What Are The Addiction Recovery Levels Of Care?

People first exploring drug or alcohol addiction recovery services may be overwhelmed by the many different treatment options available. However, treatment programs offered by rehab centers typically fall into one of just four main levels of care, and understanding these care levels can help you or your loved ones feel more confident when seeking an addiction treatment provider.

Taking that first step and seeking help is often critical. More than one in six Americans age 12 or older reported experiencing a substance use disorder (SUD) in 2022, according to the U.S. Centers for Disease Control and Prevention (CDC). The CDC also reports that most people who require addiction treatment never receive it, no doubt contributing to the opioid epidemic and record number of overdose deaths in America today.

Treatment professionals at drug and alcohol rehab centers help potential clients determine which level of care is best. Through providing assessments and evaluations, addiction specialists uncover people’s unique needs and goals in recovery and recommend the appropriate treatment plan, including the level of care.

For the most part, rehab centers will recommend their own treatment programs when applicable but can also refer you to another level of care elsewhere.

Below, we’ll explore the main levels of care in addiction recovery, as well as their subcategories.

Why Are There Care Levels In Addiction Treatment?

There is no singular, overarching type of recommended care when it comes to addiction recovery, because addiction affects everyone differently. People may have long-term or short-term histories of drug or alcohol abuse, for example, or many or few symptoms of addiction.

In general, the recommended level of care will be based on the person’s SUD severity, as determined by the American Society of Addiction Medicine (ASAM) Criteria.

ASAM’s four main levels of care in addiction recovery are:

• standard outpatient programs
• more intensive outpatient treatment
• residential programs
• inpatient treatment

Within these types of care are various treatment options.

What Is ASAM?

Formed in 1954, ASAM is a professional medical society that today represents more than 7,000 doctors, clinicians, and other professionals involved in the addiction medicine field. ASAM developed its criteria in the ’80s so that addiction specialists across the U.S. would have one set of standards to use when placing clients into care and providing results-oriented treatment.

Many addiction treatment facilities, insurance providers, and policymakers use the ASAM Criteria to help people with addiction.

Outpatient Services: Level 1

The first two levels of addiction care outlined by ASAM cover outpatient treatment options. The main difference between outpatient and other levels of care in addiction recovery is that outpatient treatment allows clients to continue living at home. People requiring help with accessing a safe home environment may also reside in sober living homes while receiving outpatient care.

For people with low-severity SUDs, the Level 1 standard outpatient treatment option may be the right fit. This level of care may also be appropriate for people who have completed a higher level of care, such as inpatient treatment, but require continued structure and recovery support upon returning back to their communities.

Level 1 clients tend to have:

• a low risk of withdrawal symptoms
• stable physical health
• a predictable mental health status
• a commitment to change
• fair and appropriate coping skills
• a safe and supportive home environment

Let’s look at the sub-levels of standard outpatient services.

1.0: Long-Term Remission Monitoring

People in recovery who have completed months of more intensive care are typically referred to this level of care.

Long-term remission monitoring involves regular follow-ups, ongoing assessments, and support to detect and address any signs of relapse. This includes periodic check-ins with healthcare providers, participation in support groups, and continuous engagement in healthy lifestyle practices.

1.5: Outpatient Therapy

Outpatient therapy is a flexible and effective level of care for clients either starting their recovery journey or looking to continue recovering after completing live-in care.

Outpatient therapy may include:

• individual counseling
• group therapy
• family therapy
• couples’ therapy
• holistic therapy

Therapy sessions are conducted in a clinical setting. Outpatient therapy helps clients develop coping strategies, address underlying issues, and prevent relapse.

1.7: Medically Managed Outpatient

Medically managed outpatient (MMO) treatment provides medical and therapeutic support for people facing SUDs, including those who require detoxification services or have severe mental health symptoms.

Though clients receive medical care, they still return home after a session is completed.

MMO includes:

• medical monitoring
• medication management
• comprehensive therapy sessions

Intensive Outpatient And Partial Hospitalization: Level 2

Though Level 2 outpatient programs also don’t require clients to live onsite, this level is more intensive than Level 1, providing additional structure and support.

Some clients in Level 2 may have low-severity SUDs, but others have moderate addictions or have experienced longer bouts of substance abuse.

Level 2 clients typically:

• have a moderate risk of experiencing withdrawal symptoms
• have stable physical health
• are unsure about or reluctant to change
• display inconsistent coping skills
• have a home life that gets in the way of recovery
• experience mental health issues that impact recovery, but still function independently

Three treatment options fall under the Level 2 criteria.

2.1: Intensive Outpatient Program

Intensive outpatient programs (IOPs) provide a higher level of care than standard outpatient therapy, with multiple therapy sessions per week.

IOP services may include:

• individual therapy
• group therapy
• family counseling
• psychoeducation
• relapse prevention
• life skills training
• holistic therapy
• support groups
• regular assessments

IOP typically involves at least nine hours of recovery sessions at a treatment facility weekly, but every IOP schedule is different.

2.5: High-Intensity Outpatient/Day Treatment

Level 2.5 covers high-intensity outpatient or day treatment, sometimes called partial hospitalization programs (PHPs). PHPs are usually shorter in overall duration than other forms of care.

This level of care offers treatment similar to inpatient programs for the day, but with clients returning home each evening.

PHP may involve intensive therapy sessions; individual, group, and family counseling; extensive support for relapse prevention; and holistic therapy. In addition, day treatment clients may receive care for co-occurring mental health disorders, such as depression. More than 7.7 million American adults experience co-occurring substance use and mental health disorders, according to the National Institute on Drug Abuse (NIDA).

The 2.5 Level often serves as a transitional phase for people between live-in and standard outpatient levels of care in addiction recovery, offering significant ongoing support.

2.7: Medically Managed Intensive Outpatient

Similar to Level 1.7, this level combines medical supervision with therapeutic care, only at a higher level of care. Many clients in medically managed intensive outpatient programs may be experiencing severe withdrawal symptoms or co-occurring disorders.

This intensive approach to treatment addresses all facets of a client’s recovery, and may take place in a hospital-like setting with trained medical professionals.

Residential Treatment: Level 3

Level 3 addiction treatment programs take place at rehab centers, where clients live onsite and receive access to around-the-clock care from trained addiction treatment providers. Many people begin their recovery journey in residential treatment.

Residential programs focus on treating addiction as well as re-forming a client’s life after long-term substance use. Programs often feature transportation assistance, family visitation, and vocational help in addition to living accommodations and comprehensive treatment so that clients can achieve a brighter future.

Clients in Level 3 facilities usually have:

• a high chance of withdrawal support needs
• poor physical health
• trouble caring for themselves mentally
• little desire to change
• poor coping skills and overall well-being
• high stress involving their current living situation

The first two types of residential care are clinically managed, while the last is medically managed.

3.1: Clinically Managed Low-Intensity Residential

While it’s the least intensive form of residential care, the 3.1 Level still offers essential structure, support, and supervision in a live-in setting for people in early recovery from addiction.

Clients participate in many of the same treatment methods offered in intensive outpatient care but also explore reintegration into daily life, emphasizing the development of life skills, employment readiness, and personal responsibility.

3.5: Clinically Managed High-Intensity Residential

Clinically managed high-intensity residential treatment offers a more structured and rigorous approach than a low-intensity program.

Some of the main differences include:

• 24/7 supervision
• frequent therapy sessions
• a highly structured daily routine

This level of care is for people with severe addiction issues or co-occurring disorders requiring constant support and monitoring from clinicians.

3.7: Medically Managed Residential

A medically managed residential treatment program differs from a clinically managed one because it offers medical care, whereas a clinical setting usually doesn’t.

Features of a medically managed residential program include:

• medical interventions, including medications for substance use disorders
• medication management
• constant monitoring by healthcare professionals

Many of the same treatment approaches offered in clinical settings are also offered at medically managed facilities. Clients in medically managed treatment may have more physical or mental health needs than others.

Inpatient Treatment: Level 4

The most intensive level of care according to the ASAM Criteria is inpatient treatment, where clients live onsite in a hospital or medical-like facility due to prolonged substance use.

Level 4 clients usually:

• are unable to function
• have severe withdrawal symptoms
• are experiencing a severe or even life-threatening medical condition
• reject the idea of treatment and the need to change
• are still actively using substances
• display safety and health risks to others
• are unemployed, unhoused, or unable to maintain life responsibilities

This level of care is for severe addiction cases and for people when outpatient options have not been effective.

Inpatient programs include detoxification services to manage withdrawal safely, followed by a range of therapies such as individual counseling, group therapy, and family therapy. The focus is on stabilizing physical health, managing cravings, and developing coping skills.

People usually spend a short time in inpatient care, then transfer to residential care once withdrawal is completed.

Determining An Appropriate Level Of Care In Addiction Recovery

Determining the appropriate level of care for addiction treatment typically involves an assessment and evaluation provided by treatment professionals at a rehab center.

Key considerations for recommending client placement include:

• using the ASAM Criteria to assess withdrawal risks, medical conditions, psychological and emotional stability, readiness to change, and living environment
• evaluating the severity of substance use disorder, including frequency and duration of substance use, presence of withdrawal symptoms, and history of relapse
• addressing any mental health issues alongside addiction, as a dual diagnosis often requires integrated treatment approaches
• assessing the strength and availability of family, community, and other social supports
  reviewing previous treatment experiences to determine what has been effective or unsuccessful
• considering the individual’s preferences and readiness for specific types of treatment settings, whether outpatient, residential, or hospital-based

Rehab centers that offer comprehensive care typically provide several different levels of care, making it easy for clients to transition from one phase of recovery to the next. Those that don’t offer a particular care level will be able to provide a referral.

Resources

The following resources can help you and your loved ones learn more about addiction and the treatment options available.

• Health Resources & Services Administration’s (HRSA) Health Center Locator: HRSA focuses on improving access to healthcare services for people who are uninsured, isolated, or medically vulnerable.
• National Institute on Alcohol Abuse and Alcoholism (NIAAA): Part of the U.S. National Institutes of Health (NIH), this funding agency and research institute is focused on promoting effective treatment and prevention strategies for alcohol-related issues.
• National Library of Medicine: Operated by the federal government, the National Library of Medicine is the world’s largest medical library.
• Substance Abuse and Mental Health Services Administration’s (SAMHSA) Treatment Locator: SAMHSA is dedicated to advancing behavioral health by improving access to addiction treatment and mental health services nationwide.
• U.S. Centers for Disease Control and Prevention (CDC): As the U.S.’s national public health agency, the CDC is focused on disease prevention and health promotion.