Levels of Care for Drug Rehab and Addiction Treatment

The ASAM Levels of Care for drug rehab and addiction treatment are established by The American Society of Addiction Medicine (ASAM). People trying to understand more about standardized recovery services across the United States and access these programs use this guide to compare plans when seeking treatment.

Here you’ll learn why the levels of care provide a common language and why this matters for creating effective treatment plans.

We’ll explore each level and evaluate differences and similarities. We’ll also analyze how they connect across the continuum of care while offering practical strategies for those seeking recovery programs for themselves or a loved one.

Levels of Care: Key Facts

• ASAM Levels of Care guide genuine personalized recovery treatment plans in the U.S.
• Each level of care addresses addiction’s unique challenges at every stage of treatment.
• A person’s medical, emotional and social needs determine their initial placement on the continuum.
• Movement across levels is flexible and shaped by periodic assessment of recovery progress.
• Insurance coverage, state funded initiatives and various financial aids make treatment accessible to individuals from all walks of life.
• Help is available. This guide shows you where to find it.

What are Levels of Care in Addiction Treatment?

The ASAM created a system to give providers as well as individuals seeking addiction treatment a simple way to determine the intensity of treatment that’s needed.

ASAM’s system involves five levels of care for drug rehab programs that shape the recommended treatment protocols. It’s based on an assessment of the patient’s medical, psychological and social needs.

• Level 4 is the highest level of care and consists of medically managed inpatient rehab treatment. It takes place in a hospital or clinic setting.
• Level 3 involves clinically managed care that takes place during residential treatment instead of through hospitalization.
• Level 2 care is provided through partial hospitalization or intensive outpatient programs.
• Level 1 care is general outpatient addiction treatment including therapy and telehealth.
• Aftercare is an additional level of care that’s not numbered in the ASAM but is standard for those who’ve completed formal treatment. These programs are provided through aftercare services at a rehab or at a recovery residence or sober home.

Level 4: Medically Managed Intensive Inpatient (Medical Detox)

Level 4 care is needed when patients have significant withdrawal symptoms or are at risk of severe or complicated withdrawal should they undergo treatment. This level may also be needed for patients who require medical stabilization for other reasons.

Medically assisted detox is provided while substances and toxins are simultaneously cleared from the body. The process is done under the supervision of a medical team that usually includes nurses and medical and mental health clinicians.

Level 4 interventions are used in cases of acute alcohol intoxication or opioid addiction. Drugs such as benzodiazepines and anticonvulsants may be used to lessen the impact of certain withdrawal symptoms like anxiety and insomnia. These meds can also treat delirium tremens.

Level 4 care involves inpatient treatment at a hospital or a residential rehab center where 24 hour medical care and supervision are featured. Services are provided by a team of doctors, nurses and other clinical professionals.

Inpatient treatment lasts up to 10 days. If provided in a residential rehab it may take place in a specialized area set aside for detox services. Once this process is complete the patient goes or returns to a general residential care setting for additional treatment. At this point the focus usually turns to counseling.

Level 3: Residential & Inpatient Rehab

Inpatient addiction treatment involves living at a facility while receiving drug treatment. When this occurs at a hospital it’s considered Level 4 care. When inpatient care takes place at a residential rehab and detox isn’t involved the client is considered to have stepped down to Level 3 care.

A variety of inpatient rehab programs are available and range from low cost and often government funded programs to expensive luxury programs. Inpatient programs typically last 30, 60, or 90 days and cost at least $6,000 per month. 

Luxury programs with premium amenities and customized treatment plans can cost between $50,000 and $100,000+.

All inpatient programs provide addiction counseling and relapse prevention education as well as food and housing.

Level 3.7 Medically Monitored Inpatient / Detox

For individuals who require after hours monitoring or robust support level 3.7 provides access to biomedical services for managing subacute detox, withdrawal symptoms, pregnancy, wounds, IV medications, infections and relapse and mental health risks.

This medically managed level includes physician daily rounds, onsite nurses and psychiatric care. It functions as the critical bridge between hospital detox and residential rehab.

Level 3.5 High Intensity Therapeutic Community

Level 3.5 is suited for individuals with severe behavioral and social functional impairments who can benefit from highly structured settings and 24 hour support.

They can access mild withdrawal symptoms support and peer supervision to prevent substance use. Psychosocial counseling for navigating interpersonal interactions and fulfilling daily responsibilities alongside life and recovery-sustaining skills are available to promote long-lasting behavior change.

Level 3.3 Medium Intensity (Long Term Care)

Level 3.3 was removed from the latest version (4th edition) of the ASAM criteria.

These long term programs ran longer than 90 days and helped individuals with cognitive impairments address chronic relapse patterns by tailoring slow paced interventions that incorporated vocational training and community responsibilities.

ASAM’s updated treatment criteria include slow-paced modalities in all levels to embed care for individuals with cognitive deficits within each stage of recovery.

Level 3.1 Low Intensity Residential

Level 3.1 helps individuals with moderate risks of substance use and have unstable home environments to benefit from 24 hour residential support and structure.

Patients access assistance for managing daily routines, develop skills to better function in society, participate in peer support and relapse-prevention activities and receive counseling while attending work or school part time.

Level 2: Intensive Outpatient & Partial Hospitalization

People who step down from Level 3 typically enter outpatient care. Level 2 comprises more intensive treatment in which clients attend programs that last several hours per day throughout the week. Level 2 generally consists of intensive outpatient and partial hospitalization programs.

Partial Hospitalization Programs (Level 2.7)

A partial hospitalization program (PHP) or day program provides drug rehab treatment for 20+ hours per week through outpatient services that take place for 4 to 6 hours a day on 3 or more days a week. There are no overnight stays even though PHP treatment is provided as an option at some residential rehab facilities.

Programs typically last for a minimum of 30 days and cost about $11,000 to $13,000 per month. PHP treatment usually includes individual and group counseling, addiction and relapse prevention education and often treatment for co-occurring mental health disorders.

Intensive Outpatient Programs (Levels 2.1 & 2.5)

An intensive outpatient program (IOP) is also considered Level 2 care on the ASAM criteria continuum. IOP typically provides 9 to 20 hours of treatment per week over 2 or 3 days. Sessions usually last 3 to 6 hours per day.

IOP is a popular choice among people who’ve mild to moderate addiction and who aren’t at risk for withdrawal symptoms. The recommended duration for IOP treatment is 90 days.

IOP can be used as an entry point to rehab treatment or as a stepdown program following inpatient or residential treatment. The cost for IOP is around $15,000 to $20,000 for a 3 month program.

Level 1: Standard Outpatient Treatment

Beneath Level 2 is general outpatient care. Offsite services such as telehealth programs are also included. This level is reserved for those who have mild addictions.

Outpatient Treatment (Level 1)

Outpatient treatment is the largest subgroup of Level 1 care. It’s best for individuals with less severe addiction symptoms and low risk for severe withdrawal symptoms.

Outpatient services typically take place in a freestanding clinic or a practitioner’s office. Treatment hours involve less than nine hours per week spread over 1 to 3 sessions per week. Program lengths vary from 28 days to six months, with three months being typical.

The cost of an outpatient treatment program is often a flat fee of around $5,000 for a 3 month program. Studies show that inpatient treatment results in greater abstinence during the first month following discharge.

After six months people attending outpatient treatment are equally as likely as inpatient clients to still be abstinent.

Online Rehab & Telehealth

Telehealth for addiction treatment offers care remotely through an internet video connection or a phone call. This format has become widely used since the COVID-19 pandemic. Both individual and group sessions can be attended via telehealth.

Telehealth sessions are often more affordable than traditional office visits. They’re also more convenient since no travelling is involved. This is especially true for people who live in areas where treatment centers and providers are scarce.

Potential drawbacks might include challenges in mastering digital technology and the possibility of technology failures. But telehealth for all kinds of medical and mental and behavioral health services is effective and here to stay.

Level 0: Intervention and Aftercare

Under Level 1 care are additional services that professionals may use to address substance use disorders. Interventions and aftercare respectively take place before and after treatment programs. Interventions are used to induct a candidate into a program while aftercare acts as maintenance for program graduates.

Level 0.5: Early Intervention Services

Level 0.5 in the ASAM Criteria refers to Early Intervention.

This level is designed for people who are at risk of developing a substance use disorder but don’t yet meet the criteria for one. Services at this level focus on education, screening, and brief counseling to help prevent progression. They often take place in schools, primary care offices or community settings and are typically short term.

This is different from a formal intervention. In that case family and friends stage a meeting, often with the help of a specialist. The intervention is designed to constructively confront a loved one about their addiction and urge them to enter treatment.

These kinds of interventions can be effective in motivating someone to seek help but they are not part of the ASAM continuum of care. Instead they are a potential first step that might lead someone into an appropriate ASAM level based on their clinical needs.

Level 0.0: Recovery Residence & Sober Living

Sober living homes are also considered aftercare on the ASAM continuum. These are residences shared by multiple individuals in the process of recovery after they have completed their treatment programs.

These facilities are an inexpensive option for those who want to maintain social connections and share mutual accountability with others who also desire to maintain a sober lifestyle.

A sober home typically has a house manager who assigns household chores and enforces drug free environment rules. Some sober homes hold 12 Step meetings onsite, which have been shown to have positive effects on residents’ ongoing sobriety.

Rent in sober homes is the responsibility of the resident but government assistance and grants are often available.

Moving Through the Continuum: Step Up & Step Down Care

When enrolling in a program you don’t necessarily stay at your initial level of care. As you progress and withdrawal symptoms wane you may step down to a lower level of care. But relapse is common in addiction and this may necessitate interventions or detox at more intensive stages before stepping down again.

Typical Treatment Timeline

According to ASAM’s criteria each person moves along the continuum of care based on how they respond to treatments. There are no predetermined lengths of stay at any level.

A person may stay five days in a Level 4 program while detoxing, then transition to a 30 day Level 3 program to address the underlying reasons for substance abuse. Then they may enroll in an 8 week intensive outpatient treatment program (IOP) to develop life skills. After IOP they could join an outpatient program for continuous support.

Each stage of the healing journey embeds prevention strategies throughout to promote lasting recovery.

Warning Signs You May Need to Step Back Up

Addiction’s chronic nature means that relapse is always a possibility. If a person in a Level 2 program develops uncontrollable drug cravings, misses counseling sessions or tests positive in drug screens these warning signs could indicate a need for a reassessment of the level of care needed.

The Recovery Capital Index (RCI) is used by medical professionals to periodically evaluate a client’s progress along the continuum of care. If the warning signs suggest the client requires additional support the RCI can be used to decide to step back on a level to reroute therapeutic progress.

Crafting a Relapse Prevention & Aftercare Plan

With adequate tools and support it’s possible to implement practical relapse prevention and aftercare strategies. For example, establishing SMART goals and signing recovery contracts can increase personal commitment to sobriety.

Accessing a crisis phone tree can offer practical support during a crisis.

Regular follow up appointments and alumni events can foster connections and instill hope. A graduate understands that care continues even after a program has formally ended. This encourages individuals to remain committed to progress within a sober community.

Supportive Services That Span All Levels

In all programs the care team may require selected services to enhance the rehab experience. Since everyone’s conditions are unique programs like methadone maintenance or counseling to address certain mental conditions may be warranted to strengthen recovery.

Medication Assisted Treatment

Sometimes medication assisted treatment (MAT) that uses a special group of FDA-approved prescriptions is necessary to ease strong withdrawal symptoms or cravings.

FDA approved methadone, buprenorphine and naltrexone can alleviate these urges in someone with opioid use disorder. Naltrexone, acamprosate and disulfiram are MAT options for alcohol use disorder.

MAT generally begins during or shortly after medical detox in the first treatment stage. Its use, response and adherence are monitored at various ASAM Levels of Care as a person progresses throughout the healing continuum as their withdrawal slowly subsides.

Dual-Diagnosis & Psychiatric Care

Approximately 44% of American adults with addictions also have mental health conditions. That’s why addressing co-occurring disorders is embedded in every level of the ASAM criteria

Mental health status can rapidly change as treatment advances. Tackling dual diagnoses with integrated mental-health meds and counseling can reduce relapse rates, while screening for PTSD, depression and ADHD early in recovery results in more robust treatments for addressing the underlying reasons for substance abuse.

Family Therapy, Peer Coaching, & Holistic Treatment

Programs such as Community Reinforcement and Family Training (CRAFT) and multidimensional family therapy (MDFT) engage the families and loved ones of adults and adolescents who are battling addiction.

They strengthen communication skills, increase problem-solving capabilities and teach family members how to help and be a source of encouragement. Peer coaches increase treatment retention 10 to 15% by fostering accountability and personal commitment.

Tools like alumni apps for check-ins are also valuable aids to promote a sense of community and dedication to sustained recovery.

Aftercare Support

Aftercare is a non-numbered level of care on the ASAM continuum that reflects the modern understanding of addiction as a chronic condition where recurrence is possible and care reinitiation could be necessary.

Once their drug rehab programs have ended, individuals still need support and ways to remain motivated and on track with their recovery goals. Drug rehab aftercare support is offered by many drug rehab facilities to meet this need.

Aftercare may involve scheduling continuing outpatient treatment sessions, attending alumni group meetings and special events or attending 12 Step peer group meetings held at the rehab facility.

There’s usually no cost for alumni meetings and events. Depending on the severity of addiction and the level of care program graduates may attend aftercare for more than a year.

Special Populations & Tailored Considerations

The ASAM Levels of Care can guide treatment, but physicians understand that programs must be customized to suit their patients. Specific demographic groups defined by age, gender and occupation may require specialized methodologies within their level of care.

Adolescents vs. Adults

Adolescents have unique recovery needs compared to adults. Adolescents’ brains are developing while they battle substance abuse. They face challenges like family dynamics, trauma, peer pressure and school stress that demand specialized recovery approaches.

Family-centric care, school coordination and experiential therapies that factor in adolescents’ shorter attention spans can aid recovery.

The ASAM is working on a new version (fourth edition) of the Adolescent and Transition Age Youth volume to update best practices to help young lives recover.

Pregnant Clients & Neonatal Concerns

Pregnant clients with addictions are often given priority access in the continuum of care due to the harm alcohol or drug abuse can pose to unborn children.

MAT is often the initial step to safely quit and reduce fetal stress. Clinicians monitor the mothers 24/7 to watch for complications and adjust the doses accordingly.

In addition, addiction can affect the capacity of pregnant women to take care of themselves. Coordination with OB/GYN, pediatric and social services is prioritized to incorporate prenatal care as part of a holistic recovery approach.

Veterans, Chronic Pain & Trauma-Informed Care

Trauma informed care is a central tenet of the ASAM criteria because trauma is strongly associated with elevated substance use.

Veteran-specific peer groups offer a military friendly environment where recovery addresses moral injury, which is a common effect of combat. These services help veterans reframe PTSD triggers with tools like eye movement desensitization and reprocessing (EMDR) therapy to break patterns that may influence addiction.

Integrated pain management is also a critical component of recovery programs. Chronic pain can result in seeking relief through addictive substances.

LGBTQ+ Affirmative Programming

The LGBTQ+ community has unique challenges that affect how they access recovery services. Issues like trauma, stigma, discrimination and isolation are all better addressed in safe spaces specifically designed to help minorities cope with stress.

Affirmative services include trained staff on pronouns, gender appropriate housing and counseling for underlying mental health conditions. Programs take place within environments that emphasize privacy to encourage comfortable disclosure and sustainable healing.

Paying for Treatment & Navigating Insurance

The cost of treatment varies and depends on the level of care, amenities, types of services, location and many individual factors.

Cost averages for main level of care are:

• Detox: Between $250 and $1000 per day depending on services and inpatient or outpatient alternatives.
• Inpatient/residential: 30 day programs cost between $6,000 to $25,000 depending on facilities, amenities and location. 60 to 90 day treatment ranges from $10,000 up to $60 to 80K.
• Partial hospitalization: These less intensive programs average between $5,000 to $20,000.
• Outpatient: These programs on average cost $1,000 to $2,000 per month with more luxurious facilities charging $3,000 or more monthly.

It’s critical to understand that most insurers cover recovery programs. To decide what to cover, most payers utilize ASAM levels as the clinical benchmark to evaluate what constitutes a medical necessity and what doesn’t.

When a person seeks help to recover a qualified professional utilizes the ASAM dimensions of addiction as decision-making parameters to assess an individual’s medical needs. The professional then generates a formal requirement via signed letters and a proposed treatment plan for insurers’ approval.

Financing, Scholarships & State-Funded Options

If you’re uninsured, there are still alternatives to explore. Most rehab facilities offer sliding scale plans, scholarships and financial aid options worth considering.

Based on your circumstances you may qualify for state and nonprofit-financed rehab centers, employee assistance programs (EAP), SAMHSA block grants, specialty court vouchers and other financial alternatives.

Get resourceful. Overcoming addiction can be the most valuable investment you ever make for yours and your family’s future.

Frequently Asked Questions About Levels of Care

Many clients are concerned about feeling boxed in by ASAM guidelines that might not meet their needs. Here are some questions that are commonly asked concerning the ASAM Levels of Care.

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