A Residential Rehab Checklist

You may be about to live at a program, or to send someone you love there, and the brochure is not answering the questions that keep you up. Residential treatment means you live at the program while you are in care. SAMHSA says that stay is usually a few weeks to a few months, and that more serious conditions can mean a year or more. NIAAA, writing about alcohol, places residential care in a 24-hour setting, at lower or higher intensity, separate from a medically directed inpatient unit that may manage withdrawal. The questions below are how those agencies say to look at a program. They are not a ranking, and they do not name a facility. The choosing guide gives a shorter cross-setting list. The admissions guide covers the phone call. The list here is the residential file: license, accreditation, staff, medicine, and what happens after you leave.

If someone is in withdrawal with a seizure, severe confusion, or trouble breathing, call 911 before you compare brochures. For a mental health crisis, call or text 988.

Confirm what "live-in" means at that program

Ask how long people usually stay, and what would make a stay shorter or longer. SAMHSA's range is weeks to months, sometimes longer. A fixed "28 days" on a website is a marketing length until the program can say how it is chosen for you. Ask whether you can leave the site, who you can contact, and how family is included. SAMHSA says family members can be part of treatment as the person in care wants, because families can help someone understand the impact of the illness and offer support. Inclusion is not the same as a family member running the treatment plan.

Ask which problems the residence is built for. SAMHSA says some residential programs help people with severe mental health conditions prepare to live in the community, and others help people stop using drugs or alcohol. A campus that treats every admission the same way should be able to say so plainly.

NIAAA's consumer handout says treatment programs usually do not offer medical management of withdrawal, and that help with withdrawal comes from a health care provider. Ask who watches withdrawal, whether that person is a clinician, and what happens at night if someone seizes. Do not assume a locked door is medical care. The withdrawal guide explains why that question matters for heavy alcohol use. It is not a home plan you follow while you pack.

License, then accreditation

NIAAA separates three words people mix up.

A license is permission to practice. The state where the program operates issues it. Each state sets its own rules and its own renewal schedule, and the rules differ for physicians, therapists, and programs. For a treatment program, NIAAA's minimum is a current license, usually from the state agency that oversees addiction or mental health services. Ask for the license type and the place you can look it up. A scanned certificate in an email is weaker than the state record.

Certification, in NIAAA's definition, is a sign of specialty training, often coursework plus an exam, usually from an independent board. A physician can be board certified in addiction medicine. A psychiatrist can be board certified in addiction psychiatry. A counselor might hold a certification such as National Certified Addictions Counselor or Master Addiction Counselor. Certification is about a person's extra training. It is not the facility's license.

Accreditation is about the facility. NIAAA says it means the program passed an independent review of procedures, records, staff, and facilities. It is usually granted for three to five years, and then the review has to be done again. The agencies NIAAA says most often do that review are The Joint Commission, CARF, and the National Committee for Quality Assurance. The credential table also lists the Council on Accreditation as an above-minimum mark for programs, along with counselors who are licensed and trained in addiction treatment. Ask which body accredited the program and when the current review expires.

SAMHSA's quality page says programs and their health care professionals should be licensed and accredited. Passing a review is evidence of a process. It is not a promise that you will do well there, and it does not replace the state license. A program can be licensed and still be a poor match. A glossy seal with no state license is not a pass.

Staff you can ask to name

NIAAA's table is a floor, not a ceiling. It says a license is common and still may not mean the person has the expertise you need.

For the program, the floor is the current state license. Beyond that, NIAAA points to accreditation and to counselors who are licensed and trained to treat addiction. Individual clinicians have their own floors: a doctoral degree and a current license for a clinical psychologist; a master's degree and a current license for professional counselors, marriage and family therapists, and clinical social workers; a medical degree and a current license for physicians and psychiatrists. Extra marks include addiction-specific counseling credentials and, for doctors, board certification in addiction medicine or addiction psychiatry.

You do not need to audit every diploma on the first call. You do need a straight answer to who assesses you, who leads counseling, and who can prescribe. SAMHSA says therapy usually happens with a licensed behavioral health professional. If the only description is "meetings all day," ask who is licensed.

Medicines and therapies with names

SAMHSA's quality checklist says to ask about evidence-based practices. The examples it lists include motivational interviewing or motivational enhancement therapy, cognitive behavioral therapy, cognitive processing therapy, education about the condition, supportive therapy, social skills training, and, for youth, behavioral management training. Ask which of those are actually on the schedule, not which words appear in a brochure.

For drug or alcohol use, SAMHSA says the program should provide only FDA-approved medication for alcohol, tobacco, or opioid problems. There are currently no FDA-approved medicines whose purpose is to prevent a return to methamphetamine or cocaine. A program that claims a special shot or supplement for those substances is offering something SAMHSA does not describe as approved treatment. Clinical trials, if any, are listed on ClinicalTrials.gov, not in an admissions pitch.

Ask whether prescribed buprenorphine, methadone, or naltrexone can continue if a clinician has already started them. Stopping a working medicine to fit a house rule is a clinical decision, not a loyalty test. The medication FAQ explains what those medicines are for.

After you leave the building

SAMHSA says quality programs support other parts of life: other medical care, and benefits such as housing, food assistance, job placement, supported employment, and long-term recovery. Ask which of those the program provides and which it only mentions. NIAAA says alcohol treatment, across settings, is measured in months, not days or weeks, and that detox or a residential stay is not the whole course. The aftercare guide covers that next step. Get the plan in writing for the town you will live in, including who you see in the first week after discharge.

Search FindTreatment.gov. The finding guide explains what a locator listing means. Names of residences stay on that locator. SAMHSA's National Helpline is 1-800-662-HELP (4357). Call or text (800) 653-9376 if you want those questions asked of programs that take referrals.

Additional Resources

Sources cited on this page:

• SAMHSA: Finding quality treatment
• SAMHSA: Treatment types for mental health, drugs, and alcohol
• NIAAA Alcohol Treatment Navigator: license, certification, and accreditation
• NIAAA: Recommend Evidence-Based Treatment: Know the Options
• NIAAA: Options for people who are thinking about their drinking
• SAMHSA FindTreatment.gov
• SAMHSA National Helpline
• 988 Suicide & Crisis Lifeline

Common Questions