If you or your loved one are experiencing a substance use disorder and are looking into treatment options, you may be confused about the terms “stepping up” and “stepping down.” Addiction treatment occurs on a continuum, so stepping down in addiction treatment means going from a more intense treatment setting or program to a less intense one.
When and Why Would I Step Up or Step Down?
It is important to note that a person can go up and down through different levels of treatment. Treatment options range from low-intensity outpatient treatment, which meets a few hours per week, to intensive 24/7 inpatient treatment. At any point, a person getting any level of treatment can go from less intensive services and “step up” to a higher level of treatment.
For example, a person may be in an outpatient program but is unable to maintain sobriety after going home in the evening. They may go to outpatient treatment for a few hours a day but then relapse at night after seeing friends who encourage him or her to drink or use drugs. A person in this situation may then need to step up to an inpatient program that can provide them with 24/7 support for a while, to help make sure that the person can use coping skills to resist relapse.
Another person may start treatment in an inpatient program. After being there for a few weeks or months, they may then be ready to “step down” to intensive outpatient treatment and attend treatment 20 hours a week or so, then go home at night. They may progressively step down then into less intensive outpatient, eventually just going to individual counseling sessions and/or support groups. This would typically happen after the person has gone through a certain amount of treatment programming and has a strong handle on their recovery.
What are my Treatment Options?
According to the American Society of Addiction Medicine (ASAM), a continuum of treatment options is available because one size does not fit all. For example, a person with a mild substance use disorder who is primarily using marijuana would not need the same level of treatment as a person with a severe substance use disorder who is using heroin and alcohol.
Someone with a mild substance use disorder might only need outpatient treatment for 9 hours a week or less, which is a Level 1 treatment option. If a person has a substance use disorder along with a co-occurring mental health disorder, they might need Level 2 intensive outpatient treatment, which is usually 9 or more hours of treatment each week.
The next level of treatment is partial hospitalization, which ASAM calls Level 2.5. In a partial hospitalization treatment program, a person will usually go to treatment for around 20 hours per week. The next step is residential treatment, offering 24/7 support and oversight. The amount of treatment and oversight is on a continuum, ranging from low-intensity residential treatment to highly structured residential services. The highest level of treatment according to ASAM is Level 4, which is a 24/7 structured, intensive medically managed level of treatment that involves at least 16 hours of counseling each week.
So, throughout these levels of treatment, a person may step up if he or she needs more support and intervention to maintain sobriety, and when a person is doing well, he or she can step down to a lower-level form of treatment with less support.
How do I Know if I Need Help?
If you are questioning if you or your loved one has a problem with drugs or alcohol, it can be helpful to know how a substance use disorder is diagnosed. According to the Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-V), which addiction treatment professionals use as the standard for diagnosing substance use disorders, you may have a substance use disorder if you experienced at least 2 of the following symptoms in the past 12 months:
- Using more of a substance than you originally meant to.
- Having arguments with loved ones about your use of a substance.
- Using the substance prevents you from performing your tasks at work, or in school, or in caring for your children.
- You use a substance in high-risk situations, such as driving.
- You keep on using a substance, despite knowing it makes your physical or emotional issues worse.
- Making unsuccessful attempts to stop using, or to cut back on your use of a substance.
- Spending a significant amount of time looking for a substance, using it, and recovering from using it.
- Giving up things you used to enjoy, such as friendships or hobbies, in order to use the substance.
- Cravings or urges to use a substance.
- Experiencing withdrawal when you stop using the substance.
- Developing tolerance to a substance, which means you need to take more and more of it to feel the effects of it.
You may have a mild substance use disorder if you have 2-3 of these signs. If you have 4-5, you may have a moderate substance use disorder. If you have 6 or more, you may be diagnosed with a severe substance use disorder.
Only a substance use treatment professional can diagnose you with a substance use disorder. If you are assessed and found to have a substance use disorder, numerous treatment options are available.
Source Credit: American Addiction Centers https://americanaddictioncenters.org/blog/what-does-stepping-down-or-up-in-addiction-treatment-mean