Levels of Care for Addiction Treatment
Entering substance use treatment for the first time can generate some anxiety, particularly because there are numerous unknowns. Patients likely have a host of questions, ranging from “What will treatment be like?” to “Will there be someone to help me 24/7?”
A good way to ease that anxiety is to educate yourself about the various levels of care for substance abuse. By learning more about the continuum of care levels, you’ll gain not only a better understanding of what treatment looks like but also insights into what level of care might be a good fit for you. Granted, treatment centers will typically evaluate your needs and attempt to match them with specific levels of care. But a little education goes a long way to easing fears and lessening anxiety.
Plus, it helps to know you’re not alone. According to the Results from the 2021 National Survey on Drug Use and Health, 4.1 million people aged 12 and older received substance use treatment in the past year.1
Read on to understand the differences between levels of addiction treatment, why there are different levels of care, and how to find help if you or a loved one are struggling with substance misuse or addiction.
Why are There Levels of Care for Substance Abuse Treatment?
Treatment isn’t a one size fits all solution. Everyone has unique and individual needs, which can include co-occurring medical or psychological problems, social difficulties such as relationship or family issues, vocational or job troubles, and legal issues. Treatment should take these issues into account and factor in a person’s unique characteristics, such as age, gender, ethnicity, and culture.2
The American Society of Addiction Medicine (ASAM) has developed criteria and guidelines for placement, continued stay, transfer, and/or discharge of people with addiction and co-occurring conditions. Understanding the different levels of care can help people work with their healthcare providers to find the type of treatment they need and to better understand the care they will receive.3
Different treatment centers offer different levels of care. Some facilities provide the full continuum of care, while others may offer one level and then help you transfer to another facility for additional care levels if necessary. The ASAM Criteria can also aid physicians and other qualified professionals in determining the appropriate patient placement based on the person’s unique set of recovery needs, medical and mental health issues, overall health, and social situation, while also considering their strengths, assets, resources, and support structure.3
Treatment centers can be certified for certain levels through different bodies that provide accreditation for addiction facilities. The Commission on Accreditation of Rehabilitation Facilities (CARF), for example, currently offers Level of Care Certification to residential facilities that offer substance use disorder treatment to adults consistent with levels of care described in The ASAM Criteria.4
What are the 5 Levels of Care from ASAM?
ASAM has identified five levels of care, but various sublevels are also included. The organization also offers slight differences between care for adults vs. adolescents. However, adult levels are broken down into the following groups and subgroups:3
- .5 Prevention/Early Intervention.
- 1 Outpatient Services.
- 2 Intensive Outpatient Services / Partial Hospitalization Services.
- 1 Intensive Outpatient Services.
- 5 Partial Hospitalization Services.
- 3 Residential/Inpatient Services.
- 1 Clinically Managed Low-Intensity Residential Services.
- 3 Clinically Managed Population-Specific High-Intensity Residential Services.
- 5 Clinically Managed High-Intensity Residential Services.
- 7 Medically Monitored High-Intensity Inpatient Services.
- 4 Medically Managed Intensive Inpatient Services.
People can transition between different levels and can be referred to higher or lower levels of care as needed.
Level 0.5 Early Intervention Services
Level 0.5 (Early Intervention Services) is designed to help people who are deemed to have a high risk of developing a substance-related problem but do not yet have a diagnosable substance use disorder (SUD). It provides prevention services, such as education about the risks of substance use and ways to avoid high-risk behaviors.5
Early intervention services may involve individual or group counseling, motivational interventions, and Screening, Brief Intervention, and Referral to Treatment (SBIRT). Early intervention services may be offered in different settings, such as primary care medical clinics, hospital emergency departments, community centers, work sites, a person’s home, and a physician’s office.5
Level 1 Outpatient Services
Level 1 is often the initial level of care for people with less severe SUDs. They are also used as a step-down from higher-intensity levels of care or for people who are stable but are in need of monitoring. Level 1 involves less than 9 hours of services per week.5 People who are placed in Level 1 programs should have supportive home environments, display stable physical and mental health, and be free of significant withdrawal risks.6
Outpatient Level 1 services can involve different types of therapies and treatments, such as individual and group counseling, motivational enhancement, family therapy, educational groups, occupational and recreational therapy, psychotherapy, medication therapy, and additional therapies. Level 1 services are typically offered in settings such as health clinics, primary care practices, mental health programs, and more.7
Level 2 Intensive Outpatient Services/Partial Hospitalization Services
Level 2 offers addiction education and treatment components. This level is broken down into two sub-levels, which include level 2.1 Intensive Outpatient Services and Level 2.5 Partial Hospitalization Services.3
- Level 2.1 offers 9 to 19 hours of services per week.8 Services are typically similar to those offered in Level 1 but on a more intense scale.6 Treatment, which can take place in the evenings, on weekends, or during the day, is generally offered by substance use disorder outpatient specialty providers.5 Support for psychiatric or medical needs are usually offered via consultation and referral, and medical, psychological, psychiatric, laboratory, and toxicology services are provided within 24 hours by telephone or within 72 hours in person.5,8
- Level 2.5, which is also known as day treatment, involves 20 hours or more of services per week, offered in settings that offer partial hospitalization programs.5,9 This level differs from Level 2.1 in terms of intensity, but it also directly offers medical, psychological, psychiatric, laboratory, toxicology, and emergency services by qualified providers. As such, it’s appropriate for people with unstable medical and psychiatric conditions.5,6 Partial hospitalization programs offer similar therapies to Level 2.1 but on a more intense/frequent scale.5
Level 3 Residential/Inpatient Services
Level 3 services take place in a structured, residential setting, which means that you live on-site, and staff are present 24/7.5 There are four types of Level 3 programs.
- Level 3.1 (Clinically Managed Low-Intensity Residential Services) is typically designed for people with minimal withdrawal risks and stable mental and physical health or conditions that are being appropriately managed, but who also require a structured, stable environment free of distractions due to moderate to severe SUDs.5,6 In Level 3.1 care, people learn how to deal with tasks of daily living, receive assistance with stabilizing and maintaining SUD symptoms, and develop necessary recovery skills.5
- Services are clinically managed in Level 3.1, meaning that they’re directed by an interdisciplinary team of nonphysician professionals rather than medical personnel. Therapies include individual, group, and family therapy; medication management and education; mental health evaluation and treatment; motivational enhancement and engagement strategies; recovery support services; counseling and clinical monitoring; medication and case management; and other treatments for those with co-occurring disorders.5
- Level 3.3 (Clinically Managed Population-Specific High-Intensity Residential Services) takes place in specialty facilities and is intended for those with significant cognitive impairments, such as traumatic brain injury, related to their SUD or co-occurring mental health disorder. Treatment may occur at a slower pace until the person’s cognitive abilities improve or until they can progress to the next level of treatment. Services are directed by physicians and are similar to Level 3.1 therapies, but they may also include a range of other therapies as well as physical therapy and clinical and didactic motivational interventions.5
- Level 3.5 (Clinically Managed High-Intensity Residential Services) involves high-intensity programs for adults who cannot be treated outside of a 24/7 facility due to severe physical or psychological problems or severe impulse control problems, or because they display dangerous symptoms that require 24-hour monitoring.5,6 Treatment services are provided by an interdisciplinary team, and onsite physicians are available but not required for phone or in-person consultation. Level 3.5 care typically takes place in freestanding facilities or specialty units of healthcare facilities. Services are similar to Level 3.1 programs but can also include occupational, art, music, and recreational therapies along with other services as deemed necessary.5
- Level 3.7 (Medically Monitored High-Intensity Inpatient Services) are high-intensity programs for adults who have medical, emotional, behavioral, and/or cognitive problems that are not severe enough to require direct medical management but are serious enough to warrant highly structured 24-hour care. Services are provided by addiction physicians who are available on site 24 hours daily, as well as nurses, addiction counselors, behavioral health specialists, and clinical staff. Treatment takes place in freestanding facilities or specialty units of hospitals, and services, which are similar to Level 3.5, include daily treatment to manage acute medical or behavioral problems.5
Level 4 Medically Managed Intensive Inpatient Services
Level 4 care is for people with severe biomedical, emotional, behavioral and/or cognitive conditions that require primary medical and 24-hour nursing care. Services are provided in hospital settings, such as acute care units, and involve medically directed evaluation and treatment. Primarily designed to provide stabilization, this level then helps people transition to another level of care.5
Here patients receive medically directed acute withdrawal management and intensive medical and psychiatric services. Therapies and treatments can include: cognitive, behavioral, motivational, pharmacologic, and other therapies; physical health and health education services; planned clinical interventions; and services for families and significant others.5
How to Find Treatment for Substance Abuse
Given the various substance abuse levels of care, there is a suitable solution for everyone. The first step to finding the right treatment for you or your loved one is to reach out for guidance and support.
American Addiction Centers (AAC) has many levels of care and treatment types available at treatment centers located throughout the United States. Please call our free, confidential helpline and speak to an admissions navigator to learn more about your rehab options.