The recent death of 27-year-old Presley Gerber, son of Cindy Crawford and Rande Gerber, is heartbreaking. Our thoughts are with his family and everyone who loved him.
It is also important to be careful about what is known and what is not. Gerber died September 20, 2026, at a recovery facility in Santa Monica. The Santa Monica Police Department has said detectives are investigating the death as a suspected overdose and that there was no indication of foul play. The official cause and manner of death remain with the Los Angeles County Department of Medical Examiner, which has deferred a final determination while additional testing is completed.
It would be inappropriate to speculate about what happened, what substances may have been involved, whether a particular treatment decision contributed to his death, or whether a different setting would have changed the outcome.
But the tragedy brings attention to something families, clinicians, interventionists, and even many people working around behavioral healthcare do not always fully understand: “Going to treatment” does not describe a single level of care.
A sober living home, intensive outpatient program, partial hospitalization program, residential substance use disorder program, withdrawal-management program, psychiatric facility, and hospital may all be described casually as “rehab.” Clinically, they are very different environments.
When someone is actively using substances, entering withdrawal, psychiatrically unstable, taking multiple medications, or otherwise medically vulnerable, determining the appropriate level of care before placement can be critically important.
Treatment Should Match the Person’s Current Risk
The American Society of Addiction Medicine’s ASAM Criteria were developed to help clinicians match people with substance use disorders to an appropriate intensity of care based on a multidimensional assessment.
The principle is not that everyone with a substance use disorder belongs in residential treatment. It is that the recommended level of care should reflect the person’s actual clinical needs, risks, strengths, support structure, and circumstances at that point in time.
The current ASAM framework considers intoxication and withdrawal risk, biomedical conditions, psychiatric and cognitive concerns, substance use-related risks, the recovery environment, and person-centered considerations. ASAM also emphasizes ongoing reassessment because the right level of care can change as a person stabilizes or as new risks emerge.
Someone who has already stabilized, has reliable support, and can safely participate in outpatient care may do extremely well in PHP, IOP, or another outpatient setting. Someone presenting with significant withdrawal risk, recent heavy or unpredictable substance use, unstable psychiatric symptoms, medication complications, or an unsafe recovery environment may require substantially more supervision.
The diagnosis may be the same. The appropriate level of care may not be.
Sober Living Is Not the Same as Residential Treatment
This distinction is especially important in California.
A sober living home or recovery residence primarily provides housing in a substance-free environment. It can offer structure, accountability, peer support, community, and other valuable recovery supports. Those services can be enormously beneficial.
But sober living itself is not the same thing as licensed residential addiction treatment.
California’s Department of Health Care Services explains that sober living or transitional housing that does not provide alcohol or drug treatment services is not licensed by DHCS as a residential treatment facility. If a residence provides 24-hour nonmedical residential alcohol or drug recovery or treatment services, California requires a valid DHCS license.
The distinction can become confusing because a person may live in a sober residence while attending a partial hospitalization program or intensive outpatient program. To the individual or family, that arrangement can feel residential: the person has moved away from home, lives in a recovery-oriented house, and may spend much of the day participating in treatment.
Clinically, however, outpatient treatment and a licensed 24-hour residential treatment setting are different levels of care. Having staff physically present in a recovery residence is also not necessarily the same as having nurses and clinicians continuously assessing withdrawal, monitoring vital signs, managing medications, evaluating changes in mental status, and responding to evolving medical symptoms.
PHP and IOP Can Be Excellent Care. They Are Still Outpatient Care.
Partial hospitalization programs and intensive outpatient programs serve an important role in the treatment continuum. For the right person, either may be exactly the appropriate level of care.
They can be particularly valuable after a person has stabilized in withdrawal management or residential treatment and is ready for greater independence while continuing structured therapy and psychiatric support.
But neither should be confused with continuous residential clinical monitoring. When programming ends for the day, the person is no longer in the clinical treatment setting unless separate services are available where they live.
That difference matters when the clinical question is not simply, “How much therapy does this person need?” Sometimes the more urgent question is: “How safely can this person get through the next 24 hours?”
Early Recovery Can Carry Risks That Are Easy to Underestimate
The beginning of recovery can involve far more than cravings.
Depending on the substances involved and the person’s medical and psychiatric history, clinicians may need to evaluate withdrawal progression, blood pressure and heart rate changes, hydration, nutrition, sedation, agitation, confusion, sleep disruption, medication interactions, psychiatric symptoms, and changes in the person’s overall condition.
Alcohol withdrawal is one example of why level-of-care decisions matter. ASAM’s clinical guideline recognizes that some patients can safely complete withdrawal management in ambulatory settings, while others require a more intensive setting because severe or complicated withdrawal can require closer monitoring and rapid medical intervention.
The same core principle applies broadly: outpatient care is not inherently unsafe, and residential care is not automatically necessary. The assessment comes first. The environment should follow the assessment rather than trying to make the person fit whichever program happens to be available.
Seven Questions to Ask Before Choosing a Program
- What clinical assessment determines the recommended level of care? Ask whether current substance use, withdrawal risk, medical history, psychiatric symptoms, medications, prior withdrawal complications, and the recovery environment are assessed before placement.
- Who is physically present overnight? “24/7 staff” can mean very different things. Ask whether overnight personnel are recovery support staff, behavioral health technicians, nurses, or other licensed clinicians.
- How are withdrawal symptoms and medical changes monitored? Ask about vital signs, standardized withdrawal assessments when indicated, nursing observation, physician oversight, medication management, and procedures for escalating concerns.
- What happens if the person’s condition changes after admission? Appropriate placement is not a one-time decision. A person may need movement to a more intensive level of care, or may become ready for a less intensive one, as clinical needs change.
- Where does clinical treatment actually occur? If housing and treatment are separate, ask which services are delivered at the residence and which require transportation to another location.
- How are co-occurring psychiatric needs managed? Substance use, depression, anxiety, trauma, suicidality, sleep disruption, and other psychiatric concerns frequently overlap. Placement should consider the whole clinical picture.
- Can the program safely manage this person’s needs today, not simply where everyone hopes they will be in a week? Early stabilization and later recovery often require different levels of care.
Higher Care Is Not Always Better. Appropriate Care Is Better.
There is an important balance here.
Residential treatment is not automatically superior to PHP. PHP is not automatically superior to IOP. And sober living is not deficient because it is not designed to function as a 24-hour clinical withdrawal-management program.
They are designed to do different things.
Recovery housing can provide community, independence, accountability, and a substance-free environment that may be extremely valuable for someone who has already been appropriately stabilized. PHP and IOP can provide substantial clinical structure while allowing increasing independence. Residential treatment can provide a controlled 24-hour environment when that level of support is clinically indicated.
The problem comes when the intensity of the environment does not match the intensity of the person’s current needs.
The goal should never be to place everyone in the highest possible level of care. The goal is to put each person in the right level of care and to continually reassess whether it remains right.
Ask the Most Important Question First
When a family is frightened and someone has finally agreed to accept help, there can be enormous pressure to act immediately.
Availability matters. Location matters. Insurance matters. Comfort matters.
But before any of those questions comes another: “Can this setting safely care for this person as they are right now?”
At Laguna Beach Recovery, we believe thoughtful placement begins with understanding the individual’s current substance use, withdrawal risk, physical health, mental health, medications, and treatment history. Our detoxification and residential programs are designed for individuals who require a structured 24-hour environment with medically monitored and medically supervised care before transitioning to less intensive services when clinically appropriate.
For some people, outpatient treatment or recovery housing is the right starting point. For others, it should come later. Getting that distinction right is one of the most important decisions made at the beginning of recovery.
If you are unsure what level of care you or someone you love needs, seek a professional assessment before choosing a program. In an immediate medical emergency, suspected overdose, seizure, severe confusion, breathing difficulty, or other life-threatening situation, call 911.
American Society of Addiction Medicine — The ASAM Criteria, Fourth Edition — Framework for multidimensional level-of-care assessment, placement, reassessment, and transitions across the addiction treatment continuum.
American Society of Addiction Medicine — About the ASAM Criteria — Overview of the ASAM continuum of care and use of multidimensional assessment to determine appropriate placement.
American Society of Addiction Medicine — Clinical Practice Guideline on Alcohol Withdrawal Management — Evidence-based guidance on ambulatory versus inpatient withdrawal management and clinical monitoring needs.
California Department of Health Care Services — Facility Licensing — California licensing requirements for facilities providing 24-hour nonmedical residential alcohol or drug recovery, treatment, or detoxification services.
California Department of Health Care Services — Sober Living / Transitional Housing — Explains the distinction between sober living or alcohol- and drug-free housing and licensed residential AOD treatment services.
Santa Monica Police Department — “SMPD Investigating Suspected Overdose Death” (September 21, 2026) — Official statement confirming the investigation as a suspected overdose, no indication of foul play, and that the Medical Examiner will determine the official cause and manner of death.
Reuters — “Cindy Crawford’s son Presley Gerber dies aged 27” (September 21, 2026) — Independent reporting confirming Gerber’s death at a rehabilitation facility and the family’s request for privacy.
