Addiction is complicated, and people come to addiction treatment with an expansive range of needs. For that reason, addiction recovery can be extremely complex. 

According to the National Institute on Drug Abuse (NIDA), no single treatment plan works for every person with a substance use disorder. Instead, effective treatment should address multiple needs in a way that is personal for each individual. 

But if addiction treatment is so individualized, how can it be organized and standardized with evidence-based treatment approaches?

The American Society of Addiction Medicine has developed the ASAM Criteria to help create standard names for the basic levels of care used in treatment. The criteria also created a list of factors that clinicians should consider when placing clients in one of the levels of care. 

Learn more about the continuum of care in addiction treatment and how it helps people with substance use disorders. 

What is the Continuum of Care?

The continuum of care in addiction treatment refers to four main levels of care a person may go through when seeking treatment for a substance use disorder. These levels provide a level of standardization to an otherwise individualized treatment approach. As people move  through the levels, they will likely go from more intensive to less intensive treatment. However, they can move to a more intensive level if a high-level need is identified. 

Each of the four main levels of care has sublevels between them, which allows the clinicians to address an individual’s needs more precisely. A person might not need to go through every level in the continuum before they complete treatment. Instead, their levels of care will depend on their specific needs. 

Medically Managed Inpatient Services

Medically managed intensive inpatient services are the highest level of care in addiction treatment. This level includes medical detox, which is designed for people who are likely to go through unpleasant or dangerous withdrawal symptoms. Medical detox involves treatment from medical professionals with the goal of getting individuals through the withdrawal phase or stabilizing other medical needs in the early stages of recovery. 

Medically managed withdrawal is often considered the first step in addiction treatment. Depressants like alcohol and prescription sedatives can cause deadly withdrawal symptoms and often require medical treatment or a tapering period. Other drugs like opioids and stimulants can cause extremely uncomfortable withdrawal symptoms that aren’t usually dangerous but very difficult to get through without relapse on one’s own.

Medically managed services can also address other issues that the withdrawal phase might complicate. Clinicians can also address psychological issues like depression and anxiety, which are common during withdrawal. 

Withdrawal is an important step for many people, but it’s not enough to address severe substance use disorders. According to NIDA, additional levels of care are needed to address psychological, social, and behavioral problems associated with addiction.

Inpatient Services

Also called residential treatment, inpatient services involve high-level care and 24-hour access to treatment services. Inpatient treatment can involve medically monitored treatment and clinically managed treatment. High-level residential treatment is reserved for people with high-level medical needs who might require medication. Medical monitoring refers to the supervision of medical professionals trained to respond to addiction-related conditions and complications. 

Clinically managed services refer to 24-hour access to trained counselors. This level of inpatient services is for people with multidimensional needs that pose an imminent danger. For instance, powerful stimulants like meth can cause severe depression during and after the withdrawal phase. This can increase the risk of suicidal thoughts and actions. 

Lower level residential services may also be used for people who don’t have urgent medical or psychological complications but need 24-hour care. This could be someone in stable condition in some areas with a poor recovery environment or high relapse potential. 

Intensive Outpatient Services

Intensive outpatient treatment allows clients to live at home while receiving several hours of treatment services each week. To qualify as intensive outpatient services, one needs to attend nine or more hours of treatment services each week. However, individuals can attend much more than that. 

Partial hospitalization involves 20 or more hours of treatment services each week. Intensive inpatient services treat a complex range of needs in addiction treatment. A person may go through several different evidence-based therapies that are ideal for their needs. 

Partial hospitalization is ideal for people with multidimensional instability but can live independently. At this level, clients can start to take on challenges in their home lives while receiving intensive support from treatment specialists.

Outpatient Services

Outpatient services include fewer than nine hours of treatment each week. Outpatient care is an important step before total independence. Clients can spend the majority of their time each week, tending to life goals and responsibilities. If they face challenges that come with greater independence, they can take those challenges to treatment to assess and address them. 

Outpatient treatment allows a client to continue learning relapse prevention strategies as they engage in real-world scenarios. For instance, a person going through cognitive behavioral therapy can learn to identify and cope with real-world high-risk situations that might threaten their sobriety. 

Choosing the Right Level in the Continuum of Care

The ASAM Criteria is an important list of factors treatment professionals can use to determine the right level of care for a person in addiction treatment. When someone enters a rehab facility or treatment program, they will go through an intake and assessment process designed to create a personalized treatment plan for their needs and place them in an appropriate level of care. 

The ASAM Criteria has six dimensions that are used in biopsychosocial assessments. That means it assesses biological, psychological, and social needs. The dimensions include:

    • Acute intoxication or withdrawal potential. This factor refers to a person’s current substance use and risk for uncomfortable or dangerous withdrawal.
    • Biomedical conditions. This is an assessment of one’s physical health or conditions that may need to be addressed in treatment.
    • Psychological conditions. This is an assessment of emotional, behavioral, and cognitive issues that may need to be addressed.
    • Readiness to change. Is a person seeking treatment to appease family members or court orders, or are they ready to make a change in their life?
    • Relapse potential. If a client is likely to relapse on their own, they may need a higher level of care with more oversight.
    • Recovery environment. If someone is ready to live on their own, but their recovery environment is a threat to their sobriety, they may need residential treatment or other accommodations.

Clinicians can use the ASAM Criteria to place a person into one of the four main levels of care and to create a treatment plan that’s unique for that person. However, after the initial assessment, treatment plans can be reassessed with a therapist each week. If a person isn’t in the right level of care or if their treatment plan isn’t working, a therapist can adjust it to work for the individual.

The continuum of care offers some standardization in addiction treatment, but it’s not meant to create a one-size-fits-all plan. Instead, it’s important for individuals who are entering treatment to work with medical and clinical professionals to find a personalized plan that works for them. 

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