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Providing the appropriate level of care for people struggling with substance abuse or addiction is important to give individuals the services most likely to help them achieve and maintain recovery.
For this reason, consistent guidance on matching an individual with the treatment level that meets that person’s needs – including readiness to change, degree of relapse risk, and other factors – can be a vital contribution to that individual’s motivation and ability to follow through on treatment.
The lowest level of treatment for substance abuse, as defined by the American Society of Addiction Medicine (ASAM) placement criteria, is Level I: Outpatient Services. For someone who is struggling with a substance use disorder but has a high level of skill and capability to manage the disorder, this level of service can be helpful in providing the services needed to maintain recovery with minimal intervention.
The main goal of the outpatient services level of care is to provide individuals with the motivation and support necessary to self-manage recovery from substance abuse. People placed in this level of care are those with the knowledge, skills, and social structure to avoid relapse, and the confidence to apply those tools to maintaining abstinence. They generally go about their daily lives, having regular but occasional connection with substance abuse treatment personnel to maintain recovery.
This level of care can be an entry point for people if the initial placement assessment indicates that the degree of substance abuse is appropriately low and readiness to manage recovery is high. For example, a study from the Journal of Substance Abuse Treatment shows that outpatient treatment can result in positive outcomes for adolescents, particularly if it involves family therapy.
This treatment level can also be a step down from more intensive forms of treatment, such as residential care or intensive outpatient treatment.
According to the ASAM Continuum, outpatient services – designated as Level I services – involve motivational and recovery enhancement therapies and services provided at fewer than nine hours per week (or fewer than six hours for adolescents). These types of therapies can include practices such as Motivational Interviewing that offer occasional connection with the individual to verify continued abstinence, provide feedback as needed, and enhance the person’s desire to keep up with treatment. In fact, a study in Drug and Alcohol Dependence demonstrates that this type of care can significantly enhance a person’s desire to continue with treatment and maintain abstinence.
This level of care also generally involves connection with self-help groups, such as 12-Step programs. Through these groups, people in recovery from substance abuse can obtain educational materials, stay connected with others who are also in recovery, and keep practicing abstinence skills. Work with a peer group can be continued indefinitely, which is highly beneficial for the lifelong maintenance of substance use disorders, because they are chronic conditions that always have the potential for relapse if left unmanaged.
Outpatient care is also useful for continued maintenance of recovery for people who have controlled co-occurring conditions with a low risk of contributing to future substance use.
Through outpatient care, coordinating the management of both substance abuse and co-occurring disorders can enhance the ability to maintain abstinence.
Because outpatient treatment is the lowest level of care for confirmed substance abuse on the ASAM criteria, the only step down is to completion of treatment. However, the individual who is in recovery is able to step up to outpatient care if needed for relapse, or if conditions change that make relapse more likely.
Continued assessment throughout the individual’s treatment can sometimes indicate that a step up from outpatient care is needed. If relapse occurs, or if elements of the person’s life become unstable to the degree that they are more likely to start using the substance again, a step up into intensive outpatient treatment or higher levels of care can be undertaken.
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