When a person is entering substance abuse treatment, there are specific criteria for determining the level of care needed at each treatment stage.
These criteria are based on the person’s degree of substance abuse, readiness for change, and other factors that may complicate treatment. These placement criteria, defined by the American Society of Addiction Medicine (ASAM), help to create an individualized treatment plan designed to meet the specific needs of each person in treatment.
When it comes to the first aspect of intervention in substance abuse – detox and withdrawal from the substances of abuse – there are several levels of treatment based on the person’s level of need. There is a level of detox that corresponds with each of ASAM’s defined care levels.
ASAM’s Definition of Detox
The most recent definition of detox in ASAM’s criteria, as described in an article in Counselor, is “withdrawal management.” This is because the actual detox process takes place in the body, through the liver and other natural body processes. Ultimately, treatment cannot change this body process, which progresses naturally in its own time, but it can manage the symptoms of withdrawal that arise.
In addition, as described by the Substance Abuse and Mental Health Services Administration’s Treatment Improvement Protocols, ASAM’s criteria consider that the process of withdrawal management includes efforts to curb the individual’s substance abuse. Detox and withdrawal management in and of themselves do not help a person recover from substance abuse or addiction; other forms of treatment are necessary.
For this reason, the placement criteria developed by ASAM include the intention to interrupt compulsive use of the substance at the withdrawal management stage. Without fully managing all elements of withdrawal to prevent relapse to substance use, the full treatment under this criterion is not considered by ASAM to have been provided.
Levels of Care for Withdrawal Management
There is no difference in withdrawal management criteria between adults and adolescents. As described by the Treatment Improvement Protocols, and taking into account the new withdrawal management designation, the levels of care for this stage of treatment include:
- Level I-WM: Ambulatory Detoxification Without Extended Onsite Monitoring: For those who are considered to be lower risk for continued use and placed at a lower care level requirement, this type of withdrawal management provides minimal supervision during the detox process. The care team will set a schedule for regularly checking in with the individual, but otherwise the individual is able to continue with daily life and activities.
- Level II-WM: Ambulatory Detoxification With Extended Onsite Monitoring: The individuals placed in this level of care still have relative freedom of movement and behavior, but are regularly monitored by medical staff to avoid continued use of the substance.
- Level III.2-WM: Clinically Managed Residential Detoxification: Individuals at this level of treatment are considered to be at higher risk for relapse but do not require medical management of withdrawal symptoms; nevertheless, the increased risk calls for 24-hour monitoring of the withdrawal process, and it is undertaken in a residential treatment facility.
- Level III.7-WM: Medically Monitored Inpatient Detoxification: If a person needs some medical management of symptoms during detox, this level of care provides 24-hour monitoring and treatment by medical professionals.
- Level IV-WM: Medically Managed Intensive Inpatient Detoxification: With certain substances, such as alcohol or benzodiazepines, or with polydrug abuse, the withdrawal process may necessitate acute medical intervention. In addition, people who have previously experienced severe symptoms during detox or withdrawal may be offered this level of withdrawal management, in order to avoid risks to health and safety. This level of care provides 24-hour, intensive care during the withdrawal process.
Once the detox level of care is complete, the individual is assessed for the next treatment phase and level of care required to continue rehab. Assessment is performed throughout the entire treatment process in order to shift the individual to the appropriate level of care based on the person’s readiness and ability to engage in the treatment services. For example, if a relapse event were to occur during treatment, the person could be shifted back to a higher treatment level. Once goals have been met for the particular level of care, the individual can then be moved to the next lowest level of treatment, as needed.