Substance abuse research has shown that the treatments most likely to help people achieve recovery are those that are personalized to the individual’s needs.
As described in an article from the American Journal on Addictions, these needs are generally based on the person’s motivation to change behaviors and ways of thinking. Treatment therefore is most likely to help if it is based on the individual’s readiness to change and adjusts to the current stage of change as the person moves through treatment.
To help meet this need for individualized treatment, the American Society of Addiction Medicine, or ASAM, has been working since the 1980s to help develop criteria for placing people in treatment and providing levels of care based on readiness and stages of change. These placement criteria are now a commonly used set of guidelines for addressing the treatment needs of people who are struggling with substance abuse or addiction.
The ASAM Placement Criteria
According to ASAM, the placement criteria provide a guideline for placing people in treatment, as well as for creating a treatment plan that guides an individual through the most appropriate levels of treatment for that person’s needs. The criteria also provide levels of care that help manage particular treatment needs, such as co-occurring conditions. The following outlines the basic levels of care; the higher the number, the more intensive the level of treatment.
- Level 0.5: Early Intervention – education for high-risk individuals, to intervene in behaviors that may lead to substance abuse or addiction
- Level 1: Outpatient Services – lower level treatment for people with high motivation and ability to manage addiction while maintaining typical daily routines
- Level 2: Intensive Outpatient/Partial Hospitalization Services – moderate to high level of treatment to provide intensive guidance for people who need extra help while still living at home
- Level 3: Residential/Inpatient Services – higher level of treatment for those who cannot maintain motivation for change without round-the-clock guidance and oversight
- Level 4: Medically Managed Intensive Inpatient Services – highest level of care for those who need medical intervention to maintain withdrawal and avoid relapse to use
Each of these care levels can be applied to each stage of treatment, as described in a basic guidance document from the Association for Addiction Professionals (NAADAC). There are specific elements of care under each level that can be applied as appropriate for the person’s specific condition.
Assessment for Level of Care Placement
In order to determine the appropriate level of care in which to place the individual, a preliminary assessment is done to measure the person’s current state with regards to level of substance abuse, readiness for change, and risk for relapse. This assessment includes six dimensions as explained in an article in Counselor, which include:
- Acute Intoxication or Withdrawal Potential: whether the person is in need of detox or is experiencing withdrawal symptoms
- Biomedical Conditions and Complications: whether there are any complicating physical conditions that also need to be treated, such as injury or illness
- Emotional, Behavioral, or Cognitive Conditions and Complications: whether there are any co-occurring mental health disorders or conditions that must be treated at the same time, such as anxiety, depression, or psychosis
- Readiness to Change: how much the person desires to engage in treatment or take the needed steps to move from substance abuse to recovery
- Relapse, Continued Use, or Continued Problem Potential: what the level of risk is for relapse or continued use, and how ready the person is to engage in relapse prevention
- Recovery Environment: how the person’s daily living situation might affect the ability to engage in treatment and the risk of relapse
Moving through Treatment
These assessment described above can help the professional determine which level of care is most appropriate for the person when entering treatment; however, as described in the Counselor article, the process does not stop there. Throughout treatment, the person is continually assessed in this way to assess progress. When the ongoing assessment determines that certain goals have been met within one level of care, the person can then be moved to the next lowest level of care.
On the other hand, if the assessment shows that the person’s motivation and progress have reversed or other complications have arisen, the person can be moved to a higher level of care, as appropriate. For example, if a person relapses or an underlying co-occurring disorder is discovered that wasn’t previously seen, more intense care can be provided again. This continued assessment process helps to make sure that the person is getting the most appropriate care at every stage of the treatment and recovery process.
Using the Different Levels of Care
Each level of care applies to specific elements in treatment. For example, when a person is in the detox process – which ASAM refers to in its Standards of Care as withdrawal management – the intensity of intervention and management depends on the level of care in which the person has been placed. People who are assessed as needing a lower level of care for detox might be placed using the Level III criterion, which would call for more freedom of movement with supervision during the withdrawal process. On the other hand, those who need intensive medical intervention during withdrawal might be placed using the Level IV criterion, requiring round-the-clock supervision and medication during this stage of the process.
Each progressive stage of treatment would then proceed based on the level of care indicated by the placement criteria, enabling the person to receive the appropriate care that meets the individual’s needs, in turn increasing the likelihood of long-term recovery from substance abuse or addiction.