Treatment Knowledge: Levels of Care, Evidence-Based Practice, and Change
Levels of care and matching
ASAM criteria place clients along a continuum - early intervention, outpatient, intensive outpatient, partial hospitalization, residential (clinically managed to medically monitored), and medically managed withdrawal management - using six dimensions: intoxication/withdrawal risk, biomedical conditions, cognitive/emotional status, readiness to change, relapse potential, and recovery environment. Detoxification is stabilization, not treatment.
Evidence-based practices
Know the core set: motivational interviewing (empathic, directional, non-confrontational; OARS), CBT and relapse prevention, motivational enhancement therapy, contingency management (strongest evidence for stimulant use disorder), twelve-step facilitation, and family/behavioral couples therapy. Medication for opioid use disorder - methadone, buprenorphine, naltrexone - reduces mortality and is first-line; acamprosate, naltrexone, and disulfiram serve alcohol use disorder.
Stages of change
Precontemplation, contemplation, preparation, action, maintenance. Match the intervention to the stage; relapse is data, not failure. Pushing action on a precontemplator reliably backfires.
Traps
- "MAT substitutes one addiction for another" - false; it is evidence-based treatment.
- Equating detox with treatment, or AA with professional treatment (mutual aid is an adjunct).
- Believing confrontation works; MI outperforms it.
- Assuming one modality fits everyone; matching matters.
Rule of thumb / worked example
Ask "what stage is this client in?" before choosing a technique. A court-referred client who sees no problem gets reflective listening and agenda-setting, not a twelve-step assignment or a contract they did not author.