The phrase continuum of care is commonly used in addiction treatment. But, many people, specifically those seeking treatment, may not understand what this means.  

According to the National Institutes of Health, the continuum of care definition is an integrated system of care that guides and tracks patients over time through a comprehensive array of health services spanning all levels of intensity of care. 

A person generally needs structure and support for extended periods to maintain recovery. For this reason, their continuum of care treatment plan typically includes:

  • Detox
  • Inpatient or residential treatment
  • Partial Hospitalization Program (PHP)
  • Intensive Outpatient Program (IOP)
  • Outpatient Program (OP)
  • Sober Living
  • Community Support Services

A Brief History on Addiction Treatment

Detox ProgramsSubstance use disorder (SUD) treatment has changed over the years. In the 1980s, the 28-day residential treatment model became the standard of care in addiction treatment. 

The one-size-fits-all 28-day treatment model consists of:

  • Inpatient treatment
  • Detox program
  • Introduction to Alcoholics Anonymous or AA
  • The initial steps of the 12-step program

But, this treatment model had no clinical reasoning. As a result, people would stay in treatment for 28 days, “complete treatment,” and then relapse. The issue with this model is addiction is not an acute illness. 

Why is Continuum of Care Important?

Addiction is a chronic, progressive, and potentially fatal illness if not treated. For this reason, continuum care services became the new standard of care. Treatment centers must be able to treat co-occurring substance use and mental health disorders.

Attending treatment for 30, 60, 90 days will not “cure” drug or alcohol addiction. Above all, there is no “cure” for addiction. But, to receive the best shot at maintaining a life of recovery, the intensity of treatment must change with the person’s needs.

Addiction is typically a sign of underlying issues such as mental health issues or trauma. But, struggling with substance use disorder may also lead to mental health issues such as depression and anxiety. 

Treating addiction and mental health struggles is a life-long journey, and any complacency can lead to relapse. Continuum care services such as community services and sober living houses can help hold people accountable in their recovery journey. 

Continuum Care Services in Addiction Treatment

So, why is the continuum of care important in addiction treatment? Because recovery needs can vary even years into recovery. For example, a person with ten years of recovery may experience a traumatic event and, to prevent relapse, may need an outpatient treatment program. 

Compared to addiction treatment in the past, today’s treatment offers various intensity levels to meet each person’s needs struggling with addiction. 

Detox Programs

Often, drug or alcohol withdrawals become so uncomfortable and painful it causes many people to relapse. In some cases, withdrawal symptoms can be severe and potentially fatal if not supervised by medical personnel. For these reasons, medical detox is often the first step in treatment. 

Alcohol use disorder (AUD) and opioid use disorder (OUD), for instance, may require medication-assisted treatment to rid the body of toxins safely. Depending on the addiction, withdrawals typically peak by day five, while transitioning into residential treatment generally happens on day 7. 

Inpatient or Residential Treatment

The next step after detox in continuum care is an inpatient program. This treatment program provides 24-hour supervision and treatment of both addiction and mental health disorders. People often live in the facility for 28 days. However, the length of stay is based on the individual’s needs. 

Inpatient treatment is beneficial for those who struggle with relapsing and need a high-intensity treatment program. Some people need to step entirely away from life stressors to maintain recovery. The stress management skills and relapse prevention skills learned in individual and group therapies set people up for recovery success. 

Partial Hospitalization Program (PHP)

The next step in continuum care services is a partial hospitalization program. This medium-level intensity program is sometimes referred to as a “day program.” Individuals attend treatment during the day, generally 5-6 days a week for up to 6 hours a day. 

The most significant difference is that people can work, go to school, and care for their families when not in treatment. PHPs typically provide psychotherapy, medication-assisted therapy, dual diagnosis treatment, and teach relapse prevention skills. 

Intensive Outpatient Program (IOP)

Inpatient or Residential TreatmentAn intensive outpatient program is the next step-down in continuum care services. People generally attend individual and group therapies three days a week, up to 3 hours each day. Although this program offers a lower intensity level than PHPs, individuals still receive the same support and monitoring. 

IOPs are beneficial for those who need intense treatment but, for personal reasons, cannot attend inpatient treatment. Furthermore, insurance companies are generally more likely to cover treatment in an intensive outpatient program over an inpatient treatment program.

Outpatient Program (OP)

People who are in the early stages of substance use disorder may find outpatient programs enough to achieve and maintain recovery. Additionally, for those who need to refresh their relapse prevention skills, outpatient programs focus on therapies to enforce the skills to sustain recovery.

The one-on-one focused therapies and group therapies in outpatient treatment offer the complete definition of the continuum of care. For example, an individual’s treatment plan may include multiple therapy sessions one week and a few weeks later be down to once a week. 

Group therapy offers people the opportunity to practice real-life situations that can lead to relapse. Group therapy allows those in recovery to practice and sharpens their relapse prevention skills. According to the NIH, group therapy may also be more beneficial in maintaining recovery than individual therapy.

Medication-Assisted Treatment (MAT)

For many, using one medication to treat a substance use disorder is conflicting. But, as research has proven, addiction is a chronic brain disorder. And like all chronic illnesses, they sometimes require medication to treat. 

Antabuse (Disulfiram), for example, is FDA-approved to treat alcohol use disorder. It causes people physical discomfort if they drink alcohol. This medication is often enough to prevent people from relapsing, especially those who have multiple relapses. 

So, why is continuum of care important? Because some substance use disorders require individuals to be on medications long-term, the continuum care services of medication-assisted treatment are highly successful in maintaining lasting recovery. 

Other FDA-approved drugs for addiction treatment include:

  • Acamprosate
  • Naltrexone
  • Buprenorphine
  • Methadone

Sober Living

Stepping back into the “real world” is scary for anyone fresh in recovery. The pressure of seeing people, places, and things that remind a person of misusing drugs or alcohol can be too much for some to handle. Furthermore, some people may not have a healthy, substance-free home that supports their recovery.

But, sober living homes offer the security, structure, and supportive space as people transition back into society. Although people in sober living can go to work and school, they pay rent and follow strict house rules. A study published by the NIH found people who include sober living homes in their continuum care services, compared to those who don’t, have:

  • Significantly lower relapses
  • Increased rate of employment
  • Much higher monthly income
  • And lower incarceration rates

Community Support Services

Substance use disorder is a chronic illness like diabetes or heart disease and must be managed as such. For instance, a person whose diabetes is under control must still be closely monitored by doctors. So, to manage recovery, people need the support and check-ins of community support services. 

Services often provided through community support services include:

  • Transitional housing
  • Life skills training
  • Job training
  • Parenting skills
  • Individual and group therapy

What is the Risk of Relapse Without Continuum Care Services?

When a person transitions out of treatment without another service in place, they increase their relapse risk. Furthermore, this transition period is extremely dangerous, specifically when transitioning out of inpatient treatment. 

Individuals who do not continue with continuum care services are 80 percent more likely to relapse after treatment. This rate is compared to the 30 percent abstinence rate of those who stayed in continuum care services. Furthermore, continuum care services are shown to improve lasting recovery by up to 50 percent. 

What Makes Continuum Care Services So Beneficial?

A Brief History on Addiction TreatmentAddiction treatment providers such as Discovery Institute provide continuum care services to transition from detox to inpatient treatment to a PHP and beyond, a smooth process to reduce relapse risks. 

For example, a person in an emergency room can transition to detox without waiting. This wait can be the difference between someone achieving recovery and relapsing. While going through detox, treatment plans and transitioning into inpatient treatment is already being handled. 

Perhaps the most crucial time in recovery is transitioning out of inpatient treatment. Stepping back into life and encountering triggers can be too much for some people. For this reason, community support services and sober living housing are a big part of our continuum care services. 

At Discovery Institute, we offer many aftercare options to help in maintaining lifelong recovery include:

  • Long-term psychotherapy
  • Sober living homes
  • Support groups
  • Alumni programs
  • Community support services

As you can tell, our continuum care services are vast. For this reason, there are many people involved in helping you find lasting recovery. But, the most challenging work is done by those in recovery. And, without the proper support and services in place, the risk of relapse is increased. 

Find Lifelong Recovery at Discovery Institute

Have you tried the 28-day treatment programs only to go right back to using drugs or alcohol? At Discovery Institute, we give you the tools and support to achieve and maintain lasting recovery. Contact us today to find out more.

Reviewed for Medical & Clinical Accuracy by Dr. Jeffrey Berman, MD

Dr. Jeffrey Berman is a psychiatrist in Teaneck, New Jersey and is affiliated with Robert Wood Johnson University Hospital. He received his medical degree from State University of New York Upstate Medical University and has been in practice for more than 20 years. He also speaks multiple languages, including French and Hebrew.