Levels of care in addiction treatment

Levels of care in addiction treatment

A. Tom Horvath, Ph.D., ABPP

There are many places you might receive assistance for overcoming addiction.  These places are generally referred to as “levels of care.”  By understanding the levels available you can choose the level most suitable for you.  We start with the least complicated and expensive level and work up.  We leave out detoxification (withdrawal), which occurs across several levels depending on how severe it is.  A comprehensive list of US addiction treatment facilities, across all levels of care, is provided by the federal government:

http://findtreatment.samhsa.gov/

Natural recovery.  There is no professional or organized care involved at this level.  Natural recovery is the process of using your natural environment to help you change.  Most people change addiction using natural recovery.  For instance, very few people seek any organized outside assistance to quit smoking.  What is less well known is that even for other substances, natural recovery is the most common method of recovery.

Support group attendance.  This is organized but not professional assistance.  The most widely available support groups in the US are 12-step groups, including Alcoholics Anonymous (AA)Narcotics AnonymousCocaine Anonymous, and approximately 200 other “anonymous” groups.  Other, very different types of support groups, are also available online and in some locations, including SMART Recovery, Moderation Management, Women for Sobriety, LifeRing Secular Recovery and Secular Organizations for Sobriety.  Support groups are sometimes called mutual aid or self-help groups.  Groups are led by non-professional volunteers.  Donations are requested, and literature describing the group’s approach to recovery is for sale.

Outpatient care.  Professional assistance is provided, as much as all day long, while you live at home.  If you are participating in services several days per week for several hours per day the level of care may be termed intensive outpatient.  If the frequency tapers off significantly it may be termed aftercare.  The terms are relative.  If your treatment intensity was 30 hours per week, aftercare may be one hour per week.  If your treatment was one hour per week, aftercare may be one hour per month.  While an outpatient you might also live in a sober living home or halfway house, which becomes your home while you are there (perhaps for months to years).

Residential treatment.  You live in the facility while in treatment.  The typical program is 28 or 30 days, but longer lengths of stay (e.g., 90 days, 6 months or even 2 years) are also available.  In many residential facilities the resident’s time is completely scheduled (perhaps to include breaks).  For instance, you might awaken at 7am, exercise from 7:30 to 8:30, have breakfast at 9, engage in treatment activities from 9:30am to 8:30pm (with breaks for lunch and dinner), have time to journal or read from 8:30 to 9:30, and have lights out at 10.  The treatment activities can vary considerably from facility to facility, but typically include a mixture of group sessions, educational sessions, holistic healing (yoga, meditation, guided imagery, etc.), individual sessions, and recreational activities.

Inpatient. This level of care is often confused with residential.  Inpatient care is residential treatment in a hospital.  There are few hospital programs anymore because treatment in that setting is very expensive.  For instance, a hospital must provide nursing staff 24 hours per day.  Most participants do not need that level of care, except perhaps when undergoing detoxification.