Affordable Effective Treatment for Alcohol and Drug Addiction

Treatment Levels Within Level III

Level 111.1: Clinically Managed Low-Intensity Residential Services

Level 111.1 programs offer at least 5 hours per week of low-intensity treatment of substance-related disorders (or as specified by state licensure requirements). Treatment is directed toward applying recovery skills, preventing relapse, improving emotional functioning, promoting personal responsibility and reintegrating the individual into the worlds of work, education and family life.

The services provided may include individual, group and family therapy; medication management and medication education. Mutual/self-help meetings usually are available on-site.
The kinds of care delivered by Level 111.1 programs are best understood in their component parts.

The treatment services provided by Level III. 1 programs, when considered separately from the residential component and other concurrent services, are low-intensity (Level I) outpatient services
that are focused on improving the individual's functioning and coping skills in Dimensions 5 and 6. The other component of care is a structured recovery environment, staffed 24 hours a day, which
provides sufficient stability to prevent or minimize relapse or continued use and continued problem potential (Dimension 5).

Interpersonal and group living skills generally are promoted through the use of community or house meetings of residents and staff. When these components are provided together, Level 111.1 programs often are considered appropriate for individuals who need time and
structure to practice and integrate their recovery and coping skills.
Some persons require the structure of a Level IBA program to achieve engagement in treatment (Dimension 4). Those who are in the early stages of readiness to change may need to be removed from an unsupportive living environment in order to minimize their continued alcohol or other drug use.

The residential component of Level MA programs also can be combined with intensive (Level Ill) outpatient services for individuals whose living situations are incompatible with their recovery goals, if they otherwise meet the dimensional admission criteria for intensive outpatient care.

The functional deficits found in populations typically treated at Level 111.1 include problems in the application of recovery skills, lack of personal responsibility, or lack of connection to the worlds of
work, education or family life. In a setting that provides 24-hour structure and support, residents have an opportunity to develop and practice their interpersonal and group living skills, strengthen
their recovery skills, reintegrate into the community and possibly family, and find or return to school or employment.

Level 111.1 programs also can meet the needs of individuals who may not yet acknowledge that they have an alcohol or other drug problem. Such individuals may be living in a recovery environment that is too toxic to permit treatment on an outpatient basis. Because these
individuals are at an early stage of readiness to change ("Precontemplation" in Prochaska and DiClemente's Transtheoretical Stages of Change), they may need monitoring and motivating strategies to prevent deterioration, engage them in treatment and facilitate their progress through the stages of change to recovery.

They are appropriately placed in a Level 111.1 supportive environment while receiving "discovery" services as opposed to "recovery" services. (Because continued use of substances in a "discovery" population likely will be more common than in a "recovery" population, consideration should be given to the problems inherent in housing the two populations together.)

Intoxication and withdrawal require separate consideration. Intoxication or withdrawal in an individual who is placed in a Level 111.1 program usually represents an isolated relapse associated
with problems in applying recovery skills (Dimension 5). If the intoxication or withdrawal is associated with deficits in problem recognition or understanding (Dimension 4), the individual is
appropriately placed in a Level III.1 program only if Level I or II motivational and engagement services are being provided concurrently.

Level III.1 is not intended to describe or include sober houses, boarding houses, or group homes where treatment services are not provided.

ASAM Patient Placement Criteria, Second Edition-Revised
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