In their Principles of Effective Treatment, the National Institute on Drug Abuse (NIDA) states that a variety of evidence-based treatments must be available for those struggling with substance abuse, including alcohol use disorder (AUD). These treatments typically include safe, medically supervised detox, which helps the person avoid severe alcohol withdrawal symptoms that can threaten their life. This medical supervision also helps to diagnose any health conditions that may have been exacerbated by abusing alcohol or caused by problem drinking. Once the person has safely and successfully ended their physical dependence on alcohol, a rehabilitation program can provide therapy to expand the person’s understanding of their condition and to change their behaviors around alcohol or other intoxicating substances.
The American Society of Addiction Medicine (ASAM) lists, in their criteria, a Continuum of Care for people who struggle with substance abuse. There are four broad categories, listed as Level I-IV, with sublevels to specify which kind of medical or therapeutic support the individual may need. This continuum informs addiction specialists about different approaches to treating individuals entering rehabilitation, so they get the best medical, social, and therapeutic care possible.
In this continuum, some people who have struggled with long-term, high-dose problem drinking may need years of medical and therapeutic support, including stepping down from a residential facility to outpatient treatment. For others, simply attending a few sessions of group therapy in an outpatient rehabilitation program can be enough to achieve and maintain recovery.
Outpatient vs. Inpatient Treatment Options
Generally, outpatient treatment is less intense and time-consuming than inpatient treatment. While some outpatient treatment programs may require several sessions per week, people who reside in an inpatient treatment setting typically require supervision to stay away from alcohol or drugs and likely need treatment with prescription medication, such as medication-assisted therapy (MAT) with buprenorphine or naltrexone.
For example, intensive outpatient treatment requires a similar number of therapy hours to inpatient treatment, but the person attending this kind of outpatient program can still return home at the end of therapy sessions. In comparison, long-term residential treatment may require fewer hours of therapy, but the consistent supervision at the facility is designed to help the individual stay away, physically, from addictive substances, and re-learn behaviors involving drugs or alcohol over time. The person may live in a residential treatment facility for six months or a year; those attending outpatient treatment may spend a few weeks or months attending therapy sessions in comparison.
To better understand outpatient treatment as a potential aftercare option for some in recovery, ASAM’s four general levels of care are:
- Level I: outpatient treatment
- Level II: intensive outpatient treatment
- Level III: inpatient treatment
- Level IV: medically managed intensive inpatient treatment
It is not unusual for people who have struggled with alcohol and drug abuse for a long time to require multiple levels of treatment over time. Considering outpatient treatment as a form of aftercare for those who required inpatient treatment at first may be a successful long-term approach to overall recovery.
Using ASAM’S Continuum to Provide Thorough Aftercare Treatment
When examining the more detailed Continuum of Care, a clinician can determine what course their client should follow. Level IV is medically managed services, which may include treatment for serious health conditions like heart problems or liver disease. The next step after that is Level 3.7, involving medically monitored intensive inpatient treatment; Level 3.5 is clinically managed high-intensity residential services. Both these levels may involve prescription medications, regular checkups with physicians, and other medical services.
Level 3.3 is clinically managed, population-specific, high-intensity residential services, and 3.1 is low-intensity residential services. These two categories involve group therapy in a specific, drug-free residence, and they may involve physician or nurse assistance; however, they are less likely to involve prescription drugs or medical management of specific conditions.
Levels III and IV cover inpatient treatment. A person who needs these services may have a medical condition, severe withdrawal requiring a long taper, a co-occurring mental illness, or might be unable to stop consuming addictive substances like alcohol when they are on their own. When a person in any of these levels of treatment completes the program, they may require ongoing therapy and potential medical intervention to stay sober. These needs reflect lower levels of ASAM’s Continuum of Care, including:
- Level 2.5: partial hospitalization to manage severe detox symptoms, which may be required if a person relapses
- Level 2.1: intensive outpatient treatment, where the person is required to be in group, and maybe individual, therapy for several sessions per week, but they can safely live at home
- Level I: standard outpatient services, where the person does not have to attend more than three sessions per week, allowing them to go to work, school, and meet family obligations
- Level 0.5: early intervention or education, which is an education or prevention program with a specific number of hours until completion that can help a person regain their driver’s license after a DUI, understand the consequences of relapse, or see how their abuse of alcohol affected their family
When a person in a Level IV or Level III care level completes that part of treatment, stepping down into mutual support or group therapy in an outpatient program may help them stay focused. Receiving prevention education can help them meet other societal, legal, or professional requirements. For those in Level II or I, aftercare may simply mean an online support group, periodic visits to 12-Step meetings, or activities that require a similar low level of commitment.
Because everyone has different ongoing needs, it is important to have as many options open as possible for those working to overcome alcohol addiction.