CSS: Clinical Stabilization Services Vs. Residential Treatment

Substance use disorder (SUD) is a mental health condition that develops when a person is unable to manage their use of drugs or alcohol, even when that use becomes harmful. Unfortunately, SUDs are common in the United States today, impacting an estimated 17.3% of Americans over the age of 12 each year and claiming the lives of over 100,000 Americans annually through overdoses alone, according to the 2022 National Survey on Drug Use and Health (NSDUH).

However, SUDs are also treatable, and a wide variety of different approaches and services have been developed to provide care for mild, moderate, and severe forms of drug and alcohol addiction, including inpatient and residential treatment programs. 

Live-in treatment is often considered the gold standard for substance abuse treatment, especially when it comes to moderate and severe forms of SUD. Different levels of care are available to clients who stay onsite at addiction treatment centers, including clinically managed residential services, though these services may be referred to using different terminology in different states, including the state of Massachusetts. 

What Are Clinical Stabilization Services (CSS)?

CSS is a term specific to Massachusetts addiction treatment providers, describing a level of care nearly equivalent to the American Society of Addiction Medicine (ASAM) 3.5 level, or “clinically managed high-intensity residential services.” ASAM, a professional organization representing medical professionals in the field of addiction rehabilitation across the country, developed its levels of care and other criteria to establish a standard for placement, continued service, and transfer of people with SUDs.  

In a nutshell, clinical stabilization services are a short-term intervention designed to help people make the transition from clinical detoxification programs (also called acute treatment services, or ATS, in Massachusetts) to either transitional support services (TSS) or low-intensity residential treatment programs. 

CSS programs must offer 24-hour treatment in a community setting with services provided by licensed medical providers including physicians, registered nurses, and physician assistants. Candidates for CSS treatment are people who have a severe form of SUD and need high-intensity clinical support, but who have already gone through the detoxification process and are not at risk of serious withdrawal symptoms. 

Why Is CSS Needed?

Acute withdrawal is a difficult but necessary experience that puts people who have become dependent on drugs or alcohol through a tremendous amount of mental and physical strain. Even with medical support, clients may come out of detoxification exhausted and discouraged, with ongoing symptoms like disrupted sleep and recurring cravings. 

During the period immediately after detoxification, people are often in an especially vulnerable position, still recovering from the detox process while often feeling out-of-place, discouraged, or sometimes overconfident. Without continued support, some people will relapse at this stage, facing an increased risk of overdose due to their loss of tolerance. Still others may need help with acute mental health issues or medical problems requiring close care and treatment planning. 

CSS programs can assist people with these specific challenges, helping to stabilize clients as they begin their recovery in earnest and plan out the specific treatment services they will need to help them move forward in their recovery journey. 

Treatment Services Provided By CSS Programs

Some of the services provided in CSS programs include:

• medical, psychological, and social assessments 
• treatment planning
• psychosocial treatments
• intensive psychoeducation
• group and individual counseling
• family outreach
• medication-assisted treatment (MAT)
• case management
• preliminary aftercare planning

Again, CSS treatment does not include medical detoxification.

How Long Do CSS Programs Last?

CSS in addiction recovery is a short-term intervention provided to specific people depending on their particular needs. Program length can vary from provider to provider, with most falling around 10 to 21 days before the client is transitioned to another form of treatment. 

Differences Between Residential Treatment Vs. CSS In Addiction Recovery

The main differences between residential treatment and CSS may be due to the length of treatment involved in each. Residential programs tend to provide more options for treatment length, often based on a client’s progress in meeting their recovery goals. CSS programs, on the other hand, tend to last 30 days or less. 

While CSS is focused on stabilizing a client and transitioning them to a long-term form of recovery treatment, residential treatment focuses more on laying the foundation for a lifelong recovery effort. Treatment periods are typically 30, 60, or 90 days in length, giving clients time to learn about addiction, to work through issues underlying their condition, and to develop positive and effective coping skills. 

Residential programs may also be more likely to offer alternative therapies to support a holistic healing process, such as art therapy or yoga. These programs may also provide detox services within their facility, allowing clients to receive support from the same care team throughout more stages of the recovery journey.

Similarities Between Residential Rehab And CSS

Both programs are highly structured and secure, with 24/7 live-in accommodations that can range from hotel-like to luxurious. And clients in these programs work closely with therapists, psychologists, nurses, and support staff while participating in a wide variety of personalized treatment programming that may include:

• cognitive behavioral therapy (CBT) and other forms of psychotherapy
• family therapy visits
• life-skills training
• MAT using naltrexone, buprenorphine, methadone, etc.
• peer support group sessions / 12-step meetings
• recreational activities
• aftercare coordination

Many residential and CSS programs also offer personalized dual diagnosis treatment options, which combine substance abuse treatment with treatment for specific co-occuring mental health conditions like anxiety disorders, depression, bipolar disorder, ADHD, PTSD, OCD, and more. 

Levels Of Care For Addiction Treatment Programs

As part of its overall mandate, ASAM has established five broad levels of care for addiction treatment services, each of which is suited to meet the needs of people with particular needs in recovery. 

These different levels of care, which may have different names in different states or situations, include the following.

Level 1: Outpatient Treatment

These SUD treatment programs take place in an outpatient setting, providing less than nine hours of sessions each week and typically continuing for several months or more. Outpatient treatment is intended for stable clients with less severe forms of SUD as well as for those who have already completed other, more intensive treatment services. Outpatient treatment may sometimes include support for prolonged withdrawal symptoms or other mild medical or mental issues. 

Level 2.1: Intensive Outpatient Treatment

Intensive outpatient programs (IOPs) provide part-time treatment for between nine and 20 hours a week and usually continue for four to eight weeks in total. IOPs can be a useful transitional treatment for those who have recently completed a residential treatment program.

Level 2.5: High-Intensity Outpatient Treatment

High-intensity outpatient programs (HIOPs) and partial hospitalization programs (PHPs) are full-time options for people who need daily support and care for SUD recovery, but who don’t require 24/7 medical monitoring. Treatment sessions often last six hours each day for five days each week, and often continue for 30 days total. 

Level 2.7: Medically Managed Intensive Outpatient Treatment

These specialized HIOPs and PHPs incorporate medical monitoring and treatment for clients experiencing acute withdrawal symptoms or other medical concerns that usually would not be treated as part of an outpatient treatment program. 

Level 3.1: Clinically Managed Low-Intensity Residential Treatment

This first level of residential care provides treatment for people who are medically and psychologically stable but need focused, structured, and extended support in a 24/7 residential treatment program in order to build the skills needed to recover. 

Level 3.5: Clinically Managed High-Intensity Residential Treatment

Intensive supervision and support is provided through this residential level of care for people who are considered physically stable but may need a greater degree of psychological or social support. 

Level 3.7: Medically Managed Residential Treatment

These residential treatment programs also include 24-hour nursing/medical care and at least 16 hours of counselor availability each day in order to meet the needs of non-stable clients who may experience withdrawal symptoms or other serious issues during treatment. 

Level 4: Medically Managed Inpatient Treatment

This care level indicates inpatient treatment services provided through hospitals and other intensive-care providers for people who are not stable (and who may be a threat to themselves or others) and who are typically experiencing severe challenges like hazardous withdrawal symptoms, un-managed co-occurring mental health disorders, and significant medical challenges. This level of care includes medical evaluations, 24-hour nursing care, medical detoxification, counseling, and other stabilization-focused treatment. 

Note that people who are in recovery from an SUD typically start in one level of care and transition to others as their condition and needs change over time. Ideally, people will work their way to lower levels of care as they continue to recover and are able to develop positive coping skills and motivation to live a substance-free life.

Finding The Right Level Of Care For Addiction Recovery

Specialists at addiction treatment centers can help determine the right level of care for yourself or a loved one via initial screenings or thorough assessments and evaluations. These services uncover clients’ treatment and support needs, including specific treatment services for beginning or continuing recovery. If the rehab center doesn’t offer the level of care you require, it will likely be able to refer you to an appropriate treatment provider.

In most cases, people with more severe drug and alcohol addictions will require inpatient or residential treatment, while people with milder SUDs may be good candidates for outpatient programs.

Treatment Options At Ark Behavioral Health

Personalized care for drug or alcohol addiction can make a life-changing or even life-saving difference. 

If you or someone close to you has been struggling with illicit drug abuse, prescription drug abuse, or alcohol abuse, Ark Behavioral Health can help. 

Our addiction treatment centers in Massachusetts and Ohio provide a continuum of care for all forms of substance use disorder, with treatment services that include:

• medical detoxification
• residential/inpatient treatment
• residential mental health programs/community crisis stabilization (CCS) 
• dual diagnosis care for co-occurring SUDs and mental health conditions
• MAT options
• specialized programs for veterans and first responders
• aftercare coordination 

To learn more about Ark Behavioral Health and our treatment facilities, or to explore your own treatment program or treatment options for a loved one, please reach out to us today.