Levels of Care in Addiction Treatment

The ASAM Levels of Care help patients find the type of treatment they’re looking for and understand the care they will receive.

Coming to terms with an addiction and deciding to get treatment takes immense courage and you should be congratulated for reaching this important milestone. Now, how do you know which of the levels of treatment you will need? There are various levels of care that help with addiction, so it’s important to know what the different levels of addiction treatment services are.

The American Society of Addiction Medicine (ASAM) has developed standardized language to describe the type of treatments that addiction treatment facilities usually offer. The ASAM Levels of Care describes five broad categories of treatment that vary in intensity, from least to most intensive. These categories help patients understand which levels of care are the most appropriate for their needs.

Level 0.5 Early Intervention Services

The first described level of treatment is designed for those who are at known risk for developing a substance use disorder. It’s also for people who have shown signs and symptoms of a substance use disorder but do not meet diagnosable criteria for it.

At the early intervention services level, treatment is directed toward the risk factors for developing a substance use disorder:

• Aggressive childhood behavior
• Lack of parental supervision
• Poor social relationships
• High degree of substance availability

When patients have a recognized substance use disorder, they are eligible for several types and levels of service.

Level 1 Outpatient Services

Outpatient services make up the first level, where patients maintain their daily lives but regularly meet with physicians and treatment professionals for evaluation, treatment and follow-up for a substance use disorder. After initial assessment and screening, eligible patients in outpatient services can receive medications, therapy and other treatments. Outpatient treatment is the lowest intensity level and are typically the lowest in cost, generally requiring no more than nine hours of treatment per week (or six hours for children and adolescents).

Level 2 Intensive Outpatient/Partial Hospitalization Services

Patients with more complex needs, such as those with a co-occurring disorder, may be eligible for an intensive outpatient program (IOP) or a partial hospitalization program (PHP). These programs are structured to treat patients more rigorously while offering more resources than outpatient services can provide.

2.1 Intensive Outpatient Services

In an IOP, patients receive treatment for nine to 20 hours per week and have frequent contact with physicians, psychiatrists and therapists. Many intensive outpatient programs are provided for short periods during the day or on evenings and weekends. Because of this, patients can continue working, going to school or carrying out other responsibilities while attending IOP.

At The Recovery Village, patients at this level of care and above are offered boarding to accommodate their needs as they commit to their recovery efforts.

2.5 Partial Hospitalization Services

Partial hospitalization programs are the most rigorous of outpatient programs. Treatment at facilities offering partial hospitalization services lasts for at least 20 hours per week. Individual, group and family therapy are major components of treatment, as is psychoeducation. Participants can often also utilize services like yoga and acupuncture during the day. Frequent contact with medical and therapeutic staff is expected and integrated into the partial hospitalization services model of treatment.

Level 3 Residential/Inpatient Services

Residential treatment programs, or inpatient drug treatment programs, are for patients whose addictions have created significant functional impairments. It’s also for patients who require more stability than they can achieve at home. At this level, patients live on-site or in close proximity to their treatment. Treatment is offered around the clock — 24 hours per day, seven days per week.

3.1 Clinically Managed Low-Intensity Residential Services

Level 3 care escalates based on the amount and depth of a patient’s interactions with clinicians.

At Level 3.1, at least five hours of clinical services per week must be provided. Treatment at this level focuses on teaching recovery skills, such as relapse prevention and emotion management. At this level, treatment must be capable of treating co-occurring disorders. Services at this level of treatment include:

• Outpatient substance abuse services
• A structured recovery environment
• 24-hour staffing
• House meetings
• A community that promotes living skills

3.3 Clinically Managed Population-Specific High-Intensity Residential Services

There are two distinctive features of Level 3.3 treatment. First, treatment at this level can proceed at a slower pace but with more reinforcement to accommodate those who may be experiencing cognitive or other impairments. Cognitive conditions such as traumatic injury or alcohol-related brain damage are often interlinked with substance use disorder.

Second, clinicians at this level of treatment must be capable of managing “multidimensional imminent danger.” They must be able to recognize the acute dangers of conditions like alcohol withdrawal. Since they may have patients with co-occurring disorders, they must also recognize when a patient is at imminent risk for self-harm.

3.5 Clinically Managed High-Intensity Residential Services

At Level 3.5, treatment takes place at a regular pace but is directed toward those who have multiple active needs. These needs can include a co-occurring disorder, severe functional impairment or difficulty adjusting to healthy routines.

3.7 Medically Monitored Intensive Inpatient Services

Level 3.7 is for patients in inpatient setting who are at risk for withdrawal or have medical needs that require careful observation, treatment or follow-up. This is the highest intensity service that Level 3 offers.

Level 4: Medically Managed Intensive Inpatient Services

The highest overall level of treatment, ASAM Level 4 includes 24-hour treatment and high-level medical and clinical monitoring. Among these Level 4 services are drug and alcohol detox and medication-assisted treatment. The medical detox service level is similar to the care a patient would receive at an acute care medical or psychiatric hospital, and the facility will have many of the same available resources as those institutions. At Level 4, patients are seen by a physician on a daily basis, and co-occurring disorders are readily treated.

Importance of a Continuum of Care

The levels of care are labeled in a fairly straightforward manner — the higher the number of the level, the more acute and “hospital-like” the treatment can be. A patient may be at various stages of addiction treatment and have changing needs. This is why services are said to be delivered on a “continuum of care.”

In a continuum of care model, patients may not necessarily have a linear progression in their treatment course. For example, a patient who initially met criteria for Level 1 treatment may have stopped using a drug but has a severe mental health condition (necessitating Level 3 care) or be in active withdrawal (necessitating Level 4 care). Similarly, a patient may step down from Level 4 to Level 1 outpatient treatment.

The ASAM levels of treatment allow The Recovery Village to understand which services you’ll require, and helps you understand what you can expect for a given level of service. The levels of treatment make sure that we are focused on your goals for treatment and recovery.

If addiction has touched your life and you would like to seek help, The Recovery Village can guide you toward effective treatment. Our experienced professionals can assess your needs, screen for other conditions and help you find the appropriate level of treatment for your unique situation. Call us to find out more about our programs and offerings.

Editor – Jonathan Strum

Jonathan Strum graduated from the University of Nebraska Omaha with a Bachelor's in Communication in 2017 and has been writing professionally ever since. Read more

Medically Reviewed By – Dr. Kevin Wandler, MD

Kevin Wandler holds multiple positions at Advanced Recovery Systems. In addition to being the founding and chief medical director at Advanced Recovery Systems, he is also the medical director at The Recovery Village Ridgefield and at The Recovery Village Palmer Lake. Read more