Addiction treatments involve a continuum of services offered across multiple levels and intensities, depending on individual needs. Professional assessment can help determine the level of care required and can provide information and guidance for people who are choosing to attend a facility for addiction treatment.
- Addiction treatments are offered at various levels of care, which are utilized depending on the person’s addiction severity and treatment needs.
- Common levels of addiction treatment include outpatient, intensive outpatient, residential, and inpatient rehab.
- When considering addiction treatment, it can be beneficial to seek a professional assessment to help determine the level of care required.
Understanding levels of care in addiction treatment
Level of care refers to the type and level of treatment that a person needs, depending on their individual circumstances and addiction severity. Addiction treatments should always be provided on an individualized basis, tailored to meet each person’s needs. Because of this, different levels of care are available to ensure adequate placement and care. [1]
The American Society of Addiction Medicine (ASAM) provides criteria and guidance to assist in determining the appropriate level of care depending on the individual’s needs. [2]
The ASAM overview
The ASAM criteria continuum of care demonstrates how the level of care can be determined based on the individual’s biomedical, psychological, and social needs and includes the following four levels of care: [2]
- 1 - Outpatient: Including long-term remission monitoring, outpatient therapy, and medically managed outpatient, typically offered in office or clinic settings, but also sometimes available online as a telehealth service.
- 2 - IOP/HIOP: Including intensive outpatient (IOP), high-intensity outpatient (HIOP), and medically managed intensive outpatient provided in outpatient clinics, agencies, or treatment centers, but which may also be offered virtually or as a hybrid of virtual and in-person programs.
- 3 - Residential: Including clinically managed low-intensity residential, clinically managed high-intensity residential, and medically managed residential in a 24/7 facility.
- 4 - Inpatient: Including medically managed inpatient rehab and inpatient detox in a hospital-like setting.
How clinicians determine the right level of care
The level of care required will be determined by a professional or multidisciplinary team of professionals who assess the individual to identify their needs. This will include an assessment of the individual’s mental and physical health history, social circumstances and needs, readiness to change, substance-use-related risks, and any other person-centered or environmental considerations. [2][3]
Factors that influence treatment placement
Treatment intensity varies because of several factors. For example: [1][2][3]
- Severity and duration of addiction: A person who has been addicted to a substance for a long time might experience more severe consequences of their addiction than someone with a shorter duration of addiction. As such, this might require more intensive treatment and may first involve detoxification and withdrawal.
- Type of addiction: Different types of substances and behavioral addictions will require different types of treatment. For example, some addictions will require inpatient care for careful and consistent monitoring during detox, while other addictions might be well managed through outpatient programs.
- Home environment: Someone might require a more intensive level of care if their home environment is contributing to their addiction, as they might need to be placed away from this environment in order to be adequately treated. If the home environment is supportive, a higher level of care may not be required.
- Co-occurring conditions: People who experience a severe mental health condition alongside an addiction may require a higher level of care to manage both conditions.
Addiction treatment levels
As demonstrated, treatment types vary in intensity depending on the individual’s needs and whether they require medically supervised detoxification or other medications.
Medical detoxification (Withdrawal management or WM)
The highest, or most intensive, level of care is medical detoxification. This is required for people with severe substance addiction to manage or prevent serious withdrawal symptoms. Professional medical supervision is provided around the clock in a specialized facility to ensure safety and symptom management.
Medical detox services tend to last a few days to a week. After this, it is common to move to a lower level of care to continue treatment. [1][3]
Inpatient (Level 4) and residential rehabilitation (Level 3)
Inpatient and residential rehabilitation services are often required for people with severe addiction issues and those with co-occurring mental or physical health issues. The terms inpatient and residential are often used interchangeably, although inpatient care is usually within a hospital setting, while residential care is provided within a specialist facility.
Inpatient programs offer people 24/7 monitoring and support from a multidisciplinary team of professionals who can help manage the physical, emotional, and behavioral aspects of addiction recovery. This treatment might follow on from a medical detox program provided in the same or a separate facility. Often, these programs are 30, 60, or 90 days, although they can last much longer. [1][3]
Partial Hospitalization Programs or PHP (Level 2.5)
PHPs are often a step-down program after inpatient or residential treatment, as they provide a less intensive level of care, while continuing to support the individual daily or almost daily. The timeframe might vary, but can involve six hours of treatment services per day, five days per week.
PHPs allow individuals to return to home-living, while continuing to provide a high level of support. This type of treatment can benefit those who require intensive support but have responsibilities that require them to remain at home, or those whose mental and physical health does not need consistent monitoring. [3][4]
Intensive Outpatient Programs or IOP (Level 2.1)
Similarly, IOPs also offer intensive support while the individual lives at home, serving as a slightly lower level of care than inpatient services and often acting as a step-down from these programs.
IOPs require fewer treatment engagement hours than PHPs, often a few hours per day, 3days per week, while PHP’s are often provided 5 days a week or more. This could be used to continue with recovery plans and relapse prevention that commenced during previous treatment, while allowing the individual to maintain personal or professional commitments. [3][4]
Standard outpatient treatment (Level 1)
Outpatient programs act as a lower level of care for those with mild to moderate substance use issues without severe physical or mental health concerns. This could serve as a step-down from higher-intensity treatment programs or as the initial level of care. Many outpatient programs involve once or twice weekly appointments for hour-long group, individual, or family therapy sessions.
Outpatient programs might involve medications if needed, and typically include weekly or more frequent attendance to individual or group therapeutic interventions. This type of care allows the individual to remain living at home and maintain their responsibilities, while engaging in treatment. [1][3]
Comparing addiction treatment levels
| Sober living | Supervision | Accommodation | Duration | Intensity | Costs |
|---|---|---|---|---|---|
| Detox | 24/7 | Hospital-based facility | 3 to 7 days | Highest | High cost per night, few nights |
| Inpatient | 24/7 staff and monitoring | Hospital-based facility | Usually 30 to 90 days | High | Highest cost |
| Residential | 24/7 staff and monitoring | At the facility | Usually 30 to 90 days | High | Highest cost |
| PHP | Daytime | At home | 1 to 3 months | High part-time | Can cost less than inpatient programs, as no overnight stays required |
| IOP and PHP | 3-5 times per week group and individual | At home | 3 to 12 months | High part-time | Can cost less than inpatient programs, as no overnight stays required |
| Outpatient | At office or virtual appointments 1-2 times per week | At home | Months to years | Low | Lowest |
How treatment plans change over time
Treatment plans can be changed and adapted throughout treatment. Each treatment plan is individualized and tailored to the person’s needs. As such, it can be adapted if a certain aspect is not effective or additional needs are identified.
Similarly, treatment intensity can be reduced if it is no longer necessary or as the individual improves. For example, it is common for people to utilize a range of treatment intensities, starting with detoxification, then inpatient rehabilitation, followed by outpatient treatment. [1][3]
Choosing the right level of care
People looking for professional treatment and rehab should consult with a medical professional, who can help assess their treatment needs and advise about an appropriate level of care. Treatment decisions can then be made collaboratively, and this information can help people decide which facility they will attend for treatment.
The Recovered Directory shows available rehabs across the US and can be used to find specific treatment options.
How to seek help
People who need professional support after rehab can often work with discharge planners, case managers, or counselors at the rehab facility before discharge. Most rehab facilities will provide referrals for aftercare providers, and many will even help to schedule the first appointment before you are discharged. This helps to provide continuity of care during the transition back to the community, and can significantly reduce the risk for relapse.
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