The Partial Hospitalization Program (PHP) at Roanoke Refuge is an full-day outpatient outpatient program and the highest level of outpatient care we offer. PHP delivers clinical depth comparable to residential treatment within a framework that allows clients to return home each evening, maintaining connection to family, housing, and community throughout treatment.
The name can be confusing. Despite the legacy term “partial hospitalization,” PHP is not a hospital-based program. It is an outpatient clinical treatment environment that is structured, professional, and intensive, and the name is an artifact of how the level of care was originally defined for insurance and billing purposes.
What PHP describes in practice is full-day outpatient clinical programming delivered five days per week. The clinical work happens in groups, in individual therapy, and in case management coordination, and the work is anchored to the real Roanoke Valley life the client returns to each evening. That structure is the central clinical choice of outpatient care, and the treatment approach explains why we believe it is the right one for many of the families we serve.
What PHP at Roanoke Refuge Looks Like
PHP is intensive. Five days a week, about five hours a day, roughly 25 clinical hours per week. Most people who walk in expecting a lighter version of treatment are surprised by how much real work happens here. The day is built so you can sustain the cognitive and emotional load of intensive treatment while returning home each evening to integrate what is being learned. Here is what a day looks like in practice:
Morning check-in group (15 minutes)
A facilitated group to begin the clinical day, address overnight experiences, check in on emotional state and cravings, and set the therapeutic tone.
Process group therapy (60 minutes)
The core therapeutic group, focused on recovery in real time, including what happened since the previous day, what is being struggled with, and how skills are being applied. This is where the relational therapeutic work happens. Learn more
Psychoeducation group (60 minutes)
Structured curriculum covering addiction science, brain chemistry, coping skills, stress management, healthy communication, emotional regulation, and life skills in recovery.
Individual therapy (45 to 60 minutes, several times per week)
Private sessions with the primary licensed therapist for deeper individual work, including trauma, motivation, cognitive restructuring, and treatment planning.
- Lunch break (30 to 45 minutes).
- Specialty or skills group (60 minutes) — Rotating groups covering DBT skills, family dynamics, anger management, grief and loss, recurrence-prevention planning, financial wellness in recovery, and other clinical topics.
- Afternoon wrap-up group (30 minutes) — A closing group to review clinical themes, process unresolved issues, and prepare for the transition back to the home environment.
That is a lot. It is supposed to be. The exact daily structure may shift to match the clinical needs of the cohort, but the core elements above are consistent. Our clinical team includes the licensed counselors, social workers, certified addiction specialists, peer recovery specialists, and case managers who carry the work.
What a PHP week actually looks like
PHP runs Monday through Friday, with daytime hours running roughly 9:00 a.m. to 3:00 p.m. Total clinical time lands around 25 hours per week. Programming is held in person at the Salem facility; clients return home each evening to family, housing, or supportive recovery housing.
A typical day includes one morning check-in group, one process group, one psychoeducation group, a lunch break, an afternoon skills or specialty group, and an afternoon wrap-up. Individual therapy with the assigned primary clinician happens once or twice per week, scheduled inside that daily window. Family therapy is scheduled separately — often late afternoon or evening so partners and parents can attend without taking a workday.
Program length is individualized to clinical need; most clients spend two to four weeks in PHP before stepping down to IOP.
Who PHP Is the Right Level of Care For
PHP fits when the clinical picture calls for significant daily structure but not overnight supervision, which most families recognize as the moment everyday life starts unraveling. Our admissions team uses an ASAM level-of-care assessment to make the level-of-care recommendation, and the following profiles are common reasons for a PHP placement:
- Stepping down from inpatient or residential treatment: Clients who are not yet stable enough for an IOP schedule.
- Moderate-to-severe substance use disorder — Clients whose clinical needs exceed what IOP can address.
- Co-occurring mental health conditions requiring daily contact — Clients whose depression, anxiety, post-traumatic stress disorder, or bipolar disorder benefit from daily clinical attention alongside substance use treatment.
- Post-detox transition — Clients who have completed medically supervised detox elsewhere and need intensive outpatient support before stepping down further.
- Elevated recurrence risk — Clients at higher risk because of environmental factors, social triggers, or a history of multiple treatment episodes.
PHP and the Software of Long-Term Recovery
PHP earns its clinical case through one core paradigm. Residential programs work on the physical foundation in a controlled setting away from the people and places that drove the using. PHP does the opposite work. It is the level of care where the coping software of recovery is written and rehearsed against the actual triggers of your daily life in Roanoke City, Salem, Cave Spring, or wherever home is.
Recurrence-prevention skills, family communication patterns, and the integration of work and recovery are all tested against the same environment you return to each evening. That is the clinical case for outpatient care, not a marketing claim about it.
PHP for Co-Occurring Mental Health Conditions
Dual diagnosis is the rule, not the exception. Roughly half of people seeking addiction treatment also live with a co-occurring mental health condition such as depression, anxiety, post-traumatic stress disorder, or bipolar disorder (National Institute on Drug Abuse, 2024). If the substance use never quite felt separate from the depression or the anxiety, you are not imagining it.
Untreated trauma, depression, and anxiety are among the most consistent biological drivers of recurrence of symptoms. Treating the substance use without treating the underlying mental health condition is like treating the smoke while leaving the fire burning. PHP integrates dual-diagnosis care from the first day, and clients whose conditions require psychiatric medication management beyond our clinical scope are coordinated to psychiatric providers in the Roanoke area. The full dual diagnosis program describes the integrated model.
PHP vs. IOP: Understanding the Difference
Most families ask this question on the first call. PHP involves 25 or more clinical hours per week across five days. IOP involves a minimum of nine hours per week across three or more days.
PHP fits higher clinical acuity, more complex co-occurring conditions, or step-down from inpatient. IOP fits clinically stable clients with functional work or family obligations. Many clients begin in PHP and step down to IOP after two to six weeks of demonstrated clinical stability. The step-down model is the clinical best practice endorsed by the American Society of Addiction Medicine, and the transition between levels happens as the clinical picture evolves rather than at a fixed calendar point.
Medication-Assisted Treatment Inside PHP
Roanoke Refuge prescribes FDA-approved MAT medications on-site. Clients prescribed buprenorphine, naltrexone, methadone, or other Medication-Assisted Treatment medications by an outside provider can fully participate in PHP while our medical team will continue your prescription or coordinate with your existing prescriber, depending on which path fits your care.
Medication-Assisted Treatment coordination is part of one integrated treatment plan, not a fragmented set of parallel efforts.
Insurance Coverage for PHP
PHP is covered by most major commercial insurance plans and by Virginia Medicaid when deemed medically necessary. Our clinical team documents medical necessity thoroughly and our admissions team is experienced in the prior authorization process. Free, confidential insurance verification happens before treatment begins so that the family has a clear picture of coverage and any cost share before any commitment is made.
What to Bring to Your First Day
This is one of the most common questions families ask in the days before treatment starts, and it is worth a clear answer. Admissions will confirm specifics with you during the intake conversation. The general checklist:
Photo identification
Driver’s license, state ID, or passport.
Insurance cards and information
Both medical and behavioral health insurance details.
Current medications list
Including dosage and prescribing physician for each.
Prior treatment records
Intake assessments, discharge summaries, psychiatric evaluations.
Emergency contact information
For at least one family member or close support.
Comfortable clothing
Appropriate for a full day of group programming.
Food or beverages for the day
Lunch arrangements are communicated during admissions.
Local, regional, and accessible.
Roanoke Refuge delivers this level of care from a facility at 1630 Braeburn Drive in Salem, Virginia — just off I-81 exit 137 and a short drive south of downtown Roanoke via I-581. The service area covers the full Roanoke Valley: Roanoke City, Salem, Vinton, and the surrounding counties of Roanoke, Botetourt, and Bedford. Most clients are within 30 minutes of the facility.
If you are weighing whether this program is the right fit, the answer is rarely obvious on your own — and it is exactly what the admissions team is built to help with. A short, free, confidential call walks through level of care, insurance benefits, and what the first week will actually look like. Free insurance verification happens during the same call. Call (540) 900-0353 when you are ready.