Levels of withdrawal care, in plain words
Clinical review pending. This guide was written from the sources it cites but has not yet been reviewed by a licensed clinician. It is general information, not medical advice. Medical disclaimer.
Detox (clinicians call it withdrawal management) happens in three broad settings: a hospital, a residential program where you stay overnight, or an outpatient program where you sleep at home. ASAM’s criteria split these into levels, from Level 1 (outpatient, least intensive) to Level 4 (hospital inpatient, most intensive). The right level depends on how risky your withdrawal is likely to be, not on preference alone.
The three settings
Hospital inpatient
You’re admitted to a hospital. ASAM calls this medically managed intensive inpatient withdrawal management, the top of the scale. It’s where complicated alcohol withdrawal belongs: ASAM’s 2020 guideline says withdrawal with seizures, signs of delirium or new hallucinations should be managed in inpatient settings. If someone is in severe delirium tremens, TIP 45 says they need emergency transport to an emergency department and generally a hospital stay.
Residential
You live at the program while you withdraw. ASAM’s names mark the split: some residential withdrawal management is “medically monitored,” some is “clinically managed.” Ask a program which kind it is, and what medical staff are on site.
Outpatient
You go home every night. It ranges from a check-in at a doctor’s office or a home health visit to a day-hospital program where you’re monitored for hours at a time. A clinician still runs it. For alcohol, ASAM’s protocol includes daily check-ins for up to five days and a plan to move you up if things get worse. More on this in detox at home.
The ASAM levels you’ll still see: 3rd edition
ASAM’s 2020 alcohol guideline uses the withdrawal management (“-WM”) levels from the 3rd edition of The ASAM Criteria (2013). You may still see these labels on program websites and insurance paperwork.
| Level | ASAM’s name | In plain words |
|---|---|---|
| 1-WM | Ambulatory withdrawal management without extended on-site monitoring | Office visits or home health; you go home |
| 2-WM | Ambulatory withdrawal management with extended on-site monitoring | Day-hospital style; hours of monitoring, then home |
| 3.2-WM | Clinically managed residential withdrawal management | Live-in program, clinically managed |
| 3.7-WM | Medically monitored inpatient withdrawal management | Live-in with medical monitoring |
| 4-WM | Medically managed intensive inpatient withdrawal management | Hospital-level care |
What changed in the 4th edition (2023)
ASAM released the 4th edition of its criteria in 2023. One of the changes ASAM lists is the “integration of withdrawal management and biomedical services.” In the new edition, withdrawal management is built into the main levels of care instead of having its own “-WM” levels.
ASAM’s 4th-edition adult levels are:
| Level | Sublevels |
|---|---|
| 1 | 1.0 long-term remission monitoring, 1.5 outpatient therapy, 1.7 medically managed outpatient |
| 2 | 2.1 intensive outpatient, 2.5 high-intensity outpatient, 2.7 medically managed intensive outpatient |
| 3 | 3.1 clinically managed low-intensity residential, 3.5 clinically managed high-intensity residential, 3.7 medically managed residential |
| 4 | Medically managed inpatient |
ASAM’s own slides say 3.2 withdrawal management services were integrated into Level 3.5. Vermont’s Department of Health, in an October 2024 brief, notes that the 4th edition mentions withdrawal management as a potential part of the 1.7, 2.7 and 3.5/3.7 levels of care.
You’ll see secondary sources map each old level to a new one (1-WM to 1.7, and so on). The ASAM material we checked doesn’t spell that crosswalk out, so we don’t present it as fact. If a program or insurer uses a level number you don’t recognize, ask them what it means in practice: Where do I sleep? Who checks on me, and how often? Is there a doctor or nurse on site overnight?
How the setting is chosen
A clinician looks at more than how you feel right now. For alcohol, ASAM points to:
- Your history: past seizures or DTs, how many withdrawals you’ve been through, how long and how heavily you’ve been drinking
- Your current withdrawal score, though ASAM says severity scales “should not be used alone to determine level of care”
- Other medical or psychiatric conditions, and being able to take medication by mouth
- Whether you also depend on benzodiazepines (which rules out Level 1-WM for alcohol withdrawal)
- Your support at home and whether home is safe
- Suicide risk, which often means an inpatient psychiatric setting
The level isn’t fixed. If outpatient withdrawal goes badly (persistent vomiting, hallucinations, confusion, a seizure, fainting, unstable vital signs), ASAM says to move up.
For benzodiazepines, the 2025 tapering guideline says most people can taper as outpatients, with inpatient or medically managed residential care when the risk can’t be safely managed outpatient. For opioids, the key question is less about the bed and more about medication: ASAM recommends methadone or buprenorphine over stopping abruptly, and methadone for withdrawal has to come through an opioid treatment program or, in limited cases, acute care.
Call 911 if
- Someone has a seizure.
- They’re confused, disoriented, or seeing things and don’t know where they are.
- They can’t be woken properly, or their breathing is slow or has stopped.
Finding a program at the right level
Our detox directory lists every withdrawal management program in SAMHSA’s data, organized by state and city. Start with your state’s page, or enter your ZIP in the finder. Where the listings come from is explained on our data page.
When you call, say what you’re withdrawing from and anything that raises your risk, then ask which level of care they provide and whether they can assess you today. If they can’t take you, ask who can.
Sources
- ASAM, The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management, J Addict Med, 2020 (adopted Jan 23, 2020)
- SAMHSA, Quick Guide for Clinicians Based on TIP 45: Detoxification and Substance Abuse Treatment, based on TIP 45 (2006)
- ASAM, About The ASAM Criteria, accessed Oct 24, 2026
- ASAM, The ASAM Criteria 4th Edition (presentation to NAIC), Aug 2024
- ASAM, Major Changes in the Fourth Edition of The ASAM Criteria (hosted by IRETA), Oct 2024
- Vermont Department of Health, Substance Use Disorder Withdrawal Management brief, Oct 2024
- Brunner E, et al. Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits, J Gen Intern Med, 2025 (epub Jun 17, 2025)
- ASAM, The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update, J Addict Med, released Mar 2020