Everyone enters treatment for substance use disorder (SUD) at a different place in their life. Likewise, everyone has different needs and goals for treatment. For example, individuals struggling with severe symptoms of SUD may require an intensive program that offers a safe living environment. In contrast, individuals struggling with mild symptoms may need an option that allows them to live at home to attend to childcare or other responsibilities.

With so many different treatment programs available, it can be overwhelming to determine what kind of care will best fit your needs. Within the field of substance abuse treatment, there are five levels of care. Becoming familiar with each level can help you better understand what level of care is right for you as you begin addiction treatment.

Continuum of Care & the 5 Levels of Care

The American Society of Addiction Medicine (ASAM) has established a continuum for substance abuse treatment broken into five established levels of care. This breakdown is widely accepted and used consistently across many well-recognized treatment resources. The Substance Abuse and Mental Health Services Administration (SAMHSA) explains the continuum of care as “a treatment system in which patients enter treatment at a level appropriate to their needs and then step up to more intense treatment or down to less intense treatment as needed.”

To start understanding the continuum of care, the five levels of care are as follows:

  • Level 0.5: Early intervention services
  • Level I: Outpatient services
  • Level II: Intensive outpatient program (IOP) and partial hospitalization program (PHP)
  • Level III: Residential/inpatient services
  • Level IV: Medically managed intensive inpatient services (detox)

Level 0.5: Early Intervention Services

Early intervention involves addressing substance misuse. Substance misuse occurs when an individual uses:

  • A substance for a purpose other than what it was intended for
  • Illicit drugs
  • Alcohol or other drugs with the intent to “get high” or self-medicate

These services are meant to increase treatment engagement in individuals who are misusing alcohol and other drugs. They emphasize the importance of harm reduction and work to prevent worsening consequences of substance use. Early intervention services are recommended for individuals who are experiencing symptoms of SUD but are not yet ready to enter treatment.

SAMHSA explains that the main goals of early intervention include:

  • Reducing the harms associated with substance misuse
  • Improving health and social functioning in individuals who misuse substances
  • Reducing risk-taking behaviors before they lead to injury
  • Ultimately preventing substance misuse from progressing into SUD that requires more intense treatment

Level I: Outpatient Services

Outpatient services involve regular visits to a treatment facility, often scheduled around a patient’s job, school, childcare or other responsibilities. Patients receive treatment at a rehab facility while they live at home. This level of treatment provides the most flexible scheduling for individuals seeking treatment. A variety of different interventions and approaches may be utilized in outpatient treatment.

Outpatient treatment is recommended for individuals who can hold themselves accountable to attend regular treatment sessions throughout the week. They are best for individuals with mild symptoms of SUD and a low risk of relapse. It is also crucial that individuals participating in outpatient treatment have:

  • A stable living environment
  • Reliable transportation
  • A stable support system

The duration of this form of treatment varies by program. Typically, general outpatient treatment programs require one to three hours of treatment per week and can last anywhere from a few weeks up to a year. This option is often used as a step-down once the individual has completed a higher level of care.

Level II: Intensive Outpatient and Partial Hospitalization Programs

Intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs) are more structured and intensive forms of outpatient treatment.

A journal by Psychiatric services (Washington, D.C.) states, “Substance abuse intensive outpatient programs (IOPs) are direct services for people with substance use disorders or co-occurring mental and substance use disorders who do not require medical detoxification or 24-hour supervision.” They are best for those who do not meet diagnostic criteria for inpatient treatment or for those in the process of transitioning out of inpatient treatment. IOPs generally require a minimum of nine hours of treatment participation per week, often provided in three three-hour sessions.

PHPs are slightly more intensive than IOPs. They provide intensive substance abuse and psychiatric care for individuals. This level of care is recommended for individuals who have been recently discharged from an inpatient program but still require intensive psychiatric care. Likewise, they are best for those with a high risk of relapse. PHPs usually require treatment three to five days per week, with sessions lasting about six hours. Both IOPs and PHPs vary in duration, lasting anywhere from two to eight weeks.

Level III: Residential/Inpatient Services

Residential — or inpatient — treatment offers live-in care for patients. Patients have access to medical, social and psychological support around-the-clock. Every residential program has unique rules and expectations for patients as they reside at the facility. These programs are recommended for:

  • Individuals struggling with severe symptoms of SUD or co-occurring disorders
  • Individuals who have not had success with long-term sobriety
  • Individuals without stable living or work situations
  • Individuals who have recently completed medical detoxification

Residential programs can last anywhere from a few months up to a year or more.

Level IV: Medically Managed Intensive Inpatient Services

This level of care is the most intensive and highest-structured treatment service. Most treatment facilities offer this level in the form of medical detoxification. Detox provides 24/7 medical and psychological support for patients who are withdrawing from the chronic use of alcohol and/or other drugs. As withdrawal can be uncomfortable and dangerous, staff can provide medications to help make the detox process as comfortable as possible.

These services are recommended for anyone seeking to withdraw from chronic or recurrent substance use. For detox to be effective, it must be followed by participation in a treatment program. Detox alone is not treatment, although it is the first step to successful recovery.

Prevention and Recovery Center (PaRC) is an addiction treatment facility that understands how challenging it can be to know where to begin with treatment. This is why we provide thorough evaluations for patients upon arrival at our facility. We can help you determine what level of care will best fit your needs. For more information about our programs, call (713) 939-7272.