Levels of care: addiction treatment programs

Deciding to begin addiction treatment is a powerful and courageous choice. It takes honesty, reflection, and the willingness to ask for help. Once that decision is made, the next natural question is, “What kind of treatment do I need?” The answer matters because the right placement sets the foundation for lasting recovery.

One of the best ways to reduce the anxiety around entering a program is to learn about the different levels of care. Education not only helps you understand what treatment looks like but also gives you a sense of what might fit your needs. While a qualified treatment center will perform an evaluation and recommend a level for you, having your own knowledge can make the process less intimidating.

It may also help to know you are not alone. According to the 2024 National Survey on Drug Use and Health (NSDUH) from the Substance Abuse and Mental Health Services Administration (SAMHSA), more than 4.3 million people aged 12 or older received substance use treatment in 2023. Millions of individuals face the same questions about where to begin, and there are well-established answers to guide the way.

In general, substance use disorder treatment falls into three broad categories: medical detoxification, residential treatment, and outpatient treatment. Some facilities specialize in one type, while others provide the full continuum of care, offering multiple levels of care in the same location. This integration makes it easier to move between services without disrupting progress. Beyond these broad categories are more specific services—such as partial hospitalization and intensive outpatient programs—that fine-tune the level of medical oversight and structure. These sublevels are what clinicians refer to as the official ASAM levels of care, and they allow for highly individualized, evidence-based planning.

The American Society of Addiction Medicine (ASAM)—often called the society of addiction medicine—was founded in the 1950s to define addiction as a medical condition and to research effective approaches for treatment. Over the decades, ASAM has become the leading authority in addiction medicine, setting the standard for evidence-based care. Today, the ASAM Criteria are the most widely used clinical guidelines for determining the appropriate level of care. Many psychiatrists, physicians, and addiction specialists are trained within this framework, and ASAM itself offers certifications for providers who follow its model.

The ASAM Criteria provide a multidimensional framework to ensure care is safe, individualized, and responsive to each patient’s needs. By assessing medical, psychological, and social risks, clinicians can place patients in the least restrictive level of care that still meets their needs.

The ASAM Criteria are built on six dimensions that give a comprehensive picture of a person’s health, environment, and recovery needs. This multidimensional assessment—often called a biopsychosocial assessment—helps providers determine which level of care is safest and most effective.

Each dimension is scored on a risk scale from 0 to 4:

0 is no risk. Very low concern, safe in the least restrictive setting.

1 is mild risk. Some issues present but manageable with minimal support.

2 is moderate risk. Functional impairment is noticeable and requires structured intervention.

3 is serious risk. Clear danger without immediate treatment.

4 is extreme risk. Imminent harm likely unless intensive services are provided.

These ratings are combined to guide recommendations across the full continuum, from early intervention to medically managed intensive inpatient care.

ASAM organizes levels of care on a scale from 0.5 to 4, with intensity increasing as the numbers rise. These placements are determined by evaluating all six ASAM dimensions, which take into account medical risks, emotional stability, motivation, relapse potential, and recovery environment.

Levels of care include:

Level 0.5. Early intervention services. Designed for people who are at risk of developing a substance use disorder but do not yet meet the full criteria. This may include prevention programs, educational sessions, or mandated interventions such as DUI classes. The goal is to intervene before substance use progresses to a diagnosable condition.

Level 1. Outpatient treatment. Less than 9 hours of care per week for adults. This level is appropriate for individuals with mild substance use disorders, or as a step-down from higher-intensity programs. Outpatient treatment often includes individual counseling, group therapy, education, and family sessions while allowing patients to maintain daily responsibilities.

Level 2.1. Intensive outpatient. At least 9 but no more than 19 hours of structured services per week. Treatment may occur in the evenings or on weekends to accommodate work or school. Medical, psychiatric, and laboratory services are available within 72 hours in person and 24 hours a day by phone.

Level 2.5. Partial hospitalization. At least 20 hours of structured programming per week but less than 24-hour care. Patients receive daily monitoring and a high level of support, but still return home at night or to a sober living environment. This option is often used when outpatient care is not sufficient, but full inpatient care is not required.

Level 3.1. Clinically managed low-intensity residential treatment. Residential services in a structured setting, often similar to a group home, with at least 5 hours of clinical services weekly. This level emphasizes relapse management, skill development, and building recovery routines in a supportive environment.

Level 3.3. Clinically managed population-specific high-intensity residential services. Programs designed for individuals with cognitive or functional impairments, such as traumatic brain injury or developmental disorders. Care proceeds at a slower pace, with additional reinforcement to support learning and skill-building.

Level 3.5. Clinically managed high-intensity residential services. A more structured form of residential treatment for people with severe psychological or social issues who require 24-hour support. These patients are often at risk of imminent harm without round-the-clock supervision.

Level 3.7. Medically monitored high-intensity inpatient services. Intensive residential services for patients with medical, psychiatric, or behavioral conditions that require close observation in a 24-hour setting. While not requiring daily physician interaction, patients receive oversight from addiction physicians, nurses, and clinical staff throughout their stay.

Level 4. Medically managed intensive inpatient services. The highest level of care, provided in a hospital or acute care setting. Patients receive 24-hour nursing support with daily physician visits. This level is designed for those with severe withdrawal risks or complex biomedical and psychiatric needs requiring direct medical management.

Levels allow treatment to be delivered as part of a continuum of care, meaning a person can move up or down depending on their condition. For example, someone experiencing alcohol withdrawal with tremors, nausea, or seizures would likely require Level 4 medically managed intensive inpatient care to reduce life-threatening risks. Once stabilized, they might step down to Level 3 residential treatment, then into intensive outpatient or outpatient treatment as their recovery strengthens.

On the other hand, someone struggling to stop cannabis use without serious medical complications would likely begin at a lower level, such as intensive outpatient or standard outpatient treatment. This flexibility ensures that no one is over treated or under treated.

A guiding principle of the ASAM Criteria is to place individuals in the least restrictive setting that still meets their needs. When patients are placed in overly intensive programs without justification, research shows it can create frustration and resistance to care. Conversely, underestimating risks can expose people to medical danger or relapse. By applying the ASAM Criteria, professionals strike the right balance, supporting recovery while respecting each patient’s autonomy.

Understanding the ASAM Criteria helps patients and families know why a specific level of care is recommended and reassures them that placement decisions are based on decades of research-backed medical standards.

Understanding how providers determine recommendations is only part of the process. The next, and often more challenging step, is a person’s willingness to follow through with those recommendations. At times, patients and clinicians may have different views on which level of care is most appropriate. When this happens, seeking a second opinion from another qualified behavioral health professional can be valuable—just as you would do for any other medical concern. If multiple specialists provide the same guidance, it often reinforces the direction that will be safest and most effective.

Recovery begins once you move beyond the assessment and commit to a care plan. The most important step is entering the recommended treatment program so that progress can start. If you or a loved one are unsure about where to begin, call (317) 707-9848 or complete our confidential contact form to learn more about the available levels of care and find the support that fits your needs today.

Admitting you have a substance abuse problem and asking for help is not always easy. If you or a loved one are struggling with drug addiction, alcohol addiction or another substance use disorder, help is available. Call SAMHSA’s National Helpline at (317) 707-9848 to learn about resources in your area or reach out to our team for personalized treatment.