We analyzed all 13,460 facilities in SAMHSA’s 2025 National Directory of Drug and Alcohol Use Treatment Facilities and counted how many levels of care each one provides. Just 279 — 2.1% — offer the complete range from medically supervised withdrawal through residential treatment, partial hospitalization, intensive outpatient and standard outpatient care. More than 44% offer a single level and nothing else.

What the continuum of care means

Addiction treatment is organized into levels of intensity. Medically supervised withdrawal management stabilizes someone physically. Residential treatment provides 24-hour care. Partial hospitalization runs most of the day, several days a week. Intensive outpatient runs a few hours several times a week. Standard outpatient is lighter still, and is where most people spend the longest.

The point of having levels is that people move between them. Someone completing withdrawal management steps down into residential or intensive outpatient care rather than going home. Someone whose outpatient treatment is not holding steps up. A facility offering one level can still deliver that level well, but the transition has to happen somewhere else, which means a referral, a new intake assessment, a new waiting list, and a gap.

Most facilities offer one level, or two

Counting the number of distinct levels each facility provides gives a sharper picture than counting services in isolation. 10,866 facilities — 80.7% of the directory — offer either one level or two.

Of the 5,943 single-level facilities, 4,531 provide outpatient care only and 1,260 provide residential treatment only. A further 152 provide withdrawal management and nothing else.

Why the step-down matters most after detox

Withdrawal management is a stabilization service, not a treatment for addiction. It manages the physical process of stopping and typically lasts three to ten days depending on the substance. On its own it does not address the reasons someone was using, and the period immediately afterward carries elevated risk: tolerance falls during abstinence, so a return to a previously ordinary dose can be fatal. This is why clinical guidance treats the transition out of withdrawal management as part of the intervention rather than an administrative afterthought.

The National Institute on Drug Abuse is explicit that remaining in treatment for an adequate period is one of the principles that separates effective treatment from ineffective treatment, and that detoxification alone does little to change long-term substance use. Continuity is the mechanism by which adequate duration actually happens.

What the federal survey does and does not record about follow-up

SAMHSA asks facilities separately about the supports that surround a discharge. The pattern across those three questions is a descending one, and the further the activity sits from the moment of discharge, the fewer facilities report it.

It is worth being careful about what that last figure means. The survey asks about formal outcome follow-up, which is a measurement activity rather than a care activity. Of the facilities that do not report it, 90.2% still report discharge planning and 73.9% still report aftercare. The gap is in structured measurement, not necessarily in contact or support.

That distinction points at something larger than any individual facility. There is no national dataset in the United States that follows people from treatment through to outcome. SAMHSA records what services exist. The Treatment Episode Data Set records admissions and discharges. Neither links to what happened next. Published success rates in this sector are therefore rarely comparable, because there is no shared denominator behind them.

Ownership does not run the way you might expect

Our earlier analysis of payment acceptance found for-profit facilities considerably less likely to accept public insurance or offer financial assistance. On continuity of care the direction reverses.

For-profit facilities are three times more likely to offer the full continuum and considerably less likely to offer a single level in isolation. The most plausible explanation is capital rather than philosophy: running five levels of care requires physical plant, clinical staffing across several modalities and the administrative capacity to bill them all. Non-profit and county-funded providers frequently specialize because their funding is tied to a specific service line.

Where the continuum exists, and where it does not

Seven states and territories have no facility offering all five levels: Alaska, Oklahoma, Oregon, Rhode Island, South Carolina, Vermont and Puerto Rico. Maine and New York record the lowest average number of levels per facility in the country, at 1.34 and 1.43 respectively.

The state figures should be read as a measure of concentration rather than quality. A state where treatment is delivered through many small specialized providers with strong referral relationships may serve people better than one with a handful of large facilities offering everything under one roof. What the numbers do show is how often a person has to change provider to change level of care. Our California and Florida directory pages list which levels each facility actually provides.

What this analysis does not show

This is a count of services, not a measure of outcomes. SAMHSA records what facilities report offering. It does not record how many people complete treatment, how long they stay, or what happens afterward, and nothing in this analysis should be read as ranking one facility above another.

Three further limits. The directory includes only facilities that responded to the 2024 survey and were approved for inclusion by their state substance use agency, so it is not a complete census of everything operating in the country. Every field is self-reported. And a facility with formal referral arrangements to a partner organization may deliver a seamless continuum without offering every level itself, which this method would not capture.

What to ask when you are choosing treatment

Ask what happens after this level of care ends. Specifically: does the facility provide the next step itself, and if not, who does, and is that placement arranged before discharge or afterward. A facility that can name the next program and describe how the handover works is describing a continuum. One that offers to give you a list at the end is describing a referral.

Ask how long the program expects someone to remain engaged across all levels, not just the length of the residential stay. Ask whether outpatient care is available in the evenings, since the step down to outpatient usually coincides with returning to work. And ask what the facility does if someone returns to use during outpatient care, because the answer reveals whether stepping back up is possible or whether it means starting over.

Our coverage checker and treatment cost calculator can help you work out which levels your plan covers before you call, and our payment options finder covers the routes available if it does not. Facilities carrying our verified badge have had their credentials independently checked.

Methodology

We analyzed the complete 2025 National Directory of Drug and Alcohol Use Treatment Facilities published by the Substance Abuse and Mental Health Services Administration, covering 13,460 facilities across all fifty states, the District of Columbia and five territories. The directory reflects facility responses to the 2024 National Substance Use and Mental Health Services Survey. We parsed each facility service code string and grouped the recorded service settings into five levels of care: withdrawal management (residential, hospital inpatient or outpatient detoxification), residential (short-term, long-term or general residential), partial hospitalization, intensive outpatient, and standard outpatient. A facility was counted as offering the full continuum where all five were present. Step-down analysis counts a facility as lacking step-down where it offers withdrawal management or residential care but records none of partial hospitalization, intensive outpatient or standard outpatient. Continuing care figures are the three discharge-related fields recorded in the survey. State figures are reported only for states with at least 50 facilities in the directory. 26 facilities recorded none of the five service settings and are excluded from the level-count distribution.

References

1. Substance Abuse and Mental Health Services Administration. National Directory of Drug and Alcohol Use Treatment Facilities, 2025. Rockville, MD: Center for Behavioral Health Statistics and Quality, SAMHSA.
2. Substance Abuse and Mental Health Services Administration. National Substance Use and Mental Health Services Survey (N-SUMHSS): 2024 Data on Substance Use and Mental Health Treatment Facilities. Rockville, MD: SAMHSA, 2025.
3. National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A Research-Based Guide, third edition. Bethesda, MD: NIDA.
4. McKay JR. Continuing care research: what we have learned and where we are going. Journal of Substance Abuse Treatment. 2009;36(2):131–145.
5. American Society of Addiction Medicine. The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, fourth edition.
6. National Institute on Drug Abuse. Words Matter: Preferred Language for Talking About Addiction. Bethesda, MD: NIDA.