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Level of determination

Opioids withdrawal is an uncomfortable and complicated process to make a full recovery a patient needs complete guidelines and care. This care is determined by the severity of withdrawal. As a patient may need mild care to serious 24/7 observation. Moreover, the medications and the side effects of treatment also require medical guidelines to increase the recovery process. As observed opioids addictions are usually accompanied by other substance abuse thus it makes the withdrawal more complicated. Certain risk factors also determine the care level as the mental health or physical health of a patient could affect the withdrawal and recovery process. Opioid recovery is not all about mediations it's also about the will of the patient the environment and the support system. All this contributes to a successful recovery and reduces the chances of relapse. The level of care is determined by a well-defined assessment system: the American Society of Addiction Medicines (ASAM). ASAM determines the treatment plan and level of care and observation a patient need (Kampman & Jarvis, 2015). The specifications to determine the level of care are based on the individuality of the treatment plan rather than generalization. It is observed that a plan which includes patients' own feedback needs and behavior shows more positive results. Thus, the care provided to a patent should be determined by patients' own experience (MEDICINE).

ASAM has set dimensions that help to decide on the treatment plan of the patient. There are six dimensions made by ASAM which are (Mee-Lee, Shulman, & Fishman, 2013):

1- intoxication withdrawal

2- biomedical condition

3- emotional/ behavioral/cognitive complication

4- acceptance or resistance to treatment

5- relapse/continued use problem

6- recovery environment

The treatment can be managed in two categories:

1- Clinical treatment: This treatment is provided by addiction specialists who could be non-physician. It is more suitable for patients who have emotional behavioral relapse recovery environment

2- Medical treatment: This treatment requires physician guideline and are suitable for patients requiring 24/7 medical care

Level of care:

The level of care decided by ASAM is Early intervention, outpatient services, intensive outpatient, medically monitored intensive inpatient, medically managed intensive inpatient (Gastfriend & Mee-Lee, 2004).

Withdrawal management on a scale of 1-4 (1: mild – 4: severe) depending upon the severity of withdrawal helps to decide the plan of care with different levels also ranging from 0 – 4 with zero being least intervention to 4 being intensive medical care with 24/7 medical supervision.

With withdrawal level 1 the patient can be treated as an outpatient without onsite medical management

Level 2 requires onsite management of outpatient could also lead to partial hospitalization

Level 3 could be clinically managed or medically dependent upon the patient. For example, or acute general hospitals rehab facilities can be utilized

Level 4 requires intensive inpatient monitoring and managing. A psychiatrist is required with 24/7 continuous care.


The dimensions and level of care of ASAM help to determine how a patient can be helped with his withdrawal and post-withdrawal. For example, if the patient has mild withdrawal he could be treated as an outpatient if he shows a positive response to the readiness of change and have a good support system but a patient with an intensive withdrawal sys cannot be taken care of as outpatient. Such patient has high risk of intoxication require medical care 24/7 thus has high medical complication (Kampman & Jarvis, 2015; Mee-Lee & Davis).


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