levels of care
Seeking treatment for substance use disorder is necessary for individuals wanting to gain back control over their lives. Substance use disorder can negatively impact an individual’s overall health, so finding the right treatment plan is necessary for progressing on the road to recovery. While all treatment programs have a similar goal of recovery, there are numerous types of programs and services that can help individuals become healthier and recover.
Personalized treatment plans are essential for successful recovery because every patient is different and requires varying levels of care to get better.
The levels of care that treatment facilities offer can provide the best plan for every patient who needs help recovering from substance use disorder.
Whether you’re looking for treatment for yourself or a loved one, finding the right format that fits your schedule and severity of addiction can create a path for a successful recovery.
Why Do We Need Levels of Care?
Substance use disorder looks different for every person. It can impact anyone regardless of age, ethnicity, income, occupation, location, gender or religion. Every person is unique, which is why the care provided by treatment facilities needs to have various levels to accommodate every individual who needs help.
People can have various intensities of addiction. The severity of addiction depends on the drug, the length of substance use and any co-occurring mental health conditions. Certain drugs, like fentanyl and heroin, may require a stronger detoxification process with attentive medical care, while others like cocaine or marijuana have weaker withdrawal symptoms.
How long a person has been using a substance can strengthen their dependency and make withdrawal symptoms or a lifestyle change more challenging to withstand. Individuals tackling a co-occurring mental health condition may also need additional care during treatment to ensure recovery is successful.
These reasons and many others help explain why levels of care are necessary for treating substance use disorders. Treatment facilities in the United States follow the standard levels of care set by the American Society of Addiction Medicine (ASAM). The ASAM outlines five general levels of treatment for their continuum of care. These five levels are further detailed by a decimal point system that defines specific types of care for individuals struggling with substance use disorder.
The ASAM continuum of care levels is beneficial for patients because it allows flexible treatment options to plan the right approach for each individual. Treatment programs can meet patients’ needs by offering various options to match their lifestyles, schedules and severity of addiction.
The levels of care for substance use disorder treatment make transitioning from one method to the next simple. They give care providers a comprehensive outline of what treatment options can work best for the patient and what levels of care they should include in their plan.
How Does the Continuum of Care Work?
A continuum of care is essential for individuals recovering from substance use disorder to provide them the best treatment possible. A flexible continuum of several levels of care increases the chances of a successful treatment process and allows more patients to receive adequate care. More people will have a better chance of preventing relapse, overdose and other negative situations.
The continuum of care describes the process of easing patients into various steps of substance use treatment. A patient begins treatment in the highest level of care they need, whether it’s medical detoxification or outpatient treatment. After completing the first step in their treatment plan, they’ll move on to the next phase, which will be less intensive than the first. This process will continue until the patient is in full recovery and ready to merge into the real world with a new sober lifestyle.
The goal of ASAM’s continuum of care is to standardize substance use treatment across the country. It allows medical professionals and treatment facility staff to know what type of care is best for their patients and develop plans that will best match patient needs with assistance from a guideline. The continuum of care that treatment centers follow is also beneficial for insurance providers when determining coverage.
An example of how the continuum of care works in a facility would be a patient seeking treatment for opioid addiction and needing optimal care for recovery. The patient must first undergo monitored medical detoxification to tackle withdrawal symptoms and begin the next step of treatment while sober. Detoxification is the highest level of treatment a patient can participate in during treatment.
The next step is residential inpatient treatment. After completing that stage, the patient may then transition into outpatient treatment while slowly integrating back into their life. If the patient relapses while in one of the lower stages, they can simply move up a step into the more intense treatment options to progress through recovery.
Substance use treatment centers create plans for patients with their offered levels of care or recommend other facilities that can provide the best treatment options for the patient.
How Do Providers Determine the Level of Care?
The medical professionals at the treatment facility a patient is seeking care at will determine what levels of care are necessary for recovery, typically during an initial assessment. A medical professional will ask the patient numerous questions about themselves, their lifestyle, health and other factors impacting their substance use. This information will help the medical team best understand the patient’s state and the type of care they’ll need to recover from substance use disorder.
The ASAM Criteria provide medical professionals with an outline they can use to develop structured treatment plans for their patients. The ASAM Criteria is the most widely used guideline for substance use treatment. It is regularly reviewed and revised when necessary to help medical professionals continue providing the best treatment for patients struggling with substance use disorder.
Creating a treatment plan requires gathering a significant amount of information about the patient to produce a safe methodology that’s the least intensive option. The ASAM Criteria helps medical professionals filter through this extensive information gathered from initial interviews, clinical information, field knowledge and patient goals and narrow down the best treatment options.
The most prominent aspect of The ASAM Criteria is that the outline looks at the entire person rather than solely the substance use problem. This detail makes treatment plans more effective because medical professionals can tailor them to each patient by referencing numerous aspects of their lifestyle.
The ASAM Criteria is beneficial because of the six principles that helped guide its development. These principles can help patients and loved ones understand the treatment plan creation process from the medical professional’s point of view.
Principles of The ASAM Criteria include:
- Consider the entire person: Approaching treatment simply on the substance use disorder diagnosis will only progress so far. While considering the substance use problem is crucial to creating a treatment plan, other patient details tell what level of care is best for their recovery. Many unique aspects make up the entirety of a person, and using that information about their lifestyle, interests and treatment history will help physicians or medical professionals select services and programs that will best match the patient.
- Personalize treatment times: Patients may notice some treatment programs have a specified duration or are referred to by program length. A 28-day program will treat every patient for that duration, but The ASAM Criteria details that every individual’s treatment plan should last as long as needed. Individualized treatment times are beneficial for patients so that they don’t have to worry about rushing their recovery. Some people will take more time to recover, and others may only need a few sessions.
- Create customized treatments for each individual: Treatment programs for substance use disorders should not be one-size-fits-all. Developing a plan for each patient is the best way to ensure they receive the levels of care they need. Care providers can determine the clinical services and programs that will help an individual most effectively or recommend other facilities or services that theirs doesn’t provide. The ASAM Criteria ensures medical professionals work hard to create excellent plans for every patient.
- Provide numerous services: While The ASAM Criteria outlines five general levels of care, treatment facilities should always consider an individual’s specific needs and offer numerous services and programs to help them through recovery. The general levels of care represent benchmarks on the continuum of care for substance use. Patients may need to receive care on every benchmark, a couple of benchmarks or between benchmarks. Individuals may also move up and down the continuum of care depending on their progress through recovery.
- Treat patients without the prerequisite of failure: When a provider is creating a treatment plan, they shouldn’t consider a patient’s past “failures” in previous programs. The right level of care an individual needs is based on their substance use disorder, their personality, their lifestyle and other personal factors — not their previous success with other facilities.
- Alter the definition of addiction: ASAM has provided its own definition of addiction that gives care providers an updated way of looking at the chronic condition.
What Are the ASAM Levels of Care?
The standardized levels of care outlined by ASAM help make numerous treatment services available for patients struggling with substance use disorder. Medical professionals from various treatment facilities can discuss or recommend treatment options effectively when they are all providing the same levels of care. It’s helpful for patients to be aware of the broad levels of care when seeking treatment so they have an idea of what their treatment process will look like.
Care levels for the treatment of substance use disorders range from the least intense to most intense on the continuum of care. These five basic levels of care can also break down into more specific types of treatment. Learn more about these levels of clinical care and how each can improve a patient’s treatment plan.
Level 0.5 Early Intervention Service
The first level of substance use treatment is early intervention services. The early intervention level is beneficial for individuals who have a high risk of developing substance use disorder. This stage is also a fitting option for individuals who exhibit signs of substance use disorder but don’t hit the markers of the diagnosable criteria.
The goals of this level are to target the risk factors of substance use disorder and help individuals learn how to live a healthy lifestyle. Some of the risk factors for substance use disorder include:
- Poor parental support
- History of trauma or abuse
- Aggressive behavior
- Access to substances
- Lack of close relationships
This level is a helpful preventative against developing substance use disorder and helps people with a family history of addiction learn how they can start the path of sobriety.
Level 1 Outpatient Treatment
The next level of care patients can participate in is outpatient services. Outpatient services are a popular option for individuals who are further along in their recovery and want to integrate back into the real world. Outpatient treatment is also a good first step for people who need addiction treatment but can’t miss out on obligations like work or school and are healthy enough to be unsupervised throughout the day.
Patients can continue maintaining their daily routines and live at their homes while attending outpatient appointments. People can schedule outpatient appointments at any point in the day to best fit their schedule. Outpatient treatment consists of regularly meeting with a physician or medical professional during the week, having access to various therapies or clinical services and receiving medications.
This level of care is lowest on the treatment scale because patients still live at their residence during treatment and are interacting with loved ones, co-workers and peers like usual.
Level 2 Intensive Outpatient Treatment and Partial Hospitalization
Individuals who need more care for their substance use disorder can receive intensive outpatient treatment or partial hospitalization services. These treatment programs are beneficial for people with more complex substance use disorders. This can mean a high severity of addiction or the presence of co-occurring disorders that require more attention and supervision.
Intensive outpatient and partial hospitalization services provide more resources for patients than traditional outpatient treatment. Here are further details about both treatment programs:
- Level 2.1 Intensive Outpatient: Individuals who need more frequent outpatient appointments but still need to attend school, work or other obligations can benefit from intensive outpatient treatment. Patients can sign up for intensive outpatient appointments during the week, at night or on the weekends to ensure a good fit for their schedule.
- Level 2.5 Partial Hospitalization: Partial hospitalization treatment is the most intense out of the outpatient program levels. This level of care is best for individuals who need more supervision and medical resources during this point in their recovery process but have a supportive home to return to after treatment. Partial hospitalization has a similar schedule to work or school, so most of the patient’s day will be spent at treatment.
Level 3 Residential/Inpatient Services
Patients who need around-the-clock supervision require a higher level of care to progress through recovery. Residential and inpatient services are best for patients who will benefit most from having access to medical staff and mental health professionals while they reside at the treatment facility. These patients may struggle if they continue with treatment while living at their homes — residential treatment can provide the care they need.
Treatment centers can provide various versions of residential treatment to accommodate multiple types of patients and ensure they have the right resources to provide the best inpatient care.
Level 4 Medically Managed Intensive Inpatient Services
Patients may require medically managed intensive inpatient services, which is the highest level of care from ASAM. This stage includes services like medication-assisted treatment (MAT) and medical detoxification. Patients who go into treatment with a heavy dependency on a substance and intense withdrawal symptoms will need help getting through these side effects.
Medically managed intensive inpatient services are similar to the care patients receive at medical hospitals for acute cases. Patients will have access to 24/7 care for the duration of their treatment. Withdrawal symptoms can be dangerous or life-threatening, and this level of care can help individuals start their recovery safely.
