The pathway to recovery from substance abuse is navigated through a multi-tiered system of care, beginning with the phase of detoxification. This first step makes sure that people can safely deal with withdrawal symptoms while under close medical care. Usually, this happens in an inpatient setting where doctors can closely watch and lower the risks of detoxing. (1)
Reintegration into daily life involves participation in less restrictive but highly supportive outpatient programs such as Partial Hospitalization Programs (PHPs) or Intensive Outpatient Programs (IOPs). PHPs provide substantial clinical care during daytime hours without necessitating overnight stays, catering to those requiring close clinical oversight.
Conversely, IOPs offer flexibility for individuals ready to resume work or education commitments while continuing their recovery journey through regular therapy sessions. (2)
People who are struggling with drug use disorders learn the important skills and insights they need to not only get well but also stay healthy by moving through these structured levels of care that are specific to each stage’s needs.
What Are the Substance Abuse Levels of Care?
Substance abuse treatment has no magic, one-size-fits-all plan. Just as every individual with a substance use disorder is unique, so must their type of treatment. (3)
For this reason, different levels have been established to help standardize care. This system helps providers meet the needs of patients and avoid disrupting their continuum of care as they move through the different phases of their rehab.
From outpatient services that teach vital skills to support intensive inpatient recovery programs, the ASAM (American Society of Addiction Medicine) Levels of Care provide a seamless, streamlined guide and diagnostic criteria for treatment.
The levels of care are an essential tool, allowing an experienced and committed team of health professionals to adjust the level and intensity of care to ensure the best outcome possible.
There is no “one size fits all” approach to healthcare — addiction treatment is no exception.
This principle holds especially true in the field of addiction treatment, where a “one size fits all” approach is far from effective.
Addiction itself manifests differently in every person; factors that should be addressed include the following.
- The substance used
- Duration of use
- Genetic predispositions
- Co-occurring mental health disorders
- Personal life circumstances
As a result, personalized care plans are essential for addressing these aspects effectively. (4)
In crafting addiction treatments, clinicians consider comprehensive assessments, patient history, preferences, and goals.
Treatment modalities vary, including:
- Medical detoxification
- Cognitive-behavioral therapy (CBT)
- Motivational interviewing (MI)
- Holistic therapies
The choice of specific interventions depends on the severity of dependence and the presence of any dual diagnosis-related psychological conditions. (5)
Ongoing adjustments are made in response to progress and challenges encountered along the way. Ultimately, success hinges on the ability to adapt and evolve based on the unique requirements of the person seeking to overcome a substance use disorder.
What Is the Function of ASAM?
The American Society of Addiction Medicine was established in 1954 for physicians dedicated to providing cutting-edge addiction treatment. (6)
Although drug abuse has been an issue in the United States since the late 1800s, it wasn’t until this era that drug use problems were finally recognized as an area of medicine in great need of study and treatment.
In addition to offering a focused resource for addiction treatment providers, the ASAM criteria also emphasize improving the accessibility of quality addiction treatment to patients with substance use disorders.
How Common Is Substance Abuse in the United States?
The US has one of the highest substance abuse rates in the world. The availability of a wide variety of both legal and illegal drugs has greatly contributed to the problem.
Some of the most commonly used substances include:
- Alcohol
- Opiates
- Methamphetamines
- Heroin
- Cocaine
- Marijuana
- Ecstasy/molly
According to a report released by the CDC (Centers for Disease Control), in 2021, more than 107,622 people in the United States died from drug overdoses. (7)
How Many Levels of Care Are Available for Substance Use Disorder?
There are five primary levels of care for those undergoing substance abuse treatment. Some of these have sub-levels, depending on the issues a patient may be experiencing and the type of care they may require.
ASAM has established each of these various levels. A set of criteria has also been written to help clinicians provide consistent care throughout treatment.
These criteria determine at what level and intensity a patient should be started and when they are ready to move to the next level.
The treatment received across these five levels is known as “the continuum of care” and ensures the proper treatment level is used as the patient progresses. Each level works independently but cohesively with the next, allowing an individual to receive consistent care.
Depending on the severity of a substance use disorder, the overall duration, whether or not polysubstance use is present, etc., the level of care may start at any of the five levels. Below, the criteria for each of the five levels are outlined. (8)
Level 0.5: Early Intervention Services
Early intervention services have been proven to help prevent serious addiction in the future. Level 0.5 provides a unique preventive opportunity for adolescents or adults at high risk of developing a substance use disorder.
Typically, these individuals don’t display the common signs indicating a need for more intensive treatment. (9)
Individuals predisposed to substance abuse are assessed, and a treatment plan is developed that hones in on their particular risk factors. Much of this treatment includes education surrounding the negative effects substance abuse can have on one’s life and those around them.
It also helps at-risk individuals to identify situations that trigger substance use and learn alternate coping skills. An advantage to this type of intervention is the ability of trained staff to carefully observe and identify any issues that may indicate a need for a higher level of care.
Level 1: Outpatient Services Treatment
Outpatient services are useful for those with moderate substance abuse issues. It’s an ideal option for those who can’t or won’t enter a more intensive recovery program. Outpatient treatment services provide consistent treatment while allowing patients to maintain their normal lifestyle routines.
Regular meetings provide the clinical support needed but don’t interfere with commitments such as work, family life, or other patient responsibilities. They are most effective for those with a strong support system outside of treatment, such as family or good friends who encourage sobriety. (10)
The outpatient route is also often used as the next step for individuals who have just left a more rigorous phase of treatment and need to continue developing their recovery skills. This ongoing contact and continued therapy are important for a successful outcome.
Some outpatient treatment programs encourage family therapy to help a patient’s loved ones establish healthy boundaries and learn to provide the types of support needed for that individual to continue to remain sober.
Depending on the severity of the patient’s addiction, the frequency and duration of meetings can vary. The care received by someone undergoing outpatient services should include monitoring, counseling, and follow-up services.
Level 2: Intensive Outpatient Treatment and/or Partial Hospitalization
This second ASAM level of care provides more support than Level 1.
Intensive Outpatient/Partial Hospitalization services cover areas such as:
- Medication management
- Psychiatric care
- Round-the-clock crisis intervention
- Auxiliary services, such as child care when undergoing treatment
- Vocational training to help those looking for a fresh start (11)
Intensive Outpatient Care
An intensive outpatient program provides more in-depth care than a standard outpatient program. Sessions are often longer than those in standard outpatient programs.
They touch on more education surrounding addiction and prevention, with the added benefit of referrals to outside addiction specialists such as physicians and psychiatrists.
This level of treatment is ideal for those who need a little extra support than what is provided by standard outpatient care but are not medically or psychologically unstable.
Partial Hospitalization Services
In some instances, individuals undergoing substance abuse treatment may not need 24-hour care but still require easy access to addiction specialists and clinical services.
Partial hospitalization services fill this gap between intensive outpatient treatment and inpatient treatment by providing in-house access to medical care and psychiatric services.
A partial hospitalization services program usually requires the patient to spend at least 20 hours per week onsite. The continuity in care and care providers in partial hospitalization programs is beneficial for those transitioning out of a higher level of care, such as residential treatment.
Level 3: Residential/Inpatient Care
Once an individual has reached the end of detox, they will often transition to an inpatient program. Inpatient care requires that the individual live onsite.
Residential programs are especially helpful for those recovering from severe addictions and who need stability to focus solely on recovery. 24-hour supervision and care ensure that support is always available during a person’s recovery.
Level 3.1 Clinically-Managed Low-Intensity Residential Care
Level 3.1 care is used to help patients who have not experienced cognitive damage from their substance abuse learn and apply coping, recovery, and life skills while in a safe, supportive environment. (12)
Typically, this type of program is conducted in a group home setting that builds a community of individuals experiencing the same challenges. Vocational training, support, and life skills help patients move back into society with fewer setbacks.
A level 3.1 treatment program is fully staffed 24 hours a day with addiction specialists and medical personnel who can provide care as needed.
Level 3.3 Clinically Managed Medium-Intensity Residential Care
Level 3.3 care provides a structured environment for those requiring long-term care. The majority of individuals in extended care experience more severe effects from substance abuse that affect them on a cognitive level.
These conditions include:
- Traumatic brain injuries (TBIs)
- Intellectual disabilities
- Nervous system damage
- Wernicke-Korsakoff Syndrome
- Speech difficulties (13)
The treatment of these patients uses a slower, more repetitive, and methodical approach. This accommodates the cognitive difficulties they may be experiencing and allows them time to absorb each treatment concept.
The treatment approach for these individuals is long-term. In addition to helping them overcome their cognitive impairments, Level 3.3 treatment provides multiple services, including assistance with basic needs such as transportation, housing, ongoing group therapy, mental health support, and vocational training and support.
As with Level 3.1 programs, 24-hour care is available for any issues.
Level 3.5 Clinically Managed High-Intensity Residential Care
Level 3.5 is recommended for an individual who has experienced relapses or unsuccessful treatment of substance use disorders.
These patients tend to be in situations where they don’t have any support systems or are in relationships that are abusive or non-supportive. Often, they are encouraged by those closest to them to continue their harmful behaviors, making relapse almost inevitable.
Substance use disorders are the most common problem these individuals face. They may also experience mental disorders, partake in criminal activity, or exhibit anti-social behaviors that make it difficult for them to function within society.
Treatment focuses on helping prevent relapse, developing healthy relationships, and developing life and vocational skills during the recovery process. It also strongly emphasizes adapting to and learning social skills to make re-entering society easier.
24-hour care is onsite at these treatment facilities, including nurses and addiction specialists.
Level 3.7 Medically Monitored Intensive Inpatient Services
Patients requiring a higher level of physical and mental care are usually placed into Level 3.7, also known as Medically Monitored Intensive Inpatient Services care, to ensure they receive the medical, behavioral health, and psychiatric care they need.
These individuals may be at a significantly higher risk of complications from withdrawal, such as developing DTs (delirium tremens) or having underlying medical or psychiatric issues that can impede treatment. Withdrawal management is an important aspect of level 3.7 treatment.
A highly structured program with near-constant interaction is used for these individuals. Onsite physicians and addiction counselors are available 24 hours a day to monitor and treat patients as needed.
Level 4: Medically Managed Intensive Inpatient Care
Some individuals have such severe substance use disorders or co-occurring disorders that they require special care when starting their treatment journey. Most of these patients will initially require a high level of care and start at level 4.
When considering the different levels of care available, level 4 treatment is quickly apparent as the most intensive.
Intended for those experiencing withdrawal and detoxification, it requires comprehensive services, including:
- Medical and psychological evaluations
- Medication-assisted treatment (if needed)
- Regular medical monitoring and treatment
Individuals are at the highest risk of physical complications during this period in their treatment process, making it essential that they are closely monitored.
Often, medications that may be needed short or long-term are prescribed and administered. During this level of treatment, highly structured routines are established to help create a sense of stability and dependability to support patients through this otherwise chaotic and frightening phase of their recovery.
The primary goal of level 4 treatment is to physically and mentally stabilize patients so they can proceed to the next level of care.
How Do Providers Determine the Level of Care?
Determining the appropriate level of care for individuals struggling with substance use disorders is a critical step that healthcare providers undertake with precision and empathy. This decision-making process involves a comprehensive evaluation, considering various factors to ensure that each person receives the most effective treatment tailored to their needs. (14)
- Initial Assessment: The first step is an in-depth assessment, which includes finding out about the person’s past drug use, mental health, physical health problems, and any social or environmental factors that may be making their situation worse. During this phase, standardized screening tools and diagnostic interviews are often used to find out how bad the addiction is and if there are any other illnesses present.
- Assessing Severity and Risk: Providers evaluate both the severity of the substance use disorder and potential risks associated with withdrawal complications and harm to self or others. Based on these evaluations, clinicians can categorize the level of need, ranging from outpatient services requiring minimal intervention to residential inpatient programs that offer intensive around-the-clock care.
- Considering Personal Circumstances: Beyond clinical criteria, personal circumstances and life responsibilities also play a role. For instance, someone with a strong support network and a stable living environment might be better suited for one approach, whereas another individual facing unstable housing and a lack of familial ties could benefit more from a structured setting.
Aftercare Services
An essential part of successful substance use disorder treatment is the follow-up care that a patient receives. Although rehab may be completed, support is still needed to help newly recovered individuals re-enter everyday life. (15)
Substance abuse is a chronic disease that requires vigilance to maintain sobriety.
Before finishing treatment, an aftercare plan should be made to guide the next steps in a patient’s recovery journey.
Some of the aftercare services that may be offered include the following.
Sober Living Arrangements
Many treatment facilities offer sober living for patients who have completed treatment. This community-style living provides a safe and substance-free place for patients to readjust to daily life while being responsible for maintaining their sobriety.
Individuals are expected to contribute to the house’s upkeep and pay to help cover the costs of rent, food, etc.
While house rules are established to provide structure and maintain safety, residents can come and go for work, social events, shopping, and normal daily activities.
If a treatment facility doesn’t run its own sober living site, it can refer patients to recommended homes in the area.
Individual and Group Counseling
Individual and group counseling can help by providing support for sobriety and the problems and triggers that may lead to relapse.
Many individuals who have experienced a substance use disorder had significant stressors in their lives that led them to use in the first place. These might include childhood abuse and neglect, social difficulties, unhealthy relationships, and unmanaged mental health conditions.
12-Step and Other Recovery-Focused Meetings
The camaraderie found with others going through recovery can be an invaluable tool in sobriety. Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are two of the most well-known support groups in the US. (16)
These and other recovery meetings match individuals with sponsors and create accountability. They also help individuals stay focused on their continued healing in a structured manner.
Alumni Programs
Once an individual has completed their treatment, they may be able to get involved in the facility’s alumni program. These programs host social gatherings and group meetings in a safe, substance-free setting.
Attendees can connect with others who understand the struggles of remaining sober and offer support and encouragement to one another.
Online Resources
The COVID-19 pandemic made in-person meetings difficult for individuals who had recently completed treatment. Luckily, technology such as Zoom has made it possible to have face-to-face conversations over digital means. (17)
This trend has continued, allowing patients to interface with others even when in-person meetings are impossible. Most treatment facilities will have a list of available resources; SAMHSA can also help connect individuals with groups or counselors that offer online services.
Look At Your Treatment Center and Treatment Options Today, For Recovery Support
By carefully considering the different levels of care, therapeutic approaches, and supportive environments offered by various facilities, you can find a program that resonates with your circumstances and goals for recovery.
Remember, taking this step forward reflects strength and commitment towards achieving wellness—there’s no better time than now to seek out the support that can guide you through reclaiming control over your life in pursuit of long-term sobriety and health.
If you or someone you know is struggling with a substance abuse problem, we can help. Our experienced and compassionate staff is available to help you on your road to recovery. Call Zinnia Health at (855) 430-9439 today.
Citations
- https://www.ncbi.nlm.nih.gov/books/NBK64088/
- https://store.samhsa.gov/sites/default/files/pep20-02-01-021.pdf
- https://www.ncbi.nlm.nih.gov/books/NBK64109/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486499/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031575/
- https://www.asam.org/
- https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/202205.htm
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309369/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418996/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8104924/
- https://www.sciencedirect.com/topics/medicine-and-dentistry/partial-hospitalization
- https://www.ddap.pa.gov/Professionals/Documents/ASAM%20Page/ASAM%20update/Level%203.1%20Co-occurring%20byService%20Description%203.23.pdf
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385737/
- https://www.ncbi.nlm.nih.gov/books/NBK64815/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813220/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140338/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8289897/