Adult Substance Use Disorder Continuum

​**For all services described below, please see North Carolina DMA Clinical Coverage Policies, Behavioral Health section for complete service requirements.

The adult substance use disorder continuum of care is designed to meet the needs of individuals with mild substance use problems and functional impairments, as well as individuals with the most serious substance use disorders. This includes individuals who require wraparound and residential supports to achieve recovery according to their preferences and live fulfilling lives in their communities. This continuum includes specialized crisis services to assist with crisis stabilization when necessary. The appropriate level of care is to be selected by the clinician based upon community standards, level of care assessment tools (ASAM), and clinical coverage policy criteria. The continuum is composed of the following supports and services:​

 

  • Universal Supports consist of assistance and interventions generally available to anyone through their existing connections within his or her community. Universal Supports include the following:

    • Natural Supports include unpaid resources in the community which enhance and help sustain recovery. Examples are family members, governmental supports and non-profit community agencies.

    • Primary Medical Homes are a front door for the full range of medical issues, including substance use disorder issues.

    • Prevention services are most commonly provided in school settings, but can be available in other settings to assist with preventing long term substance disorders from developing.
  • Basic Services consist of specialty, office-based assessments, therapy and medication management tailored to meet the diagnostic and treatment needs of those with mild to moderate substance use disorders. They can be​ used alone, in combination with each other, and can sometimes be used in combination with support, enhanced and residential services. Basic Services include the following:

    • Comprehensive Clinical Assessments: These assessments provide the groundwork for selecting the right service, in the right amount and in the right setting. They should assure highly accurate diagnostic formulations and recommendations for both paid services and unpaid supports.

    • Basic Psychotherapies (individual, group and family): Evidence-based psychotherapies, combined with natural supports such as Alcoholics Anonymous, are the bread and butter of the substance use disorder system and offer time-limited, problem focused interventions by licensed clinicians.

    • Psychiatric Medication Management: Psychiatrists and other psychiatric prescribers provide specialized medication-based treatments for those with more serious substance use disorders. Medication management can be an essential component of a treatment plan but options are less robust than for mental health conditions. Medication management services can be time-limited or long-term.
  • Support Services are typically add-on services which augment the basic service array and assist with treatment engagement and supporting community integration for those with more serious substance use disorders. Support Services within the Cardinal Innovations adult substance use disorder service array include:

    • Peer Support: Peer support is an evidence-based practice that employs individuals who are in recovery to help engage adults with mental health and substance use disorders. This service promotes the development of wellness self-management, personal recovery, natural supports, coping skills, and self-advocacy skills. Peer support also is used to assist an individual while he or she is receiving outpatient or other services, following a crisis event, with housing transitions and with community reintegration following hospitalization or completion of jail/prison sentences.

    • Psychiatric Consultation: provides psychiatric consultation by telephone directly to primary care providers to assist them in managing behavioral health conditions in that setting.

    • Intensive Recovery Supports (IRS) is a community program designed to facilitate recovery from substance use disorders for a woman with minor children as she transitions from more intensive substance use services.​
  • Enhanced Services are typically community-based, team-led interventions with both therapeutic and case management components to assist members with more severe behavioral health conditions. Enhanced Services within the Cardinal Innovations adult substance use disorder service array include:

    • Community Support T​eam (CST), a short-term, team-based case management and therapy intervention for individuals with severe acute episodes of behavioral health disorders and significant functional impairments.

    • Substance Abuse Intensive Outpatient Program (SAIOP), a short-term group with three multi-hour sessions per week designed for those with moderate to severe substance use disorders (ASAM 2.1) for whom outpatient treatment is not adequate.

    • Substance Abuse Comprehensive Outpatient Treatment (SACOT), is similar to SAIOP but at a higher level of intensity with four days per week of programming and longer daily sessions. Members must meet an ASAM level of 2.5 to receive this service.
    • Opioid Treatment Program (OTP), is designed for those with opiate substance dependence who benefit from a harm-reduction approach through maintenance dosing of Methadone. OPT services do not require a Person-Centered Plan; additional basic or enhanced SA treatments are generally an important augmentation to this service. Some OPT programs also dispense buprenorphine, though Suboxone is often also prescribed in a basic medication management setting.
  • Residential Services are state (non-Medicaid) funded, supervised living supports for individuals with severe mental illnesses who have substantial deficits in maintaining community integration and attending to their activities of daily living. Funding for adult behavioral health residential supports is very limited. Residential Supports range from low to moderate to high. Typically, for individuals with SA diagnoses, stays will be less than one month, whereas individuals with MH or ID/DD diagnoses may stay much longer. For SA consumers, group living low can be used for (typically) for six months for halfway house services.

    For those needing short-term SA Residential services, Cardinal Innovations provides, through Medicaid funding, the following services:
    • ​Substance Abuse Non-Medical Community Residential Treatment (ASAM 3.5)

    • Substance Abuse Medically-Monitored Community Residential Treatment (ASAM 3.7)


  • Crisis and Detoxification Services are designed to address acute symptom exacerbations for those with behavioral health disorders in an effort to either avert an inpatient crisis admission or to facilitate such an admission. Crisis Services range from brief interventions provided by the member's existing provider to intensive 24/7 stabilization and treatment provided in an inpatient setting. The full range of crisis services can be found here.

    Prior to entering substance use disorder treatment, a member may require a monitored detoxification. Monitoring is generally required for those dependent upon opiates, benzodiazepines, alcohol and/or barbiturates. Cardinal Innovations' health plan provides members a range of detoxification treatments depending upon the level of need as determined by their ASAM level. Due to the acute nature of these services, they do not generally require prior authorization. These services include
    • Ambulatory Detoxification (ASAM I-D)

    • Non-Hospital Medical Detoxification (ASAM 3.7)

    • Medically Supervised or ADATC Detoxification (ASAM 3.9)