Proper substance abuse treatment doesn’t happen with one visit to detox or one round of group programming. In order to achieve positive treatment outcomes, it’s essential to follow a series of steps, known as the continuum of care.
Continuum in substance abuse treatment
The continuum of care is a step-down model of treatment, ranked from highest to lowest intensity of services. As time in substance abuse treatment passes, a client will move from the most intensive services, like inpatient (detox and residential) to low-intensity services like routine outpatient therapy.
The American Society of Addiction Medicine (ASAM) has established five main levels in a continuum of care for substance abuse treatment:
The ASAM care model is used by Project Courage clinicians in substance abuse evaluations when determining appropriate level of care. A person may need to move into a higher intensity program before attending our services if active use is inhibiting treatment.
“A typical progression for someone who has a severe substance use disorder might start with 3 to 7 days in a medically managed withdrawal program, followed by a 1- to 3-month period of intensive rehabilitative care in a residential treatment program, followed by continuing care, first in an intensive outpatient program (2 to 5 days per week for a few months) and later in a traditional outpatient program that meets 1 to 2 times per month.”
- SAMHSA, 2016
Project Courage collaborates with outside providers and agencies to ensure that the right fit is pursued, and treatment can be tailored to each individual’s needs.
Detox and traditional rehabilitation are often not enough
Despite the importance of continuing treatment, people frequently call it quits after a five-day detox or 28-day rehab, sure they have sufficiently dealt with the problem. According to the National Institute on Drug Abuse,
“Most addicted individuals need at least three months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment.” (NIDA, 2018)
People underestimate what it's like to return home from 30 days in an inpatient setting, where they are safe from triggering situations. Instantly, they are thrown back into family dynamics, environmental stressors, and in many cases, the same people and places that enabled substance abuse disorder all along.
Treatment after inpatient is designed to slowly reintegrate a person while offering critical support and resources while doing so.
Where does Project Courage land on the spectrum?
Project Courage offers outpatient services and intensive outpatient services, putting us a step below level three, according to ASAM criteria. We and facilities with a similar level-of-care are usually step-downs from detox and residential rehabilitation as well as partial hospitalization programs (PHP).
The services we provide are the Intensive Outpatient Program (IOP), the Recovery Support Services Program (in-home treatment), Medicated Assisted Treatment (MAT), and a variety of outpatient programs such as individual and family therapy, parent coaching, psychoeducation groups, and a unique program for students who have been expelled or suspended from school. Each of our programs is meant to extend the time a client has to work on recovery and health, and push toward NIDA's suggestion of at least three months of treatment.
ASAM Continuum. (2015). What are the ASAM levels of care? Retrieved from https://www.asamcontinuum.org/knowledgebase/what-are-the-asam-levels-of-care/
NIDA. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition on 2019, August 21
Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General. (2016). Chapter 4 Early intervention, treatment, and management of substance use disorders. Facing addiction in America: The surgeon general's report on alcohol, drugs, and health (). Washington, DC: US Department of Health and Human Services. Retrieved from https://www-ncbi-nlm-nih-gov.libraryproxy.quinnipiac.edu/books/NBK424859/
By: Tim Harmon