Addiction treatment New York

Levels of care in New York

Medically supervised withdrawal. Some patients need a detox period before treatment can start, usually in a hospital or in a residential unit with nursing on site. Medication is commonly used for alcohol and opioid withdrawal. Detox by itself is short, often 3 to 7 days, and most patients are referred to another level of care afterward. In OASAS terms this is Part 816.

Residential treatment. Residential programs (Part 820) require patients to live at the facility. Length of stay varies by program and by what insurance will cover.

Outpatient treatment. Outpatient programs (Part 822) let patients live at home and come in for scheduled sessions. Opioid treatment programs, the ones that dispense methadone, are also under Part 822.

The SAMHSA listing does not print the Part number. It prints the setting: outpatient, intensive outpatient, residential, hospital inpatient. The setting on the listing usually tells you which license the program has.

How placement is decided

Placement between levels is done with a state assessment tool called LOCADTR 3.0. OASAS has required it since 2016. Programs use it, and Medicaid managed care plans use it. The tool asks about use in the last 30 days, withdrawal risk, medical and psychiatric conditions, the living situation, and earlier treatment. It returns a recommended level.

A residential program generally cannot admit a patient who asks for a bed if the LOCADTR result does not support that level. A patient placed in outpatient can be moved up later if the outpatient episode does not hold. The assessment is repeated when the situation changes.

Withdrawal risk is scored on its own. Patients with a high score go to a withdrawal setting first. Helio Health in Rochester is one. Its listing shows residential detoxification for alcohol, benzodiazepines, cocaine, and methamphetamine, with buprenorphine on site. Discharge planning and follow-up after discharge are listed. See also detox and rehab.

Outpatient treatment

Outpatient care is generally suited to patients who have somewhere stable to live and are not in acute withdrawal. Levels include:

Partial hospitalization or day treatment, usually 5 days a week for several hours a day, 20 or more hours weekly.

Intensive outpatient, typically 3 or more days a week for at least 9 hours total.

Regular outpatient. Regular outpatient treatment has the fewest hours, often 1 to 3 sessions a week, and the schedule depends on the program.

Victory Recovery Partners in Shirley is listed as outpatient and intensive outpatient, with buprenorphine and naltrexone prescribed on site. Chemical Dependency Treatment Services in Syracuse is listed with day treatment as well. Catholic Charities of Long Island in Hampton Bays is listed as regular outpatient. More on schedules is on the outpatient rehab page.

Medication in outpatient programs

Programs differ on medication. The SAMHSA listing separates three items: whether the program prescribes buprenorphine, whether it prescribes naltrexone, and whether it prescribes medication for alcohol use disorder or only accepts patients who get it somewhere else.

Some programs prescribe all of it. The Syracuse program above lists acamprosate, disulfiram, a buprenorphine implant, and buprenorphine with naloxone. Some programs prescribe buprenorphine and naltrexone but not alcohol medication. Catholic Charities in Hampton Bays is listed that way. Delaware County Alcohol and Drug Services in Walton prescribes alcohol medication on site.

Methadone is only dispensed at an opioid treatment program (OTP). Arms Acres in Carmel, Putnam County, is one. It lists methadone maintenance, buprenorphine maintenance, and intensive outpatient. A regular outpatient program without the OTP certification does not dispense methadone. Patients on methadone who enter another program usually keep the OTP for dosing and attend the other program for counseling.

Residential treatment

Residential treatment is recommended when the living situation or the severity of use makes outpatient care unlikely to work. The stay is not a fixed 28 days. Under Part 820 the length is tied to the patient's progress, and the program reviews it. Medicaid plans review it too, usually in short blocks.

Short-term residential in the SAMHSA listings generally means 30 days or less. Long-term means more than 30 days. Some programs list both.

Van Dyke Addiction Treatment Center in Ovid, Seneca County, is listed as short-term residential. It prescribes alcohol medication, buprenorphine, and naltrexone on site and lists adult men, seniors, veterans, and active duty military. Cayuga Addiction Recovery Services in Trumansburg is listed as both 24-hour residential and long-term residential, with a sliding fee. Other residential programs on this site are compared on the residential rehab page.

Payment

Medicaid is the largest payer for addiction treatment in New York, and most OASAS programs list it. Medicare and TRICARE are listed by most outpatient programs. Private insurance is listed less often by residential programs than by outpatient programs.

For patients without coverage the SAMHSA listing has two items. Payment assistance, which some programs describe as a sliding fee scale, means the charge is based on income. Federal or state funding for substance use treatment means the program can bill the state for some uninsured patients. Catholic Charities in Hampton Bays lists a sliding fee. Delaware County in Walton lists one. Van Dyke in Ovid lists both payment assistance and state funding.

Patients can usually apply for Medicaid while already in treatment. The program's admissions office generally helps with that. See rehab without insurance.

Co-occurring mental illness

Many patients entering treatment have a psychiatric diagnosis as well. The SAMHSA listing has a line for this: treatment for co-occurring disorders plus serious mental illness in adults. Programs with this line are licensed by OASAS and also work with, or are also licensed by, the Office of Mental Health.

Victory Recovery in Shirley, Catholic Charities in Hampton Bays, and Van Dyke in Ovid list it. Access Recovery in Middletown, Orange County, is an outpatient program that lists it, prescribes alcohol medication on site, and lists housing services, a recovery coach, and peer support. Ages accepted run from children to seniors. Spanish and sign language are listed.

LOCADTR scores psychiatric conditions. A high score may move a patient to residential care or to a program with psychiatric staff. Programs without this line may refer patients out for medication management.

Admission and what comes after

Outpatient programs can usually see a patient within a day or two, sometimes the same day. Residential admission takes longer, because a bed has to be open and the assessment has to support the level. Hospital withdrawal beds are filled on a triage basis.

Programs generally ask for a photo ID, an insurance card or Medicaid number, and a list of current medications. Patients without ID can usually still be admitted. Patients on methadone or buprenorphine are asked for the current prescriber's name. Tempo Group in Syosset and CEC Health Care in Glen Cove are outpatient programs that list aftercare, discharge planning, and naloxone education. See same-day rehab admission.

After a residential stay some patients go to a reintegration program, which SAMHSA lists as transitional housing, halfway house, or sober home. The Recovery Apartment Program in Cortland is one. It lists long-term residential, a halfway house, and housing services, self-help groups, and a peer. Liberty Clinic in Ferndale, Sullivan County, is an outpatient program with payment assistance and a sliding fee. Street addresses and phone numbers for all of these are in the SAMHSA treatment locator.