There is no “one size fits all” approach to healthcare, and addiction treatment is no exception. Many rehab centers utilize a continuum of care, meaning that clients enter treatment at the level of care (LOC) that aligns with their needs. Then, clients can move to a different Level of Care as their treatment needs change.
Your level of care generally refers to the intensity of services required to diagnose and treat a condition. The American Society of Addiction Medicine (ASAM) [1] has established five levels in a continuum of care for substance abuse treatment:
The five levels of addiction treatment
- Level of care 0.5: Early Intervention
- Level of care 1: Outpatient Services
- Level of care 2: Intensive Outpatient/Partial Hospitalization Services
- Level of care 3: Residential/Inpatient Services
- Level of care 4: Medically Managed Intensive Inpatient Services
Level of Care 0.5: Early Intervention
Professional services for early intervention constitutes a service for specific individuals who, for a known reason, are at risk of developing substance-related problems or for those for whom there is not yet sufficient information to document a substance use disorder. Early intervention services are a precursor to treatment. These approaches are designed for adults or adolescents at risk of developing a substance use disorder but do not display any diagnostic criteria to be admitted to rehab.
During the early intervention, treatment focuses on the risk factors that predispose the person to drug addiction and educates the individual about the negative repercussions of drug misuse. 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
- A high degree of substance availability
When patients have a recognized substance use disorder, they are eligible for several types and service levels.
Level of Care 1: Outpatient Treatment
Addiction or mental health treatment personnel provide professionally directed evaluation, treatment, and recovery service. Such services are provided in regularly scheduled sessions and follow a defined set of policies and procedures or medical protocols. Services must address significant lifestyle, attitudinal, and behavioral issues that can undermine treatment goals or inhibit the individual’s ability to cope with major life tasks without the non-medical use of alcohol or other drugs.
Outpatient treatment requires patients to attend regularly scheduled meetings. This level of treatment allows patients to carry on with their routine while receiving face-to-face services with addiction or mental health professionals. It is ideal for people who have jobs or a robust support system at home, which typically costs less than other levels of treatment.
Level of care 1 includes evaluation, treatment, and recovery follow-up services. It addresses the severity of the individual’s addiction, helps implement behavioral changes, and facilitates mental functioning. Patients may transition to the first level of treatment from a more robust program. It is also a stepping stone for people who are not ready or willing to commit to a complete recovery program.
Level of Care 2: Intensive Outpatient (IOP)/Partial Hospitalization Program (PHP)
Level of care 2 is an organized outpatient service that delivers treatment services during the day, before or after work or school, in the evening, or on weekends. For appropriately selected patients, such programs provide essential education and treatment components while allowing patients to apply their newly acquired skills within “real world” environments. In addition, programs can arrange for medical and psychiatric consultation, psychopharmacological consultation, medication management, and 24-hour crisis services.
Level 2 programs can provide comprehensive biopsychosocial assessments and individualized treatment plans, including formulation of problem statements, treatment goals, and measurable objectives—all developed in consultation with the patient. In addition, such programs typically have active affiliations with other Levels of Care, and their staff can help patients access support services such as child care, vocational training, and transportation.
The second level of care can accommodate medical and psychiatric consultation, psychopharmacological consultation, medication management, and 24-hour crisis services.
Intensive Outpatient Services
This program comprises counseling and education about mental health and substance use issues. Patients are referred to psychiatric and medical services if addiction specialists deem it necessary. However, intensive outpatient programs cannot treat unstable medical and psychological conditions.
Partial Hospitalization Services
Unlike intensive outpatient programs, where the patient has to be referred to outside psychiatric and medical professionals, partial hospitalization provides direct access to those services along with laboratory services.
Level of care 3: Residential/Inpatient Treatment
Level of care 3 encompasses organized services staffed by designated addiction treatment and mental health personnel who provide a planned care regimen in a 24‑hour live‑in setting. Such services adhere to defined sets of policies and procedures. Mutual and self-help group meetings generally are available on-site.
The defining characteristic of all Level 3 programs is that they serve individuals who need safe and stable living environments to develop their recovery skills. Level 3 may house such living environments in the same facility where treatment services are provided or in a separate facility affiliated with the treatment provider.
In line with this, Level III of the continuum of care provides residential substance abuse treatment. This level of treatment is typically appropriate for patients who have functional deficits or require a stable living space to help with their recovery. The patients may live on-site or in a living facility close to the drug and alcohol treatment center, so nearby services are readily available.
Level of care 3 Encompasses Four Types Of Programs
Clinically Managed Low-Intensity Residential Treatment
At this level, services focus on teaching recovery skills, preventing relapse, and improving emotional functions. Professionals also help people relearn essential life skills that will benefit them personally and professionally after treatment.
Residential Treatment
- Outpatient substance abuse services
- A structured recovery environment
- 24-hour staffing
- House meetings
- A community that promotes living skills
This level of treatment requires the facility to be fully staffed and equipped with treatment services.
Clinically Managed Medium-Intensity Residential Services
Also called extended or long-term care, this treatment program provides a structured environment and medium-intensity clinical services. It is designed for patients who have been deeply affected by substance abuse, including those showing temporary or permanent cognitive deficits.
Robust treatment is offered at a slower and more repetitive pace to help the patient overcome mental impairments such as Wernicke-Korsakoff syndrome, traumatic brain injury, or intellectual disability associated with drug use.
This level of treatment provides ongoing case management with services including housing, vocational needs, transportation, and continued self-help meetings. In addition, it aims to assist patients with societal reintegration.
Clinically Managed High-Intensity Residential Services
This program is designed for individuals who have multiple issues and have had a series of unsuccessful interventions. The problems may include substance use disorders, criminal activity, mental disorders, impaired functioning, and difficulty adapting to societal norms. In addition, level 3.5 caters to people with chaotic, unsupportive, and abusive relationships.
Medically Monitored Intensive Inpatient Services
Medically monitored treatment is directed toward individuals with functional deficits such as withdrawal risks, medical issues, or emotional issues that prevent the person from progressing in the recovery process.
Level of care 4: Medically Managed Intensive Inpatient Treatment
These programs provide care to patients whose mental and substance-related problems are so severe, they require primary biomedical, psychiatric, and nursing care. Treatment is provided 24 hours a day, and the complete resources of a general acute care hospital or psychiatric hospital are available. The treatment is specific to mental and substance-related disorders; however, the skills of the interdisciplinary team and the availability of support services allow the conjoint treatment of any co-occurring medical conditions that need to be addressed.
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 medical detox and medication-assisted treatment. This service level is similar to the care a patient would receive at an acute care medical or psychiatric hospital. The facility will have many of the same available resources as those institutions.
Importance Of Levels Of Care
The Levels of Care are labeled fairly straightforwardly — the higher the level, the more acute and “hospital-like” the treatment may be. A patient may be at various stages of addiction treatment and have changing needs.
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 the criteria for Level 1 treatment may have stopped using a drug but has a severe mental health condition (necessitating Level 3 care) or be inactive 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 We Level Up to understand which services you’ll require and helps you know what you can expect for a given level of service.
How Does The Continuum Of Care Work?
When evaluating substance use treatment centers, you’ll come across all of these Levels of Care. The ASAM criteria are also helpful for commercial insurance providers and other stakeholders. In theory, here is how the continuum of care works. First, someone with an opioid use disorder needs medically managed detox—the highest level of care.
After completing detox, a specialist may transition to a step-down level of care, such as inpatient treatment. After completing inpatient treatment, the client may continue with therapy in an outpatient setting. If the client relapses or requires further treatment, they may transition to a step-up level of care. In this case, they may return to inpatient treatment.
Substance Addiction is a condition that can cause major health, social, and economic problems that should not be taken lightly. We Level Up Treatment Center can provide you, or someone you love, the optimum level of care throughout your treatment. Feel free to call us to speak with one of our counselors. We can inform you about the levels of care by giving you relevant information. Our specialists know what you are going through. Please know that each call is private and confidential.
Sources
[1] American Society of Addiction Medicine (www.asam.org)