Best EHR for Addiction Treatment & Substance Use Disorder Programs in 2026

Why SUD Treatment Centers Cannot Use General-Purpose EHRs

Addiction treatment is fundamentally different from general medical care, outpatient therapy, or even other behavioral health specialties. The clinical workflows, regulatory environment, billing structures, and documentation requirements in substance use disorder treatment are distinct enough that a general-purpose EHR -- even a solid one -- creates more problems than it solves.

Consider what happens when a residential treatment center tries to use a general medical EHR like athenahealth or eClinicalWorks. There is no bed management. No census tracking. No ASAM level-of-care assessments. No 42 CFR Part 2 consent management. No group therapy documentation that maps to billing codes. No concurrent review or utilization management workflows. The clinical team ends up building workarounds in spreadsheets and paper forms, which defeats the purpose of having an EHR and introduces compliance risk at every step.

Even general behavioral health EHRs like TherapyNotes or SimplePractice fall short. These platforms are excellent for outpatient therapy practices -- individual counselors, psychologists, and social workers seeing patients for weekly sessions. But they were not designed for the complexity of a treatment center managing residential beds, multiple levels of care, daily clinical programming, medication-assisted treatment protocols, and the strict federal privacy requirements unique to SUD records.

The cost of using the wrong EHR is not just inconvenience. It is measurable in denied claims from improper documentation, audit findings from inadequate consent tracking, staff time wasted on manual processes, and clinical data that cannot be used for outcomes reporting. Treatment centers that invest in a purpose-built SUD platform recover that investment through cleaner billing, faster authorizations, and reduced compliance exposure.

Critical EHR Features for Addiction Treatment Programs

Not every feature matters equally for every program. But the following capabilities represent the minimum requirements for an EHR serving a substance use disorder treatment center. If a platform is missing any of these, it will require manual workarounds that undermine efficiency and increase risk.

ASAM Level-of-Care Integration

The American Society of Addiction Medicine (ASAM) criteria is the national standard for assessing and placing patients in the appropriate level of SUD care. The assessment evaluates patients across six dimensions: acute intoxication and withdrawal potential, biomedical conditions, emotional/behavioral/cognitive conditions, readiness to change, relapse/continued use potential, and recovery environment. Based on these dimensions, patients are placed in a level of care ranging from Level 0.5 (early intervention) to Level 4 (medically managed intensive inpatient).

An EHR serving addiction treatment must provide structured ASAM assessment templates that guide clinicians through the six dimensions, generate a recommended level-of-care determination, and produce documentation that satisfies payer requirements for admission and continued stay authorization. Without this, clinicians are completing ASAM assessments on paper or in free-text fields, which slows the authorization process and increases denial rates.

42 CFR Part 2 Compliance

This is the regulatory requirement that separates SUD treatment from every other healthcare specialty. 42 CFR Part 2 imposes privacy protections on substance use disorder records that go beyond HIPAA. Under Part 2, SUD treatment records cannot be disclosed to anyone -- including other healthcare providers, insurance companies, or law enforcement -- without the patient's explicit written consent. Each disclosure must be individually authorized, tracked, and auditable.

An EHR must support granular consent management (tracking which entities the patient has authorized to receive records, and which specific records are covered), segmented record access (the ability to share some parts of a patient's record while restricting SUD-specific information), comprehensive audit trails documenting every disclosure, and re-disclosure prohibition notices on all shared records. A system that treats all health records the same way under standard HIPAA rules will not satisfy Part 2 requirements.

Bed and Census Management

Residential treatment programs need real-time visibility into bed availability, occupancy rates, and patient census across units and locations. This includes admission and discharge tracking with timestamps, bed assignment and transfer workflows, daily census reports for clinical and billing purposes, and occupancy dashboards for operational decision-making. Census data feeds directly into billing -- residential per-diem claims require accurate admission and discharge dates, and errors in census tracking result in rejected claims.

Medication-Assisted Treatment (MAT) Tracking

MAT programs using buprenorphine (Suboxone), naltrexone (Vivitrol), or methadone require specific clinical workflows: EPCS-compliant e-prescribing for controlled substances, PDMP (Prescription Drug Monitoring Program) integration for checking patient prescription histories, dosing schedules and medication administration records, and lab result tracking for toxicology screens and liver function monitoring. The EHR should make it straightforward for prescribers to manage MAT protocols without switching between multiple systems.

Group Therapy Documentation

Group therapy is central to addiction treatment programming. A treatment center may run 20 or more groups per week, each with 5 to 15 participants. The EHR must support group session creation with attendance tracking, the ability to document a single group note and then individualize portions for each participant, proper billing code assignment for group sessions (which differ from individual session codes), and the ability to track which groups each patient attended for treatment plan compliance. Without structured group therapy documentation, clinical staff spend hours duplicating notes across individual patient records -- or worse, they skip individualized documentation, which creates audit exposure.

Discharge Planning and Continuing Care

SUD treatment does not end at discharge. Effective treatment programs create structured continuing care plans that document step-down recommendations (e.g., residential to IOP to outpatient), referral tracking to aftercare providers, follow-up appointment scheduling, and relapse prevention plan documentation. The EHR should facilitate this transition rather than treating discharge as a terminal event.

Outcomes Tracking and Reporting

Accreditation bodies (CARF, The Joint Commission), state regulators, and grant funders increasingly require treatment outcomes data. An SUD EHR should track completion and discharge status, readmission rates, treatment engagement metrics, and post-discharge follow-up outcomes. Programs that can demonstrate outcomes with data have a significant advantage in securing contracts with managed care organizations and state Medicaid programs.

Detailed Vendor Reviews

1. AZZLY Rize -- Best Overall for Addiction Treatment

AZZLY Rize was designed from the ground up for behavioral health and addiction treatment -- not adapted from a general medical platform. That distinction matters because SUD workflows are embedded in the system's core architecture rather than bolted on as afterthoughts. The result is a platform where ASAM assessments, 42 CFR Part 2 compliance, census management, and SUD-specific billing work together natively rather than requiring integrations or workarounds.

ASAM Level-of-Care Documentation

AZZLY Rize includes structured ASAM assessment tools that walk clinicians through all six dimensions of the ASAM criteria. The system generates a level-of-care recommendation based on the assessment, produces documentation formatted for payer authorization submissions, and maintains a history of ASAM assessments for each patient that maps their progression through levels of care. This is not a generic form builder -- it is a purpose-built clinical workflow that understands the ASAM framework and integrates it with the treatment planning and utilization management process.

42 CFR Part 2 Compliance

AZZLY Rize provides the consent management infrastructure that 42 CFR Part 2 demands. The platform tracks patient consent forms at a granular level -- documenting which entities are authorized to receive records, what specific information is covered, and the timeframe of the authorization. Disclosure tracking logs every instance of record sharing, and audit trails provide the documentation needed for compliance reviews. The system enforces segmentation rules so that SUD-specific information is not inadvertently included in standard record exports or health information exchange transmissions.

Integrated Revenue Cycle Management

One of the most significant advantages of AZZLY Rize is its all-in-one approach to billing and revenue cycle management. Rather than requiring a separate practice management system or third-party clearinghouse, Rize includes claims submission, eligibility verification, authorization tracking, and payment posting within the same platform. For SUD treatment centers, this integration is especially valuable because it connects clinical documentation directly to billing workflows. When a clinician completes an ASAM assessment and the patient is admitted, the authorization and billing process begins within the same system -- no manual handoffs, no duplicate data entry, and no reconciliation gaps between the clinical record and the billing record.

Census and Bed Management

For residential programs, AZZLY Rize provides real-time census tracking with bed assignment, admission and discharge logging, and occupancy reporting. The census view gives clinical directors and administrators immediate visibility into who is in the facility, which beds are available, and what the current occupancy rate is. Census data integrates with billing to ensure per-diem claims accurately reflect the days each patient was in the facility, reducing claim denials from census discrepancies.

Group Therapy and Treatment Planning

AZZLY Rize supports the heavy group therapy component of addiction treatment programming. Clinicians can create group sessions, track attendance, document group notes with individualized annotations for each participant, and map group sessions to the appropriate billing codes. The treatment planning module supports SUD-specific goals and objectives, with the ability to track patient progress against the treatment plan throughout the episode of care. Treatment plans can be tied directly to ASAM-informed goals, creating a coherent clinical narrative from assessment through discharge.

Discharge and Continuing Care Tracking

Rize includes discharge planning workflows that document the recommended step-down level of care, aftercare referrals, continuing care appointments, and relapse prevention plans. The system tracks discharge disposition and can be configured to support post-discharge follow-up workflows -- a growing requirement from accreditors and managed care organizations seeking data on treatment outcomes beyond the episode of care.

Who AZZLY Rize Is Best For

AZZLY Rize is the strongest choice for dedicated SUD treatment centers -- residential programs, IOP/PHP providers, and organizations offering multiple levels of addiction care. It is particularly well-suited for programs that want a single all-in-one platform covering clinical documentation, billing, and compliance without needing to integrate multiple vendor systems. Programs that have been using general-purpose EHRs and struggling with manual ASAM assessments, spreadsheet-based census tracking, or disconnected billing processes will see the most immediate improvement from switching to Rize.

2. Netsmart (myAvatar) -- Best for Enterprise Treatment Organizations

Netsmart myAvatar is the most widely deployed EHR in the behavioral health and human services sector, serving over 750,000 users across thousands of organizations. It is consistently ranked as the top enterprise behavioral health EHR by KLAS Research and is the de facto choice for large, multi-site treatment organizations -- especially those with state contracts, Medicaid managed care agreements, and complex reporting obligations.

For addiction treatment specifically, myAvatar supports ASAM-based assessments, 42 CFR Part 2 compliance controls, residential census management, and SUD-specific clinical documentation. Its strength lies in scalability and reporting. Organizations operating 10 or more facilities across multiple states, managing thousands of concurrent patients, and needing enterprise-level analytics and state reporting capabilities will find Netsmart's infrastructure difficult to match.

The trade-offs are real, however. Netsmart implementations are complex and expensive. Enterprise deployments can take 12 to 18 months and cost six figures for implementation alone. The user interface, while functional, is not as modern or intuitive as smaller SUD-focused platforms. And the pricing model -- which is quote-based and typically involves long-term contracts -- places myAvatar out of reach for most small and mid-size treatment centers. This is an enterprise tool for enterprise organizations.

3. PIMSY -- Best for Mid-Size Treatment Programs

PIMSY (Practice Information Management System) is a behavioral health EHR that has built a strong following among mid-size treatment programs -- organizations with 10 to 75 staff members that need more than a basic BH platform but do not require (or cannot afford) an enterprise solution like Netsmart.

PIMSY includes ASAM assessment support, treatment planning with the Wiley Treatment Planner integration (a widely used library of evidence-based treatment goals and objectives), group therapy documentation, and billing with claims management. What sets PIMSY apart is the breadth of its business operations tools. The platform includes built-in HR management, payroll processing, staff scheduling, and credentialing tracking -- functions that most EHRs do not address and that treatment centers typically handle with separate software.

For a mid-size addiction treatment program that wants to consolidate clinical, billing, and HR operations into a single platform, PIMSY offers a compelling value proposition at a price point ($99+/user/month) that undercuts most competitors. The trade-off is that PIMSY's SUD-specific workflows are not as deep as AZZLY Rize's, and the platform's 42 CFR Part 2 compliance tooling, while present, is less mature. Programs whose primary focus is SUD treatment will find AZZLY Rize more purpose-fitted, but programs offering a mix of behavioral health and SUD services may appreciate PIMSY's broader scope.

4. Valant -- Best for Prescriber-Heavy MAT Programs

Valant is a psychiatry and behavioral health EHR that stands out for its medication management and e-prescribing capabilities. For addiction treatment programs whose primary clinical activity is medication-assisted treatment -- outpatient MAT clinics prescribing buprenorphine, naltrexone, or managing methadone -- Valant's prescriber-centric design is a strong fit.

The platform offers EPCS-compliant e-prescribing for Schedule II-V controlled substances, built-in PDMP integration for prescription monitoring, structured medication management workflows, and outcome measurement tools. Valant also includes patient engagement features like a patient portal with symptom tracking questionnaires, which can be useful for monitoring patients in early recovery.

Valant's limitations for addiction treatment are its scope. The platform does not include residential census management, its group therapy documentation is basic, and its 42 CFR Part 2 compliance tooling is less comprehensive than AZZLY Rize's. Valant is best suited for outpatient MAT programs and psychiatry practices that treat co-occurring SUD -- not for residential treatment centers or multi-level-of-care programs. If your program is primarily prescriber-based outpatient MAT, Valant deserves serious consideration. If your program includes residential or IOP/PHP levels of care, look to AZZLY Rize or Netsmart instead.

Residential vs. Outpatient (IOP/PHP) vs. MAT: Different Programs, Different Needs

Not all addiction treatment programs have the same EHR requirements. The features that are essential for a 60-bed residential facility are different from what an outpatient IOP program or a stand-alone MAT clinic needs. Here is how the requirements break down by program type.

Residential Treatment (ASAM Levels 3.1-3.7)

Residential programs have the most complex EHR needs. Patients live in the facility 24/7, which means the EHR must manage beds, track a daily census, support multiple daily clinical activities (group therapy, individual sessions, medication administration, nursing assessments), and generate per-diem billing. Key requirements include:

• Real-time bed and census management with admission, discharge, transfer, and leave-of-absence tracking
• Medication administration records (MAR) with nursing documentation for medication passes
• Daily programming schedules that map to individual treatment plans
• ASAM continued stay and transfer/discharge criteria for utilization review
• Group therapy documentation with individualized annotations (treatment centers may run 15-25 groups per week)
• Per-diem billing workflows tied to census data

Best fit: AZZLY Rize (all residential features in one platform) or Netsmart myAvatar (for large multi-facility residential organizations).

Intensive Outpatient / Partial Hospitalization (ASAM Levels 2.1-2.5)

IOP and PHP programs see patients multiple times per week (typically 9-20 hours/week for IOP, 20+ hours/week for PHP) but patients do not reside at the facility. The EHR needs are centered on scheduling, group documentation, and session-based billing rather than census management.

• Flexible scheduling for patients attending multiple sessions per week across different group and individual slots
• Group therapy documentation remains essential -- IOP/PHP programs are group-intensive
• Attendance tracking tied to billing (payers require documentation of actual attendance hours)
• ASAM assessment and continued stay documentation for authorization
• Step-down and step-up workflows for patients transitioning between levels of care

Best fit: AZZLY Rize (strong IOP/PHP workflows alongside residential) or PIMSY (good IOP support with broader BH capabilities).

Medication-Assisted Treatment (Outpatient MAT / OTP)

MAT clinics and Opioid Treatment Programs (OTPs) have a prescriber-centric workflow. The primary clinical activities are medication management, toxicology screening, and counseling. The EHR must excel at:

• EPCS-compliant e-prescribing for buprenorphine (Schedule III) and other controlled substances
• PDMP integration to check patient prescription histories before prescribing
• Dosing logs for methadone clinics with daily or weekly observed dosing
• Lab integration for toxicology and metabolic panel results
• Counseling session documentation (MAT programs typically pair medication with counseling services)

Best fit: Valant (strongest e-prescribing and medication management) or AZZLY Rize (if the MAT program is part of a larger treatment organization offering multiple levels of care).

Compliance Requirements: A Deep Dive

Addiction treatment centers operate under a regulatory framework that is meaningfully more complex than general healthcare. The EHR is the backbone of compliance -- if the system does not support regulatory requirements natively, the treatment center carries the risk.

42 CFR Part 2: Federal SUD Privacy Protections

42 CFR Part 2 has been in effect since 1975 and was last substantively updated in 2024 to align certain provisions more closely with HIPAA while maintaining the core consent requirement. Under Part 2, any program that holds itself out as providing SUD treatment (and receives federal funding, which nearly all programs do through Medicaid or block grants) must obtain patient consent before disclosing SUD records.

What the EHR must support:

• Consent form management: The ability to create, store, and track patient consent forms that specify the recipient, the purpose of disclosure, the information to be disclosed, the expiration date, and the patient's right to revoke consent.
• Segmented access: The ability to separate SUD records from general health records so that authorized disclosures to non-SUD providers can exclude substance use information when the patient has not consented to its release.
• Disclosure tracking: A log of every instance where SUD records were disclosed, including the date, recipient, purpose, and scope of the disclosure.
• Re-disclosure notice: The ability to attach the required re-disclosure prohibition statement to all records shared under Part 2 authorization.
• Audit trail: A tamper-evident record of all access to and disclosures of SUD records, available for regulatory review.

State Licensing and Accreditation

Beyond 42 CFR Part 2, SUD treatment centers must meet state-specific licensing requirements that vary significantly by jurisdiction. Common state requirements that the EHR must support include:

• Specific documentation within defined timeframes (e.g., biopsychosocial assessment within 72 hours of admission, treatment plan within 5 business days)
• State-mandated reporting fields and data submissions (TEDS, state outcomes reporting systems)
• Staff credential tracking and supervision documentation

Accreditation bodies -- CARF (Commission on Accreditation of Rehabilitation Facilities) and The Joint Commission -- layer additional documentation and outcomes requirements. The EHR should provide configurable templates that map to accreditation standards and support the data collection needed for accreditation surveys.

EPCS and PDMP Compliance

Programs prescribing controlled substances for MAT must comply with the DEA's Electronic Prescribing for Controlled Substances (EPCS) regulations, which require identity-proofing of prescribers and two-factor authentication for each prescription. The EHR's e-prescribing module must be EPCS-certified and integrated with Surescripts. Many states also mandate PDMP queries before prescribing controlled substances; the EHR should integrate directly with the state PDMP to streamline this requirement.

Pricing Considerations for Treatment Centers

EHR pricing for addiction treatment is more complex than for general medical or outpatient BH practices because treatment centers have more users per patient, more diverse clinical roles, and more modules in play. Here is what to expect.

Pricing Models in the SUD EHR Market

SUD-focused EHRs primarily use two pricing models:

• Per-user/per-month subscription: PIMSY ($99+/user/month) and Valant ($100-$300/month) use this model. It is straightforward but can scale up quickly for treatment centers with 30-50 staff members who need system access.
• Quote-based/facility-based: AZZLY Rize, Ease, and Netsmart use custom pricing that considers facility size, number of users, modules selected, and program type. This model often provides better value for treatment centers because it can account for the high user-to-patient ratio (a 30-bed residential facility might have 40-60 staff needing EHR access).

Total Cost Expectations by Program Size

First-year total includes software subscription, implementation, training, and data migration. Excludes hardware and productivity loss during transition.

The Hidden Cost of the Wrong Platform

The pricing table above only captures direct costs. The indirect cost of using an EHR that does not fit SUD treatment workflows is substantially higher. Treatment centers using adapted general-purpose EHRs commonly report:

• 10-15% higher claim denial rates due to documentation that does not align with SUD-specific payer requirements
• 2-4 additional hours per week per clinician spent on manual workarounds for group documentation and ASAM assessments
• $5,000-$15,000 annually in third-party tools (spreadsheets, supplemental compliance software, paper form scanning) to fill gaps in the EHR
• Audit findings and corrective action plans that cost staff time and jeopardize program licensure

When evaluating EHR pricing for your treatment center, include these indirect costs in the comparison. A purpose-built platform that costs 20-30% more in subscription fees but eliminates workarounds, reduces denials, and simplifies compliance will cost less in total over a 3-year period. For a deeper look at total cost of ownership, see our complete EHR pricing guide.

Frequently Asked Questions

The Bottom Line

Addiction treatment is one of the healthcare specialties where choosing the wrong EHR has the most immediate and consequential impact. The regulatory complexity of 42 CFR Part 2, the clinical specificity of ASAM-based care, the operational demands of residential census management, and the billing intricacies of multi-level SUD treatment create a set of requirements that general-purpose and even standard behavioral health EHRs simply do not meet.

For dedicated SUD treatment centers -- whether residential, IOP/PHP, or multi-level programs -- AZZLY Rize and Ease are our leading recommendations. Both platforms are purpose-built for addiction treatment use cases, with ASAM-aligned documentation, Part 2-oriented controls, census/bed visibility, group workflows, and integrated operational tooling that reduces reliance on disconnected systems.

For large, multi-site enterprise organizations (50+ facilities, thousands of patients), Netsmart myAvatar provides the scalability and state-reporting capabilities that only an enterprise platform can deliver -- but at a price point and implementation complexity that is overkill for most programs.

For mid-size programs that blend SUD treatment with broader behavioral health services, PIMSY offers a balanced combination of clinical features and business operations tools at a competitive price. For outpatient MAT clinics where prescribing is the primary workflow, Valant remains a strong prescriber-first choice. For organizations prioritizing AI-native clinician productivity and admissions/operations visibility, Ease is often the best fit.

Regardless of which platform you choose, the most important decision is to use an EHR that was built for addiction treatment. The cost of workarounds -- in staff time, denied claims, compliance risk, and clinical quality -- far exceeds the difference in subscription fees between a general-purpose system and a purpose-built SUD platform.