Determining appropriate levels of care for treatment of substance use disorders
- Karen Hartwell, MD
Karen Hartwell, MD
- Associate Professor
- Medical University of South Carolina
- Kathleen Brady, MD, PhD
Kathleen Brady, MD, PhD
- Professor of Psychiatry
- Medical University of South Carolina
Patients with chronic or relapsing substance use disorders (SUD) make up 40 to 60 percent of individuals who receive SUD care [1-3]. These patients typically have marked impairments in functioning and high rates of co-occurring medical, mental health, and social problems that need to be addressed.
With increasing recognition of the substantial patient population with a chronic SUD (addiction), the SUD-treatment model is shifting from episodic to continuing care, based on the chronic care model . In managing patients with chronic SUDs, the patient’s clinical status and risk of relapse are monitored systematically and longitudinally. As the patient’s addiction waxes and wanes over time (ie, experiences periods of abstinence, relapse, or fluctuations in risk of relapse), the intensiveness and types of treatment are adjusted.
This topic describes the continuum of care for SUDs, and factors that influence the determination of patients’ level of care. Other aspects of continuing care for SUDs (ie, indications, features, efficacy, and implementation) are described separately. Treatment for individual SUDs are also described separately.
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- CONTINUUM OF CARE
- LEVELS OF CARE
- Early intervention
- Outpatient care
- Intensive outpatient programs
- Partial hospital programs
- Residential services
- - Oxford House
- - Clinically managed, low-intensity residential services
- - Clinically managed, high-intensity residential services
- Medically managed intensive inpatient services
- PATIENT ASSESSMENT
- PATIENT PLACEMENT
- Primary care referral
- TREATMENT INTEGRATION FOR CO-OCCURRING CONDITIONS
- SUMMARY AND RECOMMENDATIONS