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Levels of Care in Alcoholic Treatment

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Treatment for alcohol use disorder (AUD) is patient-centric i.e. adjusted according to the specific needs of each patient. Various factors, with the severity of alcoholism being the most crucial, play a role in determining the most suitable treatment option. So, what is the right treatment for you or a loved one with alcoholism? Scroll down to learn more about levels of care in the treatment of AUD.

Who defined levels of care?

Recognizing that addiction affects people differently, the American Society of Addiction Medicine (ASAM) described different levels of care. For that purpose, they took into consideration several factors such as the patient’s needs, liabilities, obstacles, strengths and assets, support structure, and resources. The main goal of these different options is to provide the best possible treatment option across a continuum of care. Below are described different levels of care in treatment for addictions such as AUD.

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Level 0.5: Prevention and early intervention

This level of care comprises services for people who are at a high risk of developing alcohol use disorder or other forms of SUD. Additionally, these services are also intended for people for whom there is insufficient information to document alcoholism. In other words, people with problematic alcohol use, but who didn’t develop alcohol use disorder, could benefit from these services. Prevention and early intervention help reduce the risk of addiction and the complications it causes.

Outpatient services

Level 1 outpatient services include non-residential services delivered in various settings. In other words, a patient with AUD doesn’t need to live and sleep in a treatment facility while recovering from their addiction. Patients undergo a thorough evaluation that helps customize their treatment and recovery plans.

Outpatient services include regular sessions that address a person’s lifestyle, attitudes and behaviors that would undermine the treatment. The main goal of these services is to help patients with alcoholism achieve long-term or permanent changes in their mental functioning and alcohol-using behavior.

The ASAM has expanded Level 1 outpatient services to provide better access to care for patients with dual diagnoses as well as unmotivated persons and those who are mandated into alcoholism treatment.

Outpatient services usually rely on psychotherapy sessions, but sometimes a combination of medications and therapy is necessary. The most common therapy approaches include cognitive-behavioral therapy (CBT), motivational interviewing, solution-focused therapy, and motivational enhancement therapy.

This level of care has the lowest intensity and is more affordable than others. In most cases, it requires up to nine hours of treatment a week.

Level 2: Intensive outpatient treatment or partial hospitalization

This level of care in alcoholic treatment delivers treatment services during the day before or after work (or school), or in the evenings and weekends. The main purpose of these services is to educate people with alcohol use disorder, and provide treatment, but also to teach them skills they can start applying immediately in their environment.
Level 2 is suitable for patients with more complex needs. For example, people who, besides alcoholism, also have mental health problems may benefit from this level of care.
The intensive outpatient treatment provides six to 19 hours of structured program a week. These services are provided by the interdisciplinary team comprising of psychiatrists, physicians, and addiction counselors.
At the same time, partial hospitalization provides at least 20 hours of a structured program on a weekly basis. Partial hospitalization is mainly beneficial for patients who live in unstable environments. These kinds of environments would jeopardize their recovery from alcoholism.
Under Level 2, people with alcoholism have access to psychiatric and medical consultations, medication management, 24-hour crisis services, and psychopharmacological consultation services.

In many cases, Level 2 programs have affiliations with other levels of care. Depending on their specific needs, Level 2 services may also help patients with child care, transportation, and vocational training.

Level 3: Residential or inpatient treatment

While outpatient programs don’t include living in a treatment facility, Level 3 residential treatment services do. Patients get access to self-help groups on-site. Generally speaking, this level of care comprises four types of programs:
  • Clinically managed low-intensity residential treatment – at least five hours of clinical services a week. These services include house meetings, a structured recovery environment, and 24-hour staffing, just to name a few.
  • Clinically managed medium-intensity residential treatment – created to stabilize imminent danger and prepare a person with alcoholism for an outpatient program. It focuses on group therapy.
  • Clinically managed high-intensity residential treatment – only suitable for adults with alcoholism (or other SUDs) with a cognitive disability or other impairments. This treatment includes a lower degree of the group and social therapies and services.
  • Medically monitored patient treatment – mainly created for patients at a high risk of withdrawal syndrome, especially if they also have multiple active needs such as co-occurring disorders.


Level 3 services are most suitable for people with alcoholism (or other addictions) who need more structure and a stable living environment while they’re working on their recovery.

Level 4: Medically managed intensive inpatient treatment

This level of care focuses on the medically directed evaluation and treatment of SUD and mental health disorders. The services are administered in an acute inpatient setting. The program is mainly suitable for people whose drinking problem is so severe it requires primary psychiatric, medical, and nursing care.

Level 4 is known as detox, i.e. the first stage in the treatment of addiction. At this point, a patient stops drinking alcohol. Abrupt cessation of drinking can lead to withdrawal syndrome. Detox is performed in a medically supervised setting. Some patients receive medications that reduce the severity of withdrawal syndrome and decrease cravings.

Conclusion

Treatment for alcohol use disorder or other types of addiction includes different levels of care. Healthcare professionals and addiction specialists consider the severity of alcoholism and other factors when recommending the most suitable level of care to their patients. The services in these programs aim to improve patients’ mental health and teach them skills that can support their recovery. Thanks to different levels of care, people with alcoholism can enter the treatment program most suitable for their needs and go from one level to another if or when necessary.