People will often refer to “addiction recovery treatment” as a catch-all blanket term for professional addiction rehabilitation services, but in truth, there really is no one kind of addiction treatment. There are many different therapies, methods, modes, and levels of care that can be customized to serve the needs of a given individual.
Just as no two people’s addictions are going to be exactly the same, not everyone is going to respond to, or even necessarily require the exact same treatment. This is why addiction rehabilitation is often broken down by levels of treatment for substance abuse.
These treatment levels, classified by the American Society of Addiction Medicine (ASAM), are generally referred to as the ASAM Levels of Care.
The ASAM Levels of Care are separated into five tiers, differentiated by their intensiveness and the amount of medical intervention involved. Within these levels of care are corresponding addiction recovery treatment services and elements. But how do you know what level of treatment is right for you?
There are different levels of treatment for substance abuse at every stage of an addiction recovery program. Some people may require the most intensive level of treatment at every stage, others may be able to downshift to a lower level of care as they progress through their treatment, and others still may not require certain levels of treatment at all.
The majority of addiction recovery treatment starts with detoxification. Detox is the process of flushing the drugs, alcohol, and associated toxins out of your system to achieve sobriety and stop them from doing any further mental and physical damage.
Medical detox is one that is at least partially supervised by a medical detox professional to ensure your safety, help you avoid relapse, and help ease the process of withdrawal. The level of treatment required for detox largely depends on factors such as:
These will generally be able to answer the question of what kind of withdrawal experience you can expect to have. If someone is already in poor health and is detoxing from something like alcohol, which has a wide range of potentially life-threatening withdrawal symptoms like Delirium tremens, then they might require detox hospitalization.
Detox hospitalization is the most intense form of detox treatment, falling under Level Four on the ASAM Levels of Care, with 24/7 medical care for severe, unstable withdrawals.
The next level is inpatient medical detox treatment, which still involves detoxing in a controlled environment under careful medical monitoring from a detox staff. While inpatient detox means that you are confined to the detox center, it is generally going to be a more relaxed setting than in a hospital.
Below inpatient is, as you would expect, outpatient detox. During an outpatient detox, you would make regular medical check-ins at a treatment center, potentially receiving medication as part of your detox process, and then return home.
Outpatient detox is the best level of treatment if your addiction is on the milder end of the spectrum, if you have a low chance of relapsing, or if the substance you are detoxing from is not associated with dangerous withdrawal symptoms.
All three levels of detox treatment might utilize medication-assisted treatment (MAT). MAT is often used during detox to help manage the symptoms of withdrawal and minimize cravings. Medication-assisted treatment can also be used throughout someone’s addiction recovery program in combination with therapy and behavioral treatment.
MAT can take on many forms, including the use of antidepressants and SSRIs to help deal with co-occurring disorders like depression and anxiety. MAT is also frequently used to treat opioid addiction and withdrawal, often using drugs like methadone or buprenorphine as a form of maintenance that can help prevent relapse and slowly taper down someone’s opioid use to eventually help them quit using altogether.
One major misconception regarding medication-assisted treatment is that only people with very severe addictions to drugs or alcohol can benefit from MAT therapy. However, there are many ways to apply MAT to someone’s recovery, and so many different medication options vary in purpose, strength, length of use, and more, that even someone with a more mild addiction can find MAT useful.
Inpatient treatment is a type of addiction recovery treatment in which you live onsite at a treatment facility for the entire course of your recovery program. Many times, a treatment center will offer inpatient detox that transitions seamlessly into ongoing care.
There is also the more intensive form of inpatient care, which is hospital inpatient treatment. Much like detox hospitalization, this level of treatment involves extensive medical supervision in the case of severe health issues that may persist even after you have finished detoxing. Typically, once these complications have passed, you will transition down to regular inpatient treatment.
Finally, a common form of inpatient treatment is long-term residential treatment. Residential treatment centers tend to have more focus on amenities and comfort as they are designed for people with addictions that require extensive care and therefore will be in treatment longer.
Residential treatment offers a highly-structured setting that allows you to focus entirely on your recovery with 24/7 access to medical staff and comprehensive treatment.
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However, not everyone is going to require leaving their normal life for an extended stay in treatment. Outpatient treatment encompasses the lower tiers of the ASAM Levels of Care and, like outpatient detox, does not require someone to live at a facility but instead make regular appointments for therapy and other treatments before returning home.
Outpatient treatment is a good option for those who need more support than just counseling or 12-step meetings but are able to successfully self-monitor to avoid relapse. For those who may require more intensive treatment without needing to go all the way up to inpatient, there is also intensive outpatient treatment, which requires more appointments per week that typically last longer.
Intensive outpatient treatment might also be used for someone who has progressed far enough in their recovery to no longer require inpatient treatment, but still needs a higher level of support than regular outpatient services.
If you have a health issue that requires ongoing medical observation, then you might need partial hospitalization, which is more intensive, but still allows you to live at home.
If you are struggling with a co-occurring mental health disorder on top of substance abuse issues, then you will need dual diagnosis treatment to effectively address both issues at once. Not every treatment center is equipped to offer these services, which are usually associated with a higher level of care.
Once someone has completed their addiction recovery treatment program, they may be in need of aftercare support, especially early on as they transition from treatment back to their normal lives.
For some, regular counseling appointments or support group meetings may be enough. If you had a fairly mild substance use disorder and went through outpatient treatment, you might not even require either of those things.
For others, especially those graduating from a long-term residential treatment program, transitioning back to regular life can prove to be much more difficult and stressful, with a high chance of relapse. In such cases, a sober living home can provide a safe and controlled space to help someone reintegrate themselves back into society until their lives are stable enough that they feel confident enough to move out.
As with any given individual, there are a number of factors that help to determine what level of treatment is going to prove most useful in successfully treating your addiction. These factors are what make your experience with addiction unique and are why it is so important to seek out a treatment program that offers customizable treatment plans.
Examples of some of the things that influence the decision of what level of treatment will be most effective for you include:
The substance of abuse can have a significant impact on the level of treatment that’s right for you. If you are struggling with a dependence on heroin, for example, then you most likely will require detoxification in combination with medication-assisted treatment for opioids.
According to the U.S. Centers for Disease Control and Prevention (CDC), more than 9 in 10 people who use heroin do so in combination with other drugs, so there is a high likelihood that if you are addicted to heroin you are also engaging in polysubstance abuse, which can lead to more complicated withdrawals and require inpatient detox to ensure your safety.
If your heroin addiction is particularly severe and you have relapsed before, it may be necessary for you to step away from your regular life and enter into a residential treatment program. This way, you can focus completely on your recovery without any distractions or potential triggers that could cause you to relapse.
On the other hand, if perhaps you have been abusing marijuana and you are seeking treatment before it has progressed to a full-fledged addiction, then there will most likely not be a need for the more intensive ASAM levels of care. Regular appointments as part of an outpatient treatment program may be all the support necessary for you to break your dependence.
However, it can be more complex than that. If you are abusing benzodiazepines, even if your addiction is not considered particularly severe, an inpatient medical detox may still be necessary, due to the many health risks associated with benzo withdrawal.
In other instances, the substance of abuse and the severity of the addiction may not be as significant in determining the required level of care. If you are struggling with a mental health disorder along with addiction, you may require specialized dual diagnosis treatment.
If you have a substance use disorder as well as a mental health issue that falls on the more mild end of the spectrum, such as anxiety, but have a home environment that is conducive to recovery and a strong personal support system, then intensive outpatient treatment may be enough without having to move up to inpatient treatment.
In the case of more severe mental health disorders such as schizophrenia, hospitalized inpatient treatment may be necessary.
This can also be the case if you are in poor physical health, even if that is unrelated to your substance use disorder.
Can you self-monitor well enough to avoid relapse during outpatient treatment or do you need to remove temptations from the equation with inpatient treatment?
Or, maybe the in-between option of a sober living home may be more useful as it can help keep you from relapsing without confining you to a treatment facility.
Being honest with yourself and your needs is essential to being able to properly choose the right levels of treatment for substance abuse so that you can have a successful recovery and have the best chance of maintaining long-term sobriety.
If you or someone you care about is struggling with an addiction to drugs or alcohol, you need more than just a one-size-fits-all recovery program. You need a treatment plan that’s customized to the unique needs of you or your loved one, and the level of care that can meet those needs.
Whether you require a medical detox, long-term residential treatment, or just the ongoing support of an outpatient program, Delphi Behavioral Health Group can get you connected to the treatment you need to take back your life from addiction. Our addiction specialists are on-call 24/7 to help you find the treatment program that’s right for you. They can also help get your insurance verified and answer any questions or concerns you might have as you take the first steps toward recovery and a life free from addiction.
American Society of Addiction Medicine. (2017, September 15). What Are the ASAM Levels of Care? from https://www.asamcontinuum.org/knowledgebase/what-are-the-asam-levels-of-care/
Centers for Disease Control and Prevention. (2015, July 07). Today’s Heroin Epidemic. from https://www.cdc.gov/vitalsigns/heroin/index.html
National Council for Behavioral Health. (n.d.). Medication Assisted Treatment. from https://www.thenationalcouncil.org/mat/
Substance Abuse and Mental Health Services Administration. (2014, October 01). Treatments for Substance Use Disorders. from https://www.samhsa.gov/treatment/substance-use-disorders
Substance Abuse/Chemical Dependency. Johns Hopkins Medicine. from https://www.hopkinsmedicine.org/health/conditions-and-diseases/substance-abuse-chemical-dependency