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Prior to the 1980’s, addiction treatment consisted predominantly of three core forms:
Most people would be referred to treatment either through their family doctor or friends who had experience with addiction recovery. Those doctors would also struggle with making the referrals, as there were no good guidelines to tailor appropriate treatments. The whole process was heavily based on anecdotal experience.
In the mid-1980’s, the American Society of Addiction Medicine (ASAM) started developing such guidelines to build more structure to the treatment matching process. In 1991, they released a formal set of guidelines called the Patient Placement Criteria which used a set of six dimensions to match people to a ladder of four different levels of care. The underlying theory was that more severely addicted people with more intense problems would get referred to higher levels of care, whereas more stable people with less disease burden could succeed in less intense outpatient settings.
The six dimensions, rated from 1-4 in terms of severity, according to the ASAM criteria are as follows:
After reviewing the dimensions for each patient, we would provide guidance and education about the different levels of treatment available. As there are four levels of treatment, this corresponds to the ASAM score of 1-4 for each of the six dimensions. Some clinicians will average the numbers to determine a bulk score. Others will emphasize certain variables, such as detoxification when advising people about what treatment path to take.
A sensible way of separating each of these four levels of treatment is to list the average number of hours per week with each program:
More clinical time may be needed for a more severe addiction. A person with a less severe disease can succeed with less intense treatment. Navigating this schematic for treatment matching is what a skilled, high-level treatment center will do. There is a logical, stepwise approach to linking people with the appropriate treatment and aftercare. Through being sensible and realistic about care needs, you can achieve a good recovery outcome. The continuum of care model is key.