Dual Diagnosis
Clinically managed services are directed by nonphysician addiction specialists rather than
medical personnel. They are appropriate for individuals whose primary problems involve
emotional, behavioral, cognitive, readiness to change, relapse, or recovery environment
concerns. Intoxication, withdrawal, and biomedical concerns, if present, are safely manageable
in a clinically managed service.
Level 3: Residential or Inpatient Programs
Level 3 programs include four sublevels that represent a range of intensities of service. The
uniting feature is that these services all are provided in a structured, residential setting
that is staffed 24 hours daily and are clinically managed (see definition of terms above).
Residential levels of care provide a safe, stable environment that is critical to individuals as
they begin their recovery process. Level 3.1 programs are appropriate for patients whose
recovery is aided by a time spent living in a stable, structured environment where they can
practice coping skills, selfefficacy, and make connections to the community including work,
education and family systems.
Level 3.1: Clinically Managed Low-Intensity Residential Programs
- Setting: Services are provided in a 24-hour environment, such as a group home. Both
clinic-based services and community-based recovery services are provided. Clinically,
Level 3.1 requires at least 5 hours of low-intensity treatment services per week,
including medication management, recovery skills, relapse prevention, and other similar
services. In
Level 3.1, the 5 or more hours of clinical services may be provided onsite or in
collaboration with an outpatient services agency.
- Provider Type: Team of appropriately credentialed medical, addiction, and mental health
professionals provide clinical services. Allied health professional staff including
counselors and group living workers and some clinical staff knowledgeable about biological
and psychosocial dimensions of SUD and psychiatric conditions support the recovery residence
component of care.
- Treatment Goal: Patients receive individual, group, or family therapy, or some combination
thereof; medication management; and psychoeducation to develop recovery, relapse prevention,
and emotional coping techniques. Treatment should promote personal responsibility and
reintegrate the patient to work, school, and family environments. At a minimum, this level
of care provides telephone and in-person physician and emergency services 24-hours daily,
offers direct affiliations with other levels of care, and is able to arrange necessary lab
or pharmacotherapy procedures.
- Therapies: Level 3.1 clinically managed low-intensity residential services are designed to
improve the patient’s ability to structure and organize the tasks of daily living, stabilize
and maintain the stability of the individual’s substance use disorder symptoms, and to help
them develop and apply recovery skills. The skilled treatment services include individual,
group and family therapy; medication management and medication education; mental health
evaluation and treatment; motivational enhancement and engagement strategies; recovery
support services; counseling and clinical monitoring; MAT; and intensive case management,
medication management and/or psychotherapy for individuals with cooccurring mental illness.
Level 3.5: Clinically Managed Residential Programs (high intensity for adults, medium intensity
for adolescents)
- Setting: Services are often provided in freestanding, licensed facilities located in a
community setting or a specialty unit within a licensed health care facility. Such programs
rely on the treatment community as a therapeutic agent.
- Provider Type: Interdisciplinary team is made up of appropriately credentialed clinical
staff including addictions counselors, social workers, and licensed professional counselors,
and allied health professionals who provide residential oversight. Telephone or in-person
consultation with a physician is a required support, but -on-site physicians are not
required.
- Treatment Goal: Comprehensive, multifaceted treatment is provided to individuals with
psychological problems, and chaotic or unsupportive interpersonal relationships, criminal
justice histories, and antisocial value systems. The level of current instability is of such
severity that the individual is in imminent danger if not in a 24-hour treatment setting.
Treatment promotes abstinence from substance use, arrest, and other negative behaviors to
effect change in the patients’ lifestyle, attitudes, and values, and focuses on stabilizing
current severity and preparation to continue treatment in less intensive levels of care.
- Therapies: Level 3.5 clinically managed residential services are designed to improve the
patient’s ability to structure and organize the tasks of daily living, stabilize and
maintain the stability of the individual’s substance use disorder symptoms, to help them
develop and apply sufficient recovery skills, and to develop and practice prosocial
behaviors such that immediate or imminent return to substance use upon transfer to a less
intensive level is avoided. The skilled treatment services include a range of cognitive,
behavioral and other therapies administered on an individual and group basis; medication
management and medication education; counseling and clinical monitoring; random drug
screening; planned clinical activities and professional services to develop and apply
recovery skills; family therapy; educational groups; occupational and recreational
therapies; art, music or movement therapies; physical therapy; and related services directed
exclusively toward the benefit of the Medicaid-eligible individual.
