What Is Step-Down Vs. Step-Up Addiction Treatment?

Many people in addiction recovery share common experiences, including worries, struggles, and triumphs. But this doesn’t mean that addiction recovery is the same for everyone. In fact, substance use disorders are highly individualized, and a treatment approach that works for one person may not be a good fit for another. 

This is why addiction treatment is available in such a wide variety of different formats and levels of care, allowing different treatment providers to meet different peoples’ specific needs at different points in their recovery journey. And this also means that the level of care that’s right for you will likely change over time, sometimes leading to step-down treatment plans or step-up treatment plans. 

What’s The Difference Between Step-Down Vs. Step-Up Treatment?

The terms step-down treatment and step-up treatment are used to describe a structured change in the type of treatment that a person is receiving for SUD or some other condition. 

During step-down treatment, a patient’s treatment intensity is reduced over time, usually because they have made good progress and can continue in recovery with a lower level of care. 

In step-up treatment, a patient’s treatment intensity is increased, usually because they have experienced some form of setback or are not responding to their current treatment program. 

What Are The Different Levels Of Care?

Step-down and step-up treatment shifts usually mean a move between two distinct levels of care. According to the ASAM Criteria, published by the American Society of Addiction Medicine, there are four general levels of care that describe U.S. addiction treatment services, with a variety of sublevels and specializations within these broad classifications. 

Level 1: Outpatient Treatment

Outpatient treatment programs are held locally on a part-time basis over extended treatment periods and are recommended for people with mild forms of SUD or those who have already completed other higher-intensity forms of SUD recovery like residential treatment programs. Subcategories of outpatient treatment include:

• long-term remission monitoring
• outpatient therapy
• medically managed outpatient therapy

Level 2: Intensive Outpatient Treatment 

Intensive outpatient treatment can be a good fit for many moderate forms of SUD, as these local treatment services involve many hours of treatment per week, typically for several weeks or even months. Examples of intensive outpatient treatment includes:

• intensive outpatient programs (IOPs)
• high-intensity outpatient programs (HIOPs) including day treatment/partial hospitalization programs (PHPs)
• medically managed intensive outpatient therapy

Level 3: Residential Treatment

Short-term residential treatment and long-term residential treatment are considered highly effective options for addiction recovery, and are well-suited for addressing moderate to severe forms of SUD. Treatment periods usually range from 15 to 60 days or sometimes longer, during which participants live within a treatment center for 24/7 care, support, and security. Medical detox and dual diagnosis treatment services are often included. Subcategories of residential treatment include:

• clinically managed low-intensity residential treatment
• clinically managed high-intensity residential treatment
• medically managed residential treatment

Level 4: Inpatient Treatment

Medically managed inpatient treatment is reserved for people experiencing critical symptoms, including recent drug overdose, high-risk withdrawal symptoms, mental health problems, or medical complications. Clients are treated in a hospital environment until stable, then transitioned to other forms of treatment. 

It’s worth noting that “recovery residence” is another type of care that ASAM outlines. Also known as sober living housing, recovery housing involves organized communal residences that provide shelter to people in recovery while they work to develop independence. People in recovery housing are usually also participating in case management programs, peer support groups, outpatient treatment services, and other forms of support. 

Moving Between Levels 

People may enter or reenter this continuum of treatment services at any point, depending on their needs and current condition. Moving between levels is expected and planned for in different ways throughout the recovery process.

For instance, someone who struggles with illicit drug use may first enter inpatient treatment due to critical health complications, and then transfer to residential treatment once they are stable. This may then be followed by outpatient treatment for longer-term support, as per their personalized treatment plan. 

Or, a person may transfer from residential treatment to outpatient treatment, only to find that the level of support they are receiving isn’t enough. So, they may instead be transferred to an IOP, or even back to residential treatment for a longer period of treatment if needed.

When And Why Would A Person Step Down Their Care?

There are many reasons why stepping down care is not only an option in addiction treatment, but a goal. The first is that it means a person is making progress. 

Once someone completes a treatment program and is doing well, their care will be stepped-down as per their treatment plan, as is often the case with residential and outpatient treatment programs.

However, treatment may also be stepped down due to client preference or other reasons. For example, whereas an intensive outpatient treatment program may require a client to attend sessions three to five days a week, regular outpatient care may only have weekly sessions, some of which could even be offered remotely and supplemented with peer support meetings. This could be a good fit for someone who has made good progress, but it may also be necessary if someone is unable to find childcare or has transportation issues, limiting their ability to participate. 

If someone’s care is stepped down too quickly, there is a risk that their progress may be stalled or they may even relapse. 

When And Why Would A Person Step Up Their Care?

Stepping up care is not a sign of failure or a punishment. It is simply a change to provide the right care and support for the person’s current needs. 

Relapse is often cited as the trigger for step-up treatment, as 40-60% of people in recovery from substance use disorders do experience relapse at some point, according to the National Institute on Drug Abuse (NIDA). However, step-up care may be recommended if someone is struggling to make progress in their current treatment program but has not yet relapsed, or if someone experiences significant personal stress or trauma that greatly increases their risk of returning to substance use. Treatment may also be intensified if someone’s withdrawal symptoms are more intense or last longer than expected, as can be the case with post-acute withdrawal syndrome (PAWS). 

Examples of step-up treatment could include a person moving from an outpatient treatment program to a residential program because they cannot focus on recovery in their home environment, or someone moving from a residential treatment program to an inpatient setting due to severe withdrawal complications.

Comprehensive Care Through Ark Behavioral Health 

Getting the right care for your needs makes a tremendous difference in recovery, so it can be important to work with a provider that offers a wide range of treatment options. 

At Ark Behavioral Health, we provide clinical, medical, and psychiatric care for all forms of substance use, major mental health disorders, and co-occurring disorders. If you have never received care for a drug or alcohol use disorder before, or you have tried other treatment services in the past but with limited success, we can help with comprehensive treatment services including:

• expert evaluation and assessment
• medical detox services
• personalized treatment planning
• psychotherapy/behavioral therapy
• family psychoeducation
• medication-assisted treatment (MAT)
• dual diagnosis treatment services
• peer support
• case management
• alternative treatment approaches
• aftercare services and alumni events

Our treatment facilities are modern, comfortable, and private, and boast amenities like exercise centers, semi-private rooms, outdoor recreation, and more. 

Contact us today to learn more about our services and how we can help you meet your goals for recovery, including either step-down treatment or step-up treatment services.