There are four main levels of treatment for substance abuse:

  • Level I — outpatient treatment
  • Level II — intensive outpatient treatment
  • Level III — medically monitored intensive inpatient treatment
  • Level IV — medically managed intensive inpatient treatment

Outpatient treatment is an organized nonresidential treatment service or an office practice with addiction professionals and clinicians providing professionally directed alcohol and other drug (AODA) treatment. This treatment occurs in regularly scheduled sessions, usually totaling fewer than nine hours per week. Examples include weekly or twice-weekly individual therapy, weekly group therapy or a combination of the two in association with participation in self-help groups.

Intensive outpatient treatment (which includes partial hospitalization) is a planned and organized service in which addiction professionals and clinicians provide several AODA treatment service components to clients. Treatment consists of regularly scheduled sessions within a structured program, with a minimum of nine treatment hours per week. Examples include day or evening programs in which patients attend a full spectrum of treatment programming but live at home or in special residences.

Medically monitored intensive inpatient treatment can be described as an organized service conducted by addiction professionals and clinicians who provide a planned regimen of around-the-clock, professionally directed evaluation, care and treatment in an inpatient setting. This level of care includes 24-hour observation, monitoring and treatment. A multidisciplinary staff functions under medical supervision. An example is a program with 24-hour nursing care under the direction of physicians.

Medically managed intensive inpatient treatment is an organized service in which addiction professionals and clinicians provide a planned regimen of 24-hour medically directed evaluation, care and treatment in an acute care inpatient setting. Patients generally have severe withdrawal or medical, emotional or behavioral problems that require primary medical and nursing services.

It should be noted that several AODA treatment service models do not precisely fit within the four levels of care described here. These service levels include halfway houses and extended residential programs such as therapeutic communities. These programs are designed for people who do not have housing, who experience housing instability or who lack an organized support system. The programs are often used in conjunction with intensive outpatient treatment (IOP) or inpatient treatment.

This Treatment Intervention Protocol focuses on the second level of care: IOP. Much like AODA abuse treatment in general, IOP represents a continuum of services that range from less to more intensive treatment. Thus, IOP can be described as a range of services within the larger range of AODA treatment services. Some of the services provided are withdrawal management, group therapy, relapse prevention training, individual counseling, family counseling and pharmacotherapy.

IOP should not be described solely by the number of hours per week spent in sessions. Because of the number of services that are provided, the contact hours at IOP programs may range from a minimum of several hours (often described as about nine hours) to 70 or more hours per week. Further, minimal requirements for IOP may vary by state law or regulation. Since IOP involves a structured therapeutic environment combined with living at home or in a therapeutic residence, IOP affords patients an opportunity to interact with the real world while benefiting from a structured program in a therapeutic environment.

Whatever the level of care being provided, AODA treatment programs should provide services that reflect the treatment needs of the patients and should modify services according to cultural, demographic and geographic differences.

Mark S. Gold, M.D. contributed to this article.