Levels of Care

Treatment programs must be individually tailored to fit the needs of each person affected by a substance use disorder. Five main levels of treatment exist to allow patients to begin the treatment process and guide them through recovery.
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Every person has different needs when it comes to substance abuse treatment. When patients first enter rehab, it is important they are assigned to the proper level of care.

This approach to treatment, or continuum of care, ensures that patients receive adequate care upon admission and are smoothly transitioned to a higher or lower level of care as needed. According to the American Society of Addiction Medicine, there are five main levels of treatment in the continuum of care for substance abuse treatment.

The five levels of addiction treatment

The continuum of care was developed to ensure uniformity through the treatment process. This makes what happens in rehab more efficient for patients who transition from one level of care to the next.

Dr. Kevin Wandler of Advanced Recovery Systems discusses the levels of care provided by alcohol and drug rehab facilities.

Level 0.5: Early Intervention Services

Early intervention services are a precursor to treatment. They are designed for adults or adolescents who are at risk of developing a substance use disorder but do not display any diagnostic criteria to be admitted to rehab.

During 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.

The duration of early intervention services greatly depends on the patient’s understanding of the perils of substance use and whether he or she makes behavioral changes to avoid the path to drug addiction. Patients are closely monitored for symptoms that indicate they need a higher level of treatment.

Level I: Outpatient Services

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 strong support system at home, and it typically costs less than other levels of treatment.

Level I care includes evaluation, treatment and recovery follow-up services. It addresses the severity of the individual’s addiction, helps implement behavioral changes and ameliorates mental functioning. Patients may transition to the first level of treatment from a more robust program. Level I is also a stepping stone for people who are not ready or willing to commit to a complete recovery program.

Level II: Intensive Outpatient/Partial Hospitalization Services

The second level of treatment can accommodate medical and psychiatric consultation, psychopharmacological consultation, medication management and 24-hour crisis services. The program is affiliated with other levels of treatment in the continuum of care and provides support services such as child care, vocational training and transportation.

Nanci Stockwell of Advanced Recovery Systems explains why outpatient treatment may be more appropriate for some people in recovery from addiction.

Level II.1: 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.

Level II.2: 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 III: Residential/Inpatient Services

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.

Nanci Stockwell of Advanced Recovery Systems discusses the advantages of inpatient, or residential, treatment for addiction.

Treatment and assistance are provided around the clock, and the facility is staffed 24 hours a day, seven days a week. The patients may live on site or in a living facility in close proximity to the drug and alcohol treatment center so nearby services are readily available.

Did you know that some treatment services can be done online? Learn About Online Rehab

Level III.1: Clinically Managed Low-Intensity Residential Services

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.

Level III.1 treatment includes:
  • 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.

Level III.3: 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. It aims to assist patients with societal reintegration.

Level III.5: 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 issues may include substance use disorders, criminal activity, mental disorders, impaired functioning and difficulty adapting to societal norms. Level III.5 caters to people with chaotic, nonsupportive and abusive relationships.

Level III.7: 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.

Facilities offering level III.7 treatment provide 24-hour professional evaluations, observation, medical monitoring and addiction treatment.

Beds in an inpatient drug rehab treatment facility

Level IV: Medically Managed Intensive Inpatient Services

Out of the four levels of treatment, level IV is the most comprehensive and intensive. It offers 24-hour medically directed evaluation, care and treatment, including daily meetings with a physician. The facilities are usually equipped with the resources of general acute care or psychiatric hospitals and offer substance abuse treatment that also addresses co-occurring disorders.

The last level of treatment focuses on stabilizing patients and preparing them for transfer to a less robust level of care for continued monitoring as they progress toward recovery.

Medical Disclaimer: DrugRehab.com aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

Sonia Tagliareni
Author, DrugRehab.com
Sonia Tagliareni is a writer and researcher for DrugRehab.com. She is passionate about helping people. She started her professional writing career in 2012 and has since written for the finance, engineering, lifestyle and entertainment industry. Sonia holds a bachelor’s degree from the Florida Institute of Technology.

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