility |
| Residential (if needed) | Live-in treatment for people who have relapsed after outpatient care or have no safe home | Typically about a month | Partner facility |
| Partial hospitalization | 5 to 6 hours a day on weekdays; groups, individual therapy, psychiatry, medication | 2 to 4 weeks | Rockland Recovery, home or sober living at night |
| Intensive outpatient | About 3 hours a day, 3 to 5 days a week; skills practiced in real life | 6 to 12 weeks | Rockland Recovery, while working |
| Standard outpatient | Weekly therapy tapering to monthly; medication management; peer support | A year or more | Rockland Recovery |
Step Five: Outpatient Care and the Long Year
Standard outpatient care is one to three hours a week: an individual session, sometimes a group, and medication management monthly once stable. It lasts a year or more, tapering from weekly to every other week to monthly. People tend to think of this as the wind-down. It is where most of the time in recovery is spent and where the skills learned in PHP and IOP either take hold or do not. Peer support outside the program, whether twelve-step, SMART Recovery, or a recovery community center, fills the days between sessions, and the alumni program keeps you connected to the people you went through treatment with. Our addiction aftercare page describes how these pieces fit together.
What Runs Alongside All of It
Medication, when it is indicated, starts early and continues through every level. For opioid use disorder that means buprenorphine (Suboxone) or naltrexone (Vivitrol), which roughly halve the risk of overdose death. For alcohol, naltrexone or acamprosate. Psychiatric medication for depression, anxiety, or other co-occurring conditions is managed by the same prescribers, because most people in addiction treatment have a mental health condition underneath the use and treating one without the other tends to fail. Family sessions are available at every level. Sober living, for people whose home is where the using happened, can be combined with any outpatient level; Rockland Recovery’s homes are MASH-certified and cost $275 a week alongside treatment.
What It Feels Like
The first week is disorienting. You are in a room with strangers, your body is adjusting, and the structure feels like a lot. By the second week most people have said something in group, learned a few names, and stopped watching the clock. Somewhere in the first month, the hour you dreaded becomes the one you look forward to. Somewhere in the second or third month, the crisis part of recovery ends and the ordinary part begins, and that is its own adjustment, which is what outpatient care and peer support exist for.
If you relapse during treatment
It happens, and it is not the end of treatment. A relapse is a reason to reassess the level of care, not to leave. Sometimes the answer is a step back up to PHP; sometimes it is a return to a partner detox with a plan to come back. Nobody at a good program is turned away for having used, and the people who do worst are the ones who disappear out of shame rather than calling. For opioids, the weeks after a period of abstinence are when overdoses happen, so keep naloxone within reach.
Paying for It
With commercial insurance, your cost is your deductible and copays. Federal parity law requires plans to cover addiction treatment the way they cover medical care, and Massachusetts Chapter 258 requires up to 14 days of medically necessary inpatient treatment with no prior authorization, which covers the partner detox for most people. Our post on whether insurance covers rehab goes plan by plan. We do not accept MassHealth, Medicare, or other state insurance; the Massachusetts Substance Use Helpline at 800-327-5050 maintains a live list of programs that do. The full picture of our substance use programs is on the drug rehab in Massachusetts page, and our intensive outpatient program page describes the level where most people spend the longest.
—This article is for information and does not replace advice from a licensed clinician. If someone is unresponsive, breathing slowly, or has blue lips after using opioids, give naloxone if you have it and call 911. The Massachusetts Good Samaritan law protects people who call for help during an overdose. For a mental health crisis, call or text 988.
