The Levels of Addiction Treatment

When it comes to substance abuse treatment, every person has different needs. There is no ‘one size fits all’ for the treatment of addiction. Every substance use disorder is different, so there must be different levels of care to accommodate all patients.

This is why the American Society of Addiction Medicine (ASAM) created five ‘levels of care’ for treating addiction. Using the levels of care as a model, treatment providers can decide what kind of care a patient needs when they are admitted, and then they can adjust that care to a higher or lower level if needed. 

ASAM considers the levels of care to be important markers along a ‘continuum of care’. This means that while there are five main levels of care, there are actually ways of treating patients that fall in between and on different ends of each level, perhaps borrowing certain aspects of treatment from two levels. 

Still, knowing these levels of treatment can be very helpful in understanding addiction treatment as a whole. It is very common for patients to move down the levels of care as they progress with their recovery, until they finally do not need treatment at all. The levels of care begin at 0.5 and end at 4. Treatment becomes more intensive with higher levels. 

Level 0.5: Early Intervention

This level actually comes before any substance abuse treatment is necessary. Level 0.5 is preventative care for people who show signs of being at risk for abusing alcohol or drugs. Since this level of care is not actually designed for people who are suffering from addiction, it focuses instead on educating patients about the downfalls of drug use. 

The early intervention stage is appropriate for children, adolescents, and adults. Anyone who is predisposed to developing a substance use disorder can receive early intervention care. Programs like D.A.R.E. fall into this level of treatment. These programs educate at-risk youth about the dangers of substance abuse.

How long someone stays in early intervention depends on how they respond to the treatment. If they continue to show signs of going down the path of drug and alcohol abuse, they might stay in this stage for longer. If this level of care fails and the patient develops a substance use disorder, they will be moved up to the next level of care.

Level I: Outpatient Services

Outpatient services are the first level of treatment for patients who have an existing substance use disorder. In this level of treatment, patients must attend meetings every week. The patient can continue with their daily lives and routines, but they also get regular time with substance abuse and mental health professionals.

Usually, treatment for patients in outpatient care totals less than nine hours per week. Examples of treatment that a person might receive in outpatient care include different types of therapy, including either individual or group therapy, or both. Non-substance abuse-specific self-help groups are also common during this level of treatment.

Outpatient services are good for patients who have a strong support system outside of the treatment they are receiving. It costs less than the other levels of care, so if a patient does not need intensive treatment, this can be a good option for them. They can continue attending school or going to work, and not need to sacrifice too much in order to receive treatment. 

It is common for people to receive level I care after transitioning from a higher level. It is also common for patients to need to be moved to higher levels of care if outpatient treatment doesn’t work for the patient.

Level II: Intensive Outpatient/Partial Hospitalization Services

Level II care covers a fairly wide range on the continuum of substance abuse treatment services. In this level, patients still live mostly on their own, but they receive intensive care for their substance abuse issues. Direct treatment is usually no less than nine hours per week in this level. Medication is common in this level in order to help the patient abstain from using, or to stabilize other co-occurring mental health conditions. 

Level 2.1: Intensive Outpatient Services

In this stage of level 2 care, patients live on their own or in special housing, such as a sober living home. They attend some combination of therapy, group meetings, and regular visits with medical providers and addiction specialists. This type of care tends to be less expensive than inpatient treatment, and it still allows patients some autonomy in their daily lives.

Level 2.5 Partial Hospitalization Services

This is the last level of addiction treatment before inpatient care. Partial hospitalization services 

give patients direct access to medical professionals and lab services.

Level III: Residential/Inpatient Services

Level 3 on the continuum of care includes residential treatment centers and other inpatient treatment programs. This level of care is for patients who need a stable place to help with their recovery, away from the distractions and triggers of daily life.

In level 3 treatment, patients live in a facility that also offers clinical treatment services. The facility will have staff available at all times. Not all level 3 treatment looks the same. There is a wide spectrum of care even within this level.

Lower-End Level III Treatment

Treatment services in level 3 facilities range quite a bit. At the lower end of the spectrum, you will find patients who are fairly stable and nearly ready to transition to intensive outpatient care. This stage of care focuses on teaching skills for self-reliance, preventing relapse, and handling emotions and relationships better. Behavioral therapies such as Cognitive Behavioral Therapy are common in lower-end level 3 treatment situations. Still, patients at this stage are living in a full-time treatment center and being monitored for any signs of relapse or instability.

Higher-End Level III Treatment

In the more intensive end of the inpatient treatment spectrum, patients are monitored and/or medically managed 24/7. This part of treatment is for people who are at risk for withdrawal or relapse. Additionally, patients who have intense medical, emotional, or mental health issues might benefit from this type of care. 

Patients in this level of care receive regular medical attention including addiction treatment and treatment for other medical or mental health issues. They are monitored around-the-clock in case further issues come up. The main goal during this phase is to keep a patient medically stable and begin to introduce some therapy and other long term addiction treatments. Nursing care is given under the direction of physicians.

Level IV: Medically Managed Inpatient Treatment

This is the most intense level of substance abuse treatment. Physicians and addiction professionals give 24-hour care to patients in this phase. Patients who are in Level IV care are either in withdrawal from drugs or alcohol, or they require acute care for other medical or emotional problems. This level of treatment is designed to be short-term and is meant to stabilize patients medically so they can be transferred to lower levels of care. 

The levels of care are a guide to help you better understand the full spectrum of substance abuse treatment. Every patient’s needs are different. Each person who receives treatment enters at a slightly different point on this continuum of care, and progresses through the levels of treatment at their own pace. There is no formula for how long treatment takes or exactly how it should go.

The one universal truth about addiction treatment is that it is always the right choice to seek treatment for a substance use disorder. These are not problems that tend to go away on their own, or treat themselves. Being proactive with treatment is a way to save time, money, and potentially, your own life. Call a treatment center today if you or a loved one is suffering from addiction.