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Addiction Treatment: What Level of Care Do You Need?

6 minute read

You or a loved one has made the difficult but life-changing decision to get help for substance abuse. Now you need to determine what kind of addiction treatment you need to get better. The best way to ensure you’re entering the appropriate level of care is to work with a behavioral health professional.

They are specially trained to assess your situation and can help you find the best addiction treatment program based on:

  • The severity of your substance use disorder
  • The type of substance abused
  • How long you’ve been abusing drugs or alcohol
  • Your medical and psychological background
  • The presence of co-occurring disorders
  • Your life situation and logistical factors

A resource some clinicians use to guide this process is The American Society of Addiction Medicine (ASAM) levels of care. This is a set of ASAM patient placement criteria that provides guidelines for assessing the appropriate type of treatment for an individual. It’s a multi-dimensional approach for clinicians and care managers that allows for:

  • Objective decision-making
  • Individualized care
  • Improved client outcomes
  • A biopsychosocial approach to treatment decisions

The ASAM criteria helps people struggling with substance use disorders obtain the tools and services that will promote long-term recovery for their individual situation. 

ASAM Levels of Care Criteria

ASAM criteria helps determine what level of care you need. The ASAM encourages patients to walk through the criteria with their therapist so they can be an active and educated participant in their treatment plan. These are the six dimensions of ASAM criteria used by clinicians to help guide treatment decisions: 

#1 Acute Intoxication and Withdrawal

This ASAM criteria dimension considers your substance use patterns and risk for drug or alcohol withdrawal symptoms. This may include:

  • How often you use drugs or alcohol
  • The last time you used substances
  • Current withdrawal symptoms
  • History of severe withdrawal symptoms such as seizures
  • Extent of support if severe withdrawal symptoms occur 

#2 Biomedical Conditions and Complications

Identifying factors that could impact withdrawal and addiction treatment is the focus of the second dimension of ASAM criteria. This includes any current physical illnesses and chronic conditions. Guidelines can help determine if you are able to manage these conditions on your own or if additional support is needed during the recovery process. 

#3 Emotional, Behavioral, or Cognitive Conditions and Complications

The third dimension of ASAM criteria looks at psychiatric and mental health issues that can complicate treatment or create risk. Considerations include:

  • Identifying any co-occurring mental health disorders
  • Evaluating the severity of co-occurring disorder symptoms
  • Assessing if mental health symptoms are autonomous or as a result of substance abuse
  • Determining if psychiatric symptoms require specific mental health treatment
  • Identifying your coping skills and ability to manage everyday tasks 

#4 Readiness to Change

The fourth dimension of ASAM criteria assesses the degree to which you’re ready to make a change. This includes both internal and external factors that have motivated you to get help. Your clinician may refer to The Stages of Change, which can help determine readiness and how aware you are of the relationship between addictive behaviors and negative life consequences.

This considers factors like:

  • Awareness of the need for change
  • Readiness and level of commitment to change
  • Participation and cooperation in treatment
  • Recognition of negative consequences tied to drug and alcohol abuse 

#5 Relapse/Continued Use, Continued Problem Potential

This fifth ASAM dimension identifies your risk for continued relapse. You’ll look at impulse control capabilities, coping skills, and past patterns of substance abuse. ASAM criteria for dimension five evaluates your:

  • Risk of immediate danger from substance abuse and mental health issues
  • Skills to cope with your addiction, mental health disorder, or suicidal thoughts
  • Awareness of triggers
  • Severity of substance use and mental health issues and probability that they will continue without treatment
  • Ability to cope with cravings, impulses, and triggers

#6 Recovery and Living Environment

The sixth dimension of ASAM criteria assesses your living situation and the level of support or roadblocks to recovery. For instance:

  • Are you living with other people who are using substances?
  • Who is in your support system?
  • Are you involved in community support programs like Alcoholics Anonymous, Narcotics Anonymous, or SMART Recovery?
  • Do any loved ones, work, school, or living situations limit your ability to engage in treatment?
  • Do you have supportive people, adequate finances, and vocational or educational resources to help you be successful in sobriety?
  • Do you have legal, vocational, or criminal situations that are driving your motivation for treatment?
  • Are there issues with employment, childcare, transportation, or housing that need to be addressed?

Addiction treatment occurs on a continuum, with a range in the level of structure, intensity, and monitoring. The ASAM criteria puts addiction treatment on a continuum of five levels of care that are designated in Roman numerals from 0.5 to IV. Within each level of care, there are decimal number rankings from .1 to .9 to signify the intensity of services within those designations. 

ASAM criteria is not a one-time assessment. It’s used to assess and reassess your needs throughout the course of care. It not only helps you enter the appropriate level of care but can also guide your ability to “step up” or “step down” in treatment.

Depending on your needs, addiction treatment may include some or all of the following:

Medical Detox

The first step in treatment is often medical detox. This is the process that eliminates drugs and alcohol from your system. During detox from alcohol or drugs, you may experience uncomfortable or life-threatening withdrawal symptoms, so it’s best to undergo detox with the help of medical professionals. At a detox center, you’ll get 24-hour support. Staff will help manage drug or alcohol withdrawal with research-backed medications, monitor your vital signs, and immediately attend to urgent medical situations.

Residential Treatment

Residential addiction programs provide you a place to live onsite while receiving treatment. Also known as inpatient treatment, you’ll attend groups, activities, and therapy during the day and retire to the treatment centers’ residences in the evenings. This option gives you space and distance from everyday triggers so you can focus on yourself and learn the relapse prevention skills for long-term recovery.

Partial Hospitalization Program (PHP)

Partial hospitalization programs (PHP) provide frequent and structured programming without the 24-hour feature of inpatient treatment. Partial hospitalization programs usually run around six hours a day, five days a week. While attending a PHP, some people prefer to live in a sober-living residence rather than home. This can minimize triggers and provide peer support outside of treatment hours. PHP programs typically have individual and group therapy as well as direct access to psychiatric care to monitor and manage co-occurring and post-acute withdrawal symptoms.

Intensive Outpatient Program (IOP)

Intensive outpatient programs (IOP) are structured clinical programs in an outpatient setting. Group and individual sessions are usually offered several times throughout the week. An IOP program provides structure and support while you navigate early recovery in everyday life. IOPs meet less than PHPs and can serve as a step down as you gain more confidence in your sobriety. Hours vary, but generally IOPs meet for about three hours a day, three or four times a week.

Outpatient Program (OP)

Outpatient programs (OP) help you keep a foothold in addiction treatment as you attend work or school and return to everyday responsibilities. Hours are less than PHPs or IOPs, with some programs only meeting one to three hours per week. OPs are typically scheduled sessions tailored to help you achieve goals related to addictive behaviors, behavior/emotional issues, and coping with stressors without the use of substances. The goal is to achieve stability in recovery and develop outside supports. 

Get Help For Addiction

Because each person comes with their unique journey and experience, treatment is not “one size fits all.” Using multi-dimensional criteria allows for assessment of the whole person to match them with the most effective interventions and support. If you or a loved one is struggling with substance abuse, reach out to Footprints to Recovery. We offer a full continuum of care and evidence-based treatment approaches that address the underlying issues that fuel addiction and help you develop healthy coping skills to prevent relapse. Contact us today. 

References

  1. https://www.asam.org/asam-criteria/about
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