Treatment for substance use disorder involves a flexible continuum of care, allowing people with the condition to move through various levels as needed.
Seeking treatment for substance use disorder (SUD) can feel like an overwhelming task, and part of this concern may be fear of the unknown: What will treatment be like? Can I get part-time treatment and keep my job? What if my addiction is severe?
First, know you’re not alone. In 2018, an estimated 21.2 million people, ages 12 and older, needed substance use treatment. This equals about 1 in 13, or 7.8% of all adolescents and adults in the United States.
Treatment for SUD involves a flexible continuum of several levels of care. People with substance use disorder can move up or down the levels as needed.
Treatment for substance use disorder (SUD) is not a one-size-fits-all solution.
Every person who enters treatment for substance use has unique needs. Some may require intensive inpatient care, while others can find success in a part-time outpatient setting. And some may need both types of treatment at different times.
In the United States, substance use treatment centers adhere to a standard of care put forth by the American Society of Addiction Medicine (ASAM).
The ASAM standard features a “continuum of care,” defined by four broad levels of treatment and an early intervention level. Decimal numbers further indicate specific types of treatment under the broad categories.
The ASAM “continuum of care” model refers to a flexible treatment system in which people with the condition can enter the level most suitable to their needs, and if necessary, step up or move down in treatment intensity.
An effective continuum results in an easy transfer from one level to the next and offers similar treatment across all levels. Some people move through all levels of care, while others attend only one or two.
The five main levels of care for substance use disorder established by the American Society of Addiction Medicine (ASAM) are:
- Level 0.5: Early intervention treatment
- Level I: Outpatient treatment
- Level II: Intensive outpatient/partial hospitalization treatment (subdivided into levels 2.1 and 2.5)
- Level III: Residential/inpatient treatment (subdivided into levels 3.1, 3.3, 3.5, and 3.7)
- Level IV: Medically managed intensive inpatient treatment
Level 0.5: Early intervention treatment
Early intervention treatment provides education, resources, and counseling to adults and adolescents at risk for SUD but who don’t meet the diagnostic criteria defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
For instance, a person who enters this program may be misusing alcohol or another substance but hasn’t developed an addiction.
Level I: Outpatient treatment
Level 1 outpatient treatment involves fewer than 9 hours a week for adults and fewer than 6 hours per week for adolescents.
The regularly scheduled sessions take place at a nonresidential treatment center or a practitioner’s office and are administered by addiction professionals or trained clinicians.
Overall care includes an evaluation, treatment, and recovery follow-up services.
Outpatient treatment typically provides:
- medication treatment
- group and individual abstinence counseling
- relapse prevention programming
- drug and alcohol education
Outpatient programs are likely to offer help with medical appointments, family therapy sessions, psychotherapy, and employment counseling.
Level 1 care is ideal for individuals who have busy schedules and a strong personal support system.
Level II: Intensive outpatient / partial hospitalization treatment
This level is divided further into levels 2.1 and 2.5.
Level 2.1: Intensive outpatient services
Level 2.1 Intensive outpatient treatment (IOT) provides services for 9 or more hours a week for adults and 6 or more hours a week for adolescents. The recommended minimum duration for IOT is 90 days.
Similar to outpatient programs, IOT programs provide:
- group and individual abstinence counseling
- relapse prevention programming
- drug and alcohol education
In general, the IOT programs may provide more substance use counseling than the outpatient treatment programs, according to
Intensive outpatient treatment can be provided in any setting that meets state licensure or certification criteria.
Treatment is designed to meet the multidimensional needs of people with addiction and comorbid conditions. People may attend the program during the day (before or after work) or in the evening and/or the weekends.
Level 2.5: Partial hospitalization services
If you require more hours, Level 2.5 provides 20 or more hours of this type of care per week.
Plus, it generally involves partial hospitalization.
Level III: Residential/inpatient treatment
This level is divided further into levels 3.1, 3.3, 3.5, and 3.7, depending on your needs.
Level 3.1: Clinically managed low-intensity residential services
Level 3.1 offers 24-hour low-intensity treatment for both adults and adolescents in a residential setting like a big house in which multiple people live.
The program is staffed by designated addiction treatment, mental health and general medicine personnel who provide around-the-clock care and treatment. This includes at least 5 hours of clinical service per week.
Level 3.3: Clinically managed population-specific high-intensity residential services
This is an adult-only level of 24-hour care in a residential setting designed to stabilize imminent danger among people with cognitive disability or other impairments. It involves a lesser degree of social and group treatment.
Level 3.5: Clinically managed medium-intensity residential services for adolescents OR clinically managed high-intensity residential services for adults
This is 24-hour care for adolescents and adults in a residential setting, designed to stabilize imminent danger and prepare you for outpatient treatment. Participants use the full group therapy.
Level 3.7: Medically monitored high-intensity inpatient services for adolescents OR medically monitored intensive inpatient services withdrawal management for adults
This program for adults and adolescents provides 24-hour nursing care in an inpatient setting with an available physician. People in this level require medication and have had recent experience with not being able to complete a withdrawal management program. This level is appropriate for those with severe medical, emotional, behavioral, or cognitive problems.
Level IV: Medically managed intensive inpatient treatment
Level 4 provides 24-hour nursing and physician care for adults and adolescents with acute levels of intoxication and/or withdrawal potential and people with medical, emotional, behavioral, or cognitive issues. Counseling is available 16 hours a day.
This level is also sometimes known as detoxification, or simply “detox,” though some people consider this term an oversimplification, as this type of treatment isn’t as straight-forward as “washing out” a substance.
Substance use disorder is a challenging but treatable condition. Because treatment for the condition is not a one-size-fits-all solution, ASAM has established different levels of care. People can enter the level most suitable to their needs or switch levels as their needs change.
If you think you have substance use disorder, consider reaching out to a trusted healthcare professional.
You can also call the Substance Abuse and Mental Health Services Administration (SAMHSA) helpline at 1-800-662-4357. This is a free, confidential treatment referral and information service.
You may also consider joining a recovery support group, such as one of the 12-step programs like Alcoholics Anonymous (AA). You can find a list of them