The term “detoxification” or “detox” has historically been used in SUD treatment, including in Minnesota regulations and earlier editions of the ASAM Criteria. However, the ASAM Criteria, 3rd Edition replaces this term with “withdrawal management” (WM) to better reflect a comprehensive and medically informed approach.

WM is not just a set of services: it is a level of care that must be clinically appropriate and based on medical necessity. WM is defined as “services required for Dimension 1: Acute intoxication and/or withdrawal potential.” These services are only appropriate when medical necessity has been determined through a comprehensive assessment that identifies the need for support in managing intoxication and/or withdrawal symptoms. While the liver naturally detoxifies substances, clinicians are responsible for managing the physiological and psychological effects of withdrawal. If withdrawal symptoms are not present, or if they do not pose a significant health risk, WM services may not be medically necessary, and another level of care may be more appropriate. In cases where a person is intoxicated but not yet in withdrawal, dimension 1 services focus on monitoring and managing intoxication.

Level 3.2-WM, often called “social detoxification,” is designed for people experiencing moderate withdrawal symptoms who need 24-hour support and monitoring. This level of care focuses on providing peer and social support rather than medical or nursing care. Some facilities at this level are also equipped to supervise the self-administration of medications to help manage withdrawal symptoms. 

Support systems:

• Availability of specialized clinical consultation and supervision for biomedical, emotional, behavioral and cognitive problems
• Follow clinical protocols to identify clients who may need medical services that go beyond what the facility can provide and ensure they are transferred to a higher level of care if necessary
• Ability to conduct or arrange for appropriate laboratory and toxicology testing

Level 3.7-WM programs provide 24-hour observation, evaluation, monitoring and treatment for individuals whose withdrawal signs and symptoms are severe enough to warrant round-the-clock inpatient care. Services are delivered under a defined set of physician-approved policies and physician-monitored procedures or clinical protocols. This does not require the full resources of an acute care general hospital or medical managed intensive inpatient treatment program.

Support systems:

• Availability of specialized clinical consultation and supervision for biomedical, emotional, behavioral and cognitive problems
• Availability of medical nursing care and observation as warranted, based on clinical judgement
• Direct affiliation with other levels of care
• Ability to conduct or arrange for appropriate laboratory and toxicology tests 

Level 4-WM withdrawal management is an organized service delivered by medical and nursing professionals that provides for 24-hour medically directed evaluation and withdrawal management in an acute care inpatient setting. Services are delivered under a defined set of physician-approved policies and physician-managed procedures or medical protocols. This level provides care to patients whose withdrawal signs and symptoms are sufficiently severe to require primary medical and nursing care services. 

Support systems:

• Twenty-four hour observation, monitoring, and treatment
• Availability of specialized medical consultation
• Full medical acute care services
• Intensive care, as needed