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The Continuum of Care — From Detox To Transitional Living

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Levels In The Addiction Treatment Continuum Of Care

According to the American Society of Addiction Medicine (ASAM), the continuum of care for substance use disorder treatment includes five levels. These levels do not exist separately from one another, but instead should flow seamlessly together.

Level 0.5 – Early Intervention

Early intervention services provide support to patients at risk of developing substance use disorder, as well as those showing signs of addiction but cannot yet be diagnosed with a disorder.

The goal of this level of treatment is to stop the development of substance use disorder before it occurs. Treatment services aim to make patients aware of their potential to develop a substance use disorder, as well as the steps they can take to avoid this outcome.

Early intervention services may include:

  • screening
  • individual counseling
  • group counseling
  • motivational intervention
  • brief intervention
  • referral to treatment

Level I – Outpatient Treatment

Outpatient treatment involves no more than nine hours of treatment per week for adult patients, and less than six hours per week for adolescent patients. Treatment focuses on motivational enhancement, and outpatient services can be delivered in a variety of environments.

Outpatient care is appropriate for patients who have less severe disorders or are in the early stages of change. Outpatient treatment may also be used as a “step-down” service for patients who have already completed a more intensive treatment program. The goal of outpatient treatment is to help patients build coping skills and overcome addictive behaviors.

Level II Intensive Outpatient Treatment/Partial Hospitalization Services

Level II in the continuum of care consists of intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs).

IOPs consist of at least nine hours in treatment each week for adults, and at least six hours in treatment each week for adolescents. Services may be available during daytime hours, as well as in the evenings or on weekends to accommodate varying patient needs.

PHPs require a greater time commitment than intensive outpatient programs. Partial hospitalization programs involve at least 20 hours of services per week. However, patients undergoing PHPs will not receive 24-hour care.

Level III – Residential Treatment/Inpatient Services

Residential treatment services provide 24-hour support to patients, as well as continuous access to trained personnel.

These programs are staffed by mental health professionals, addiction treatment professionals, and general medical professionals, all of whom provide services to patients as needed. Inpatient treatment services vary in intensity based on the needs of patients.

The goal of residential/inpatient treatment is to provide patients with a safe and stable environment to begin their recovery. For many patients, especially those with severe disorders and/or co-occurring mental health problems, residential treatment is the entry point to the continuum of care.

In addition to counseling, behavioral therapy, and other evidence-based services, medication management and education may also be included in these programs.

Level IV – Medically Managed Intensive Inpatient Services

Medically managed intensive inpatient services represent the highest level of care available to patients. With this level of care, patients have access to daily care from physicians, as well as 24-hour nursing support.

Medically managed intensive inpatient services are conducted in an acute psychiatric unit, psychiatric hospital, or acute care general hospital. Services include direct daily care from a licensed physician who will assist the patient in making treatment decisions.

The goal of medically managed intensive inpatient services is to alleviate severe cognitive, behavioral, and emotional distress associated with substance use disorder, as well as prepare the patient for a less intensive level of care.

Most patients will transition to a residential treatment program following stabilization in a medically managed intensive inpatient setting.

ASAM Patient Placement Criteria

Patients enter the continuum of care at a specific level based on their needs at the time of admission. In order to help healthcare providers decide on the appropriate entry level for patients, the American Society of Addiction Medicine (ASAM) developed a set of criteria.

The ASAM criteria are a comprehensive set of guidelines that can be used to place patients in the most appropriate treatment setting. The ASAM criteria use six different dimensions to assess patients thoroughly. These dimensions include:

Dimension 1: Acute intoxication and/or withdrawal potential, which explores the patient’s previous experiences with withdrawal and substance use in general.

Dimension 2: Biomedical conditions and complications, which explores the patient’s current physical condition and medical history.

Dimension 3: Emotional, behavioral or cognitive conditions and complications, which explores the patient’s mental health condition. This dimension also covers thoughts and emotions.

Dimension 4: Readiness to change, which explores and evaluates the patient’s level of interest in treatment services and their desire to make a lasting change.

Dimension 5: Relapse, continued use, or continued problem potential, which considers the patient’s potential to continue using drugs, as well as their history of relapse.

Dimension 6: Recovery/living environment, which explores the patient’s living situation and home environment.

In order to determine the most appropriate entry level for treatment, clinicians consider all of these dimensions together. In most cases, this will involve a comprehensive biopsychosocial assessment of the patient, as well as in-depth interviews with key members of the patient’s support system.

Providing Ongoing Patient Care Within The Continuum

As patients progress through treatment, their needs are likely to change. For this reason, continued evaluation is essential. When our clinical team sees evidence of patient progress or regression, the patient may need to be moved to a less intensive or more intensive level of treatment.

For example, when a patient shows progress within an inpatient treatment setting and no longer requires 24-hour supervision and support, our clinical team may recommend moving the patient to a partial hospitalization program.

On the other hand, patients who are showing signs of relapse within a partial hospitalization program may need to be moved to an inpatient program to better promote their recovery.

Planning For Aftercare

As the patient progresses through treatment, both the patient and treatment staff must be actively involved in the patient’s transition from one level of care to the next. This provides an important connection between the patient’s current treatment provider and their next treatment provider.

During a residential program at Vertava Health, an ongoing recovery plan will be developed alongside the patient before they discharge. Once the treatment program is complete, therapists and counselors will:

engage the patient in the recovery plan, set goals, and identify activities that promote healthy living and sobriety after treatment

connect the patient with services and resources that are available in their community
develop working relationships with local agencies that facilitate the patient’s transition into sober-living programs or other aftercare services

transfer clinical arrangements and obtain the patient’s written consent for transferring to a new treatment program or transitional living situation

Because the continuum of care plays such an important role in effective addiction treatment, our clinicians and treatment staff develop individualized treatment plans that care for the patient through every step of the recovery journey, from detox support to transitional living.

To learn more about the continuum of care Vertava Health, contact us today.


American Society of Addiction Medicine—What Is the ASAM Criteria?

Medicaid Innovation Accelerator Program—Overview of Substance Use Disorder (SUD) Care Clinical Guidelines: A Resource for States Developing SUD Delivery System Reforms

Substance Use: Clinical Issues in Intensive Outpatient Treatment—Chapter 3. Intensive Outpatient Treatment and the Continuum of Care