The severity of a substance use disorder is determined based on the number of symptoms a patient experiences:

  • Taking the substance in larger amounts or for longer than you intended to

  • Wanting to cut down or stop using the substance but not managing to do so

  • Spending a lot of time getting, using, or recovering from use of the substance

  • Cravings and urges to use the substance

  • Not being able to perform well at work, home, or school because of substance use

  • Continuing to use, even when it causes problems in relationships

  • Giving up important social, occupational, or recreational activities because of substance use

  • Using substances repeatedly, even when it puts you in danger

  • Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance

  • Needing more of the substance to get the effect you want (tolerance)

  • Experiencing withdrawal symptoms, which can be relieved by taking more of the substance


Level 0.5: At risk: > weekly use + 1 symptom

Level 1: mild severity (2-3 symptoms)

Level 2: moderate severity (4-5 symptoms)

Level 3: high severity (6-11 symptoms)

Early intervention is critical. The higher the level of severity, more intensive treatment is needed. As a patient progresses through treatment, they should step down to less intensive levels of care. A patient may start with inpatient services and then graduate to intensive outpatient care. Progress should be continually monitored so that the level of treatment can be adapted as needed. Research has shown that the longer a patient receives treatment, the better their chance of sustaining recovery. Ongoing monitoring and wrap-around recovery services ensure that a patient can be re-engaged with treatment should symptoms return.




The chronic care model of addiction treatment recognizes that severe substance use disorders, or addictions, are chronic, relapsing brain disorders that require long-term medical management. When a patient suffering from substance use disorder is treated with a chronic care model, the goal of any treatment episode is to help the patient achieve remission and to teach them effective strategies for self-management. Healthcare providers should work with the patient to develop a treatment plan that includes defining goals, setting priorities, and identifying potential challenges and strategies to overcome them. Ongoing care should be managed through coordination between the patient and both their addiction treatment provider and their primary care provider.

Self-management interventions can include providing education resources, skills training, behavioral counseling, and recovery support services. These interventions should empower the patient to manage their own health, ensuring that they know what to do if they have, or feel they are at risk for, a relapse.

To learn more, visit:

Treating Opioid Addiction as a Chronic Disease (ASAM)