Continuum of Care
There are several different options for treatment:
- Inpatient treatment takes place at a hospital or acute care setting and is medically directed. The most common inpatient service is medical detoxification.
- Residential treatment provides individuals residence in a therapeutic environment and participation in treatment services several hours each week. At some point, the time spent in treatment decreases and clients are expected to work in the community while still residing and participating in the therapeutic environment.
- Intensive outpatient treatment is defined as a minimum of nine hours of outpatient services weekly. Outpatient treatment services are typically involving one to three hours of treatment per week.
Because these services represent a continuum of care, individuals may begin treatment at one level, but then be stepped up or down to another level depending upon their progress in treatment.
Agencies should constantly evaluate whether the level of treatment provided is still appropriate as their clients meet challenges, gain successes, or encounter setbacks.
Best practice guidelines suggest using the American Society of Addiction Medicine's Placement and Continued Stay criteria to determine the level of treatment a client needs. This involves a clinical assessment of the client's level of functioning on six different dimensions:
Dimension 1 - Risk of acute intoxication/withdrawal: Is the client suffering acute and severe withdrawal symptoms? Can these symptoms be safely managed in an outpatient setting?
Dimension 2 - Risk of medical conditions/complications: Does the client have biomedical conditions which will interfere with treatment?
Dimension 3 - Risk of emotional, behavior, or cognitive conditions: Are there mental health issues that must be addressed in order for the client to succeed in treatment? Can they be addressed in an outpatient setting?
Dimension 4 - Assessment of client's readiness to change: Is the client currently motivated to participate in treatment?
Dimension 5 - Risk of relapse/continued use/continued problem potential: Is the client still using drugs or alcohol or engaging in drug seeking behavior? Are even brief periods of abstinence difficult to achieve?
Dimension 6 - Adequacy of physical environment and support system: Will continued exposure to the client's work, school, or home environment impede recovery? Does the client lack a support system of individuals who do not abuse alcohol or use drugs?
Only an appropriately licensed clinician - one who is able to diagnose mental health issues in addition to substance abuse issues - can assess individuals using the ASAM dimensions and determine the appropriate level of treatment.
Matching the appropriate level of care to the specific needs of the individual increases the likelihood of treatment success. For example, an individual who is drinking daily and is homeless may have difficulty managing to attend outpatient treatment. Similarly, placing an individual who has stable employment and a supportive environment in residential treatment may not only be unnecessary and expensive, but may risk job security or cause undue emotional stress that increases the severity of the addiction rather than mitigating it.
For more guidance, read these questions that can help you find the best treatment options.