Addiction Treatment Through Partial Hospitalization Programs (PHPs) in Nashville, TN

The Need for PHP in Nashville, TN

The ongoing epidemic surrounding substance misuse in the Nashville area and throughout Middle Tennessee requires solutions that focus on both clinical efficacy as well as practical application. State and county health officials report ongoing high rates of emergency department visits related to substance use in Davidson County, and that thousands of Davidson County residents annually present for treatment of overdose, alcohol poisoning, and other medical issues resulting from drug misuse.[1]

Government organizations state that a significant number of residents meet criteria for substance use disorder, but due to a lack of understanding of how to access treatment or fear that treatment will disrupt their entire life, many do not pursue appropriate treatment options.[2]

Individuals who complete detoxification, who are stepping down from inpatient treatment, and who have addiction severity that exceeds what weekly counseling can effectively provide can all benefit from PHP. Partial hospitalization programs offer individuals with a substance use disorder (SUD) the highest level of outpatient services, providing the same level of intensity of treatment that an individual would receive in an inpatient setting.

How Often Do Participants in PHPs Attend Treatment?

PHPs typically have participants attend programming five to six days per week for five to eight hours per day. Participants in PHPs have a rigid and structured program/schedule that occupies the majority of their daytime hours. This intensive program structure helps to set PHPs apart from less-structured/less-intensive outpatient programs and makes PHPs more closely aligned to a full-time commitment to treatment. As a result of the extensive hours of programming offered, PHPs allow for an extensive clinical assessment (upon admission), multiple (up to three) individual therapy sessions per day, and the ability to respond immediately to any new issues or crises that arise.

Therapy Techniques Utilized in Partial Hospitalization Programs

Participants in PHPs engage in a broad spectrum of therapeutic activities on a daily basis. Participants will participate in group therapy sessions focused on specific themes, engage in individual counseling sessions with their primary therapist, have the opportunity to consult with psychiatric specialists and receive medication management, take part in family therapy and family education sessions, participate in psychoeducation workshops about addiction and recovery, engage in experiential therapy groups (e.g., art, music, movement), and receive case management assistance related to housing, employment, legal, or any other needs.

Full-Time Medical Supervision

The level of medical supervision for a PHP far exceeds what most outpatient treatment facilities provide. Many PHPs employ or consult with psychiatric providers, nurse practitioners, or physicians who are responsible for assessing participants’ physical and mental welfare, prescribing and adjusting medications, and ensuring that participants remain medically stable.

For those with co-occurring mental health disorders needing medication management or for those whose medical issues require monitoring as they transition into recovery, a PHP can serve as a safe and effective transitional option.

Who Benefits From Participating in PHP in Nashville?

Generally, PHPs are to be used for the treatment of at-risk and/or vulnerable populations whose clinical needs are too intense for services offered through standard outpatient treatment programs but not so significant that they require placement through a residential treatment program.

Finding placement for an individual in the proper level of care is very important because it directly impacts their ability to achieve successful recovery outcomes.

Individuals Stepping Out of a Residential or Detoxification Setting

For some individuals who transition out of a residential treatment setting, the abrupt transition into weekly outpatient treatment is too overwhelming. Integrating back into their home life, while continuing to receive clinical support, is essential to successfully transitioning individuals back into their normal living situation. The PHP “step down” structure provides a gradual transition from a fully structured residential environment while continuing to build upon the therapeutic momentum developed through inpatient and/or detoxification treatment.

Individuals Whose Clinical Needs Are Greater Than What Outpatient Programs Can Address

While many individuals entering treatment for the first time have addiction severity that is greater than the intensity of treatment provided in outpatient programs, those individuals do not have the medical need for inpatient treatment.

For PHPs to function effectively, the individual’s living situation must be stable and become a support system to reinforce recovery. Individuals must live in a safe environment, free from relapsing or engaging in drug-using behaviors, and must have access to transportation to allow them to participate in programming daily and must have family and support systems in place that can provide encouragement and understanding while they participate in a PHP. When individuals have environmental stability, the combination of environmental factors plus intense clinical issues and needs makes PHPs an excellent treatment option for that individual.

Individuals with Co-Occurring Mental Health Diagnoses

PHPs provide effective services for individuals with substance use disorders and complex mental health conditions. Frequent contact with a mental health provider allows for comprehensive medication management and a quick response should the psychiatric symptoms of any individual begin to worsen.

What Daily Programming Looks Like in PHP

Understanding what daily programming looks like in a PHP can help to alleviate some of the uncertainties that potential participants may have about entering into an intensive treatment program and provide them with a clearer understanding of the expected level of commitment to be involved in treatment.

Average Day in PHP

Most PHPs in Nashville provide programming five to six days a week and operate between 9:00 a.m. and 3:00 p.m. or 10:00 a.m. and 4:00 p.m., but several programs also have extended hours and/or evening programming tracks (to accommodate individuals with jobs during the day).

A sample daily schedule might include a morning community meeting where participants check in and set daily goals, followed by a process group focusing on emotional processing and interpersonal dynamics. Late morning might involve individual therapy sessions on a rotating basis, followed by lunch provided on-site. Early afternoon could bring a psychoeducational group teaching specific concepts like cognitive behavioral therapy skills or relapse prevention strategies. Mid-afternoon might include specialty groups such as mindfulness practice, experiential therapy, or gender-specific processing groups, with the day concluding with a wrap-up session reviewing what was learned.

Medical and Psychiatric Services

Medical and psychiatric support distinguishes PHPs from less-intensive outpatient treatment options. Medical providers in PHPs assess and treat individuals with co-occurring mental health conditions; provide medication for depression, anxiety, PTSD, and other mental health conditions; initiate and maintain medication-assisted treatment for individuals with opioid or alcohol use disorders; and monitor for psychiatric symptoms that may complicate recovery.

Nursing staff monitor participants’ vital signs, coordinate with outside medical providers, educate participants regarding their health and wellness, and help ensure that participants remain in optimal physical health.

Family Involvement and Engagement

PHPs recognize that addiction affects all individuals within a family unit, which is why quality PHPs actively include family members in all phases of treatment. Participants’ family members are provided education about addiction and recovery through participation in family therapy sessions that focus on mending broken relationships, improving communication, setting healthy boundaries between family members and participants, and creating a supportive, nurturing environment in the households where participants reside.

Additionally, quality PHPs help improve family dynamics by helping strengthen family relationships so that when the individual finishes PHP treatment and returns home, the family environment supports the individual’s ongoing recovery efforts.

Real-World Application

With Partial Hospitalization Programs (PHP) designed specifically around the lifestyles of the people utilizing this type of treatment, participants in PHP will be able to utilize newly acquired skills in their day-to-day lives, while receiving the benefits of intensive support. A participant in PHP that learns stress management skills on a Wednesday, for example, will be able to practice those skills on that same Wednesday evening, and will then be able to process with their peers the next day what worked, what didn’t work, how to improve their stress management skills, etc. This immediate feedback loop of being able to use newly acquired skills and receive feedback creates a much quicker learning curve and ultimately builds participant confidence.

Clinical Effectiveness and Expected Outcomes of Partial Hospitalization Programs

A number of studies on PHP outcomes have shown that PHP produces comparable results to residential treatment for many appropriately qualified individuals, demonstrating that PHP is an extremely effective avenue of treatment, balancing rigorous clinical care with practical accessibility.[3]

Follow-up studies tracking participants months and years after PHP completion reveal many individuals maintain sobriety, demonstrate improved mental health functioning, report better quality of life, sustain employment or return to work, and rebuild family relationships. These long-term outcomes reflect PHP’s ability to help participants internalize recovery skills and build lives that support ongoing wellness.

When compared to standard outpatient care, PHP is usually much more intensive than standard outpatient care and provides a greater degree of structure for individuals in the program. PHP allows for greater monitoring and faster responses to problems that occur during treatment.

Duration and Continuing Care Planning

Usually, PHP participation is spread out over several weeks, with the length and duration of each participant’s time in the program depending on his/her individual needs and progress. For example, most participants usually spend about three to four weeks in PHP; however, some participants can be successful in completing PHP in two weeks, and others benefit from being in PHP for six to eight weeks.

During the weekly treatment, the treatment team members will review each participant’s progress to determine whether the participant is ready to step down to a less intensive level of treatment or will continue to require support at the PHP level of service.

As a participant progresses through the PHP treatment, the treatment team members will work with the participant to formulate a plan for transitioning to the next level of recovery. For most participants, moving down from PHP will be into an Intensive Outpatient Program (IOP), where treatment continues at a reduced frequency; this method creates a controlled way for participants to transition from intense daily treatment to less frequent support. For some participants, based on their continued progress and stability, transitioning from PHP to standard outpatient therapy may be appropriate.

The planning process for discharge starts within the first week of PHP, not in the last week of treatment. Case managers and therapists work with participants to provide them with the resources necessary for supporting their ongoing recovery efforts. Some of those resources include outpatient providers, mutual support groups, sober living arrangements if needed, employment assistance, community mental health services, and peer-based support services. This organized approach creates a road map for future progress following discharge from PHP.