Families often arrive here looking for some honest answer to a simple question: what will the work actually look like?
At Roanoke Refuge, every treatment approach in our clinical toolkit has been evaluated against the research, is endorsed by SAMHSA, ASAM, or the National Institute on Drug Abuse (NIDA), and is delivered by clinicians specifically trained in its application.
We do not treat clinical models as ideologies. The best addiction clinicians meet each client where they are, use what fits that person’s presentation and goals, and adapt as the person changes across the course of treatment.
The framework rests on three foundations:
- an ASAM level-of-care assessment that determine each client’s level of care.
- Evidence-based therapies our team uses inside the program.
- The whole-person model that wraps clinical care around the practical realities of life in the Roanoke Valley.
What PHPIOP actually look like day to day comes through in each program’s clinical detail.
The ASAM Criteria and Level of Care Placement
All clinical placement decisions here are guided by the American Society of Addiction Medicine (ASAM) criteria, the most widely used and clinically validated framework for determining the appropriate level of care for substance use disorders.
an ASAM level-of-care assessment evaluate six dimensions during the admissions assessment, and the recommendation that comes out of that conversation is the level of care most likely to support sustained recovery for you, at this specific moment. The six dimensions are listed below so you can see the questions we are actually asking.
Dimension 1
Acute Intoxication and Withdrawal Potential. Does the patient need medically supervised detox first, or are they stable enough to begin outpatient treatment? When medically supervised detox is needed, our admissions team coordinates the referral with a local partner provider before the client begins PHP or IOP with us.
Dimension 2
Biomedical Conditions and Complications. Are there physical health conditions, including chronic pain, pregnancy, or co-occurring medical illness, that need to be factored into the treatment plan?
Dimension 3
Emotional, Behavioral, and Cognitive Conditions. Are there co-occurring mental health conditions such as depression, anxiety, post-traumatic stress disorder, or bipolar disorder that affect treatment needs? Untreated co-occurring conditions are among the most consistent biological drivers of recurrence of symptoms, which is why our dual-diagnosis approach treats them in the same program rather than in sequence.
Dimension 4
Readiness to Change. Where is the person in terms of motivation? This dimension shapes which therapeutic approaches will be most effective at this moment, including how aggressively Motivational Interviewing should be emphasized.
Dimension 5
Recurrence, Continued Use, and Continued Problem Potential. How high is the risk of return to use without intensive structured support, and what kind of structure best addresses that risk?
Dimension 6
Recovery and Living Environment. Is the home environment supportive of recovery, or does it present significant risk? This is the dimension where outpatient care earns its clinical case, because outpatient treatment writes the coping software against the real environment rather than a controlled one.
The six dimensions feed into the level-of-care recommendation: PHP at full-day outpatient for clients who need significant daily clinical structure, or IOP at part-day outpatient for clients with a stable living environment and the ability to integrate treatment with work and family obligations. Telehealth IOP is available for clients across the service area for whom in-person logistics are not realistic.
When medically supervised detox is needed, our admissions team coordinates the referral with a local partner provider before treatment begins with us.
Integrated Dual Diagnosis Treatment
Co-occurring mental health conditions appear in roughly half of clients seeking addiction treatment, with depression, anxiety, post-traumatic stress disorder, and bipolar disorder leading the list (NIDA, 2024). Treating one without the other usually fails. We have seen it enough times to build the program around treating both at once.
Leaving the underlying mental-health condition untreated is the most consistent biological driver of return to use, which is the smoke-and-fire problem at the center of the older sequential treatment model. Our integrated dual-diagnosis program handles both diagnoses inside one coordinated treatment plan rather than waiting for one condition to clear before addressing the other.
Whole-Person Care: Clinical Therapy in Context
Clinical therapy is the core of what we do, but recovery happens in the context of a whole life. Our case managers actively address housing stability, employment, legal obligations, childcare, and transportation, not as add-ons but as clinical priorities.
You cannot stay focused on group when you do not know where you are sleeping that night. You cannot rehearse new coping skills when transportation between Botetourt County and our Roanoke facility is not figured out. The case management work makes the clinical work possible. That is the point.
Whole-person care also means connecting clients to the existing Roanoke Valley recovery ecosystem before discharge. That includes:
- AA and NA meeting maps across Roanoke City, Salem, and the surrounding counties.
- SMART Recovery and Refuge Recovery options for clients who do not connect with traditional 12-step structures.
- Peer support organizations in the region.
- Coordination with Blue Ridge Behavioral Healthcare, the Salem VA Medical Center, and Carilion Roanoke Memorial Hospital for medical or psychiatric needs that extend beyond our scope.
Local, regional, and accessible.
Roanoke Refuge serves adults across the Roanoke Valley — Roanoke City, Salem, Vinton, and the surrounding counties of Roanoke, Botetourt, and Bedford — from a facility at 1630 Braeburn Drive in Salem, just off I-81. Most clients are within a 30-minute drive of the program.
The path forward is a conversation, not a commitment. A short call with the Roanoke Refuge admissions team covers fit, level of care, and insurance — at no cost, with full confidentiality, before any clinical decisions are made. Insurance verification runs during the same call. Call (540) 900-0353 when you are ready.