Levels of Care in Addiction Treatment
No two recovery journeys are the same, and addiction treatment isn’t one-size-fits-all. People have different needs, and the right level of care can provide the structure and support needed at each stage of recovery, helping individuals build a strong foundation for lasting change.1 Understanding the different levels of addiction treatment can help you or a loved one make informed decisions and take the first step toward recovery.
Understanding the Levels of Care in Addiction Treatment
Levels of care in addiction treatment range from medical detox and inpatient rehab to outpatient programs, ensuring individuals receive the appropriate support based on their needs throughout recovery.1
Effective treatment is individualized, and matching treatment interventions, services, and settings to an individual’s needs is essential for long-term recovery.1 The American Society of Addiction Medicine (ASAM) Levels of Care are a framework that helps providers ensure appropriate and effective treatment by providing a structured approach to assessing, matching patients to the right level of care, and guiding treatment decisions across a continuum of care for individuals with substance use disorders.2 A person may transition between levels of care as their needs change, such as moving from a more intensive to a less intensive type of treatment, which is sometimes referred to as “stepping down,” while vice versa is “stepping up.”
What Is The ASAM Criteria Continuum of Care?
The American Society of Addiction Medicine (ASAM) Criteria defines a comprehensive set of standards for providing outcome-oriented and results-based care in addiction treatment.2 The criteria see treatment providers using a comprehensive, multidimensional assessment to evaluate a patient’s challenges, needs, and support system to help determine the most appropriate level of care across the treatment continuum.2
The ASAM Criteria continuum of care for addiction treatment consists of 4 levels, ranging from the most intensive (Level 4) to the least intensive (Level 1), and also includes recovery residences, which can be recommended alongside outpatient levels (Levels 1 and 2) for ongoing support.2
ASAM levels of care include:
- Level 4: Inpatient: The most intensive care includes medically managed inpatient addiction treatment.
- Level 3: Residential: A step down from inpatient treatment, patients may participate in clinically managed low-intensity residential treatment (3.1), clinically managed high-intensity residential treatment (3.5), or medically managed residential treatment (3.7).
- Level 2: Intensive Outpatient/High-Intensity Outpatient: This level encompasses intensive outpatient programs (2.1), high-intensity outpatient programs (2.5), and medically managed intensive outpatient programs (2.7).
- Level 1: Outpatient: The least intensive treatment consists of long-term remission monitoring (1.0), outpatient therapy (1.5), and medically managed outpatient treatment (1.7).
- Recovery Residence: Recovery residences are supportive sober living environments that encourage ongoing sobriety and addiction recovery. They are often recommended in conjunction with outpatient levels of care (Levels 1 and 2).
Level 4: Medically Managed Inpatient Treatment
Level 4 provides the highest intensity of care and is designed for individuals who require hospital-level care with 24-hour nursing care and daily physician care for severe/unstable intoxication/withdrawal, biomedical complications and conditions, or psychiatric/cognitive conditions.3 This includes individuals who are severely intoxicated or are experiencing or at higher risk of experiencing severe withdrawal symptoms.3
Level 4 may also be recommended for individuals with severe or unstable co-occurring disorders (e.g., depression) that complicate treatment or who have not responded to lower levels of care.3 This level provides 24-hour oversight from medical professionals, ensuring patients are stabilized and can more seamlessly transition into ongoing treatment.3
Level 3: Residential Treatment
Residential Treatment Level 3 provides 24-hour structured care in a residential setting, offering varying levels of support based on an individual’s needs.3,4 While Level 3.7 (medically monitored intensive inpatient) can be delivered in a hospital, most Level 3 care occurs in residential facilities designed to help individuals stabilize and transition to outpatient treatment.3,5
- Level 3.1 (Clinically managed low-intensity residential): This level of care focuses on community reintegration, providing at least 9 hours of clinical services per week with a psychoeducational focus.3
- Level 3.5 (Clinically-managed high-intensity residential): With a focus on psychotherapy, this level of care provides 24-hour support from trained counselors and therapists to help prevent relapse and prepare individuals for outpatient treatment.3
- Level 3.7 (Medically managed residential): This level offers 24-hour nursing care with physician oversight for individuals with significant medical or psychiatric needs.3
Level 2: Intensive Outpatient and High-Intensity Outpatient (HIOP) Treatment
Level 2 provides structured, non-residential treatment for individuals who need more support than standard outpatient care but don’t require 24-hour supervision.3,4
- Level 2.1 (Intensive outpatient): Intensive outpatient drug and alcohol rehab programs provide at least 9 hours of structured weekly services for adults, addressing various challenges that may affect recovery (e.g., mental health, relapse risk, unstable living situations) while focusing on psychoeducation.3
- Level 2.5 (High-intensity outpatient): Sometimes referred to as partial hospitalization rehab programs, HIOP includes 20 or more hours of weekly services. Similar to intensive outpatient, this level of care focuses on psychoeducation.3
- Level 2.7 (Medically managed intensive outpatient): Designed for patients with moderate to severe SUD, this level of care provides medical care, psychoeducation, psychotherapy, and withdrawal management (if needed).3
Level 1: Outpatient Treatment
Level 1 includes outpatient addiction treatment programs, which provide flexible, non-residential treatment for individuals with mild to moderate SUD or mental health concerns.3 These services provide more flexibility, often offering appointments in the evenings or on weekends, which can help individuals maintain responsibilities at home, school, or work.3,4
- Level 1.0 (Long-term remission monitoring): This level focuses on long-term remission monitoring. It involves fewer than 9 hours of weekly services and may include motivational enhancement strategies and therapies.3
- Level 1.5 (Outpatient therapy): This level of care involves low-intensity psychoeducation and psychotherapy for patients who are stable with mild to low-moderate SUD.3
- Level 1.7 (Medically managed outpatient): Patients who are stable with mild to low-moderate SUD may participate in this level of care, which involves low-intensity psychoeducation, psychotherapy, and low-intensity withdrawal management (if needed).3
Recovery Residence
Recovery residences, sometimes referred to as sober living homes, provide safe, supportive, and substance-free housing for individuals in recovery.6 These residences vary in the level of support they offer, ranging from clinically supervised programs to peer-run homes.6
The National Alliance for Recovery Residences (NARR) is an organization that sets national standards for recovery housing to help ensure support and quality. NARR’s levels of support align with the ASAM continuum of care, particularly for individuals transitioning from more intensive treatment settings to independent living while maintaining recovery. Many recovery residences use ASAM criteria to determine appropriate placements and ensure residents receive the right level of care for their needs.7
What to Expect During Addiction Treatment
Addiction treatment varies based on individual needs as a person progresses throughout treatment.1 However, it often includes behavioral therapies, medications, or a combination. Treatment approaches are evidence-based and tailored to support recovery, helping individuals address underlying issues contributing to their substance use and develop coping strategies.1
- Behavioral therapies: Various evidence-based therapies can support recovery by addressing the thoughts and behaviors associated with addiction. Examples include cognitive-behavioral therapy (CBT), motivational enhancement therapy (MET), and family therapy.1
- Group and individual counseling: Group therapy provides peer support and reinforces recovery efforts, especially when combined with behavioral therapies or individualized counseling. Individual counseling helps people stop using substances by addressing personal challenges, setting behavioral goals, and building coping skills.1
- Medication: Certain substance use disorders can be treated with FDA-approved medications that help manage cravings and withdrawal symptoms.1
- Self-help and peer support groups: Mutual aid groups provide a sense of accountability, community, and encouragement. These groups can be introduced during inpatient treatment and continued afterward to support long-term recovery.1
Which Level of Care is Right for Me?
As mentioned, there is no one-size-fits-all approach to addiction treatment, and the right level of care for you will depend on your needs.1 The National Institute on Drug Abuse (NIDA) notes that effective treatment is individualized and tailored to a person’s medical, personal, and substance use history.1
If you’re unsure where to start, consider speaking with a doctor or mental health professional who can assess your situation and recommend an appropriate treatment plan. You can also call to speak with an American Addiction Centers (AAC) admissions navigator to discuss your options and get connected to the right resources. Understanding the different levels of care can help you have an informed conversation with your provider and take the next step toward recovery.
Start the Recovery Journey
If you or a loved one is ready to take the next step, we’re here to help when you call . American Addiction Centers (AAC) is a leading addiction treatment provider with top-rated facilities across the U.S. We can help you find the right treatment program for your needs, answer your questions, help you understand how to use health insurance coverage for rehab, and easily verify your insurance at an AAC facility.