1 | THE INSTITUTE OF MEDICINE’S CONTINUUM OF CARE

THE INSTITUTE OF 

MEDICINE’S 

CONTINUUM OF CARE

Many behavioral health services seek to prevent and reduce substance 

misuse. Any of them may be the first point of contact for a person with a 

substance use disorder (SUD) or at risk of developing one.

Because there are so many points of entry, substance misuse service 

providers can benefit from understanding how the specific services they 

deliver relate to those of their partners working elsewhere in the behavioral 

health service system. This knowledge can help them better coordinate 

services with other providers and offer the most appropriate referrals.

The Institute of Medicine’s 

continuum of care is a 

classification system that 

organizes and defines the 

wide scope of behavioral 

services.1 The system offers 

substance misuse providers 

one way to understand 

how their services fit within 

their wider field. It is 

organized according to four 

areas: promotion, prevention, treatment, and recovery)—each is described below. While the 

continuum can be applied to any field of behavioral health (e.g., mental health, substance 

misuse, problem gambling), this resource presented it through a substance misuse lens.

PROMOTION

Promotion interventions are designed to help people improve their overall emotional, mental, 

and physical well-being.”2 Nurturing peoples’ emotional and mental well-being allows them to 
2 | THE INSTITUTE OF MEDICINE’S CONTINUUM OF CARE

cope with life’s stressors in healthy ways and reduce their risk of substance misuse. Improving 

physical health is also associated with reduced rates of substance misuse—though the reasons 

why are still being investigated.3

Promotion interventions can range from individual-focused activities to system-level change. 

Promoting individual health might include encouraging a healthy diet and exercise or offering 

socialization activities such as after-school clubs.4 Examples of activities to promote system-level 

change include advocating for health equity in policy making and advancing cross-sector 

collaboration.2

Health promotion can occur long before any other behavioral health services, as well as at any 

stage of the continuum of care. It can have lasting impacts even among people who are not 

currently at risk of substance misuse, especially among children. In fact, promoting wellness in 

childhood can help build a foundation for positive health outcomes throughout a person’s life.5

PREVENTION

Prevention interventions provide people with facts, skills, and other knowledge intended to stop 

the development of negative health behaviors or the onset of SUDs. They seek to reduce risk 

factors and strengthen protective factors associated with these negative health outcomes, with 

the goal of preventing them from occurring at all.6

Investing in prevention results in fewer people needing treatment and recovery services and 

promotes population health and well-being. Specifically, prevention efforts are associated with:

• Reductions in substance use and harms related to substance misuse (e.g., overdose)7

• Improvements in quality of life and academic and workplace performance8

• Lower health care costs for acute and chronic conditions9

Preventive interventions are designed to address three levels of risk: universal, selective, and 

indicated.1

• Universal interventions focus on an entire population (e.g., a whole community, school, 

or neighborhood) without any consideration of substance misuse risk. Examples include:

o Community policies that promote access to early childhood education

o Implementation or enforcement of anti-bullying policies in schools

o Education for prescribers on prescription drug misuse

o Social skills education for youth in schools
3 | THE INSTITUTE OF MEDICINE’S CONTINUUM OF CARE

• Selective interventions focus on groups of people with an above-average risk of engaging 

in substance misuse. Importantly, they serve everyone within that group equally rather 

than focusing on specific individuals. Examples include:

o Prevention education for new immigrant families living in poverty with young 

children

o Peer support groups for adults with a history of family mental illness and/or 

substance misuse

• Indicated interventions focus on specific people who already misuse substances or 

engage in high-risk behaviors for beginning substance misuse. However, they are not 

treatment services and are not appropriate for people who have developed an SUD. 

Examples include:

o Information and referral for young adults who violate campus or community 

policies on alcohol and drugs

o Screening, consultation, and referral for families of older adults admitted to 

emergency rooms with potential alcohol-related injuries

TREATMENT

Treatment interventions provide people with clinical and supportive services that encourage and 

facilitate them to make behavioral changes. Although more costly and intensive than promotion 

or prevention, treatment services are a vital piece of the continuum for people with SUDs. 

There are many different treatment avenues and modalities, depending on the specific needs of 

a person. Treatment begins with case identification, a process where a person is screened for a 

SUD by a provider who then determines whether pursuing treatment services would be 

beneficial.10 The provider also determines what type and intensity of treatment would be most 

beneficial to the person, and whether they can offer it themselves or if a referral to another 

provider is necessary.

Treatment services can include a wide range of therapies, counseling, education, medications, 

and other offerings,1 and can be organized into their own “mini” continuum of care11:

• Outpatient services offer a less intense, community-based level of care for people with 

less severe SUDs.
4 | THE INSTITUTE OF MEDICINE’S CONTINUUM OF CARE

• Intensive outpatient or partial hospitalization services provide more intense, 

comprehensive care for people with more severe SUDs or un-stabilized mental or 

physical health conditions.

• Residential or inpatient services provide continuous, interdisciplinary care in a structured, 

live-in setting for people with severe SUDs, other significant health impairments, or 

otherwise require full-time monitoring.

• Medically managed intensive inpatient services are continuous, medically directed care 

for people who require around the clock acute stabilization.

RECOVERY 

Recovery interventions provide individuals with a network of comprehensive, long-term services 

to help them achieve treatment goals and prevent relapse. Interventions can be provided 

alongside or following the completion of treatment services. Recovery from SUDs is a non-linear, 

person-driven process of change through which individuals improve their health and wellness, 

live a self-directed life, and strive to reach their full potential.12 The ultimate goals of recovery 

are to achieve personal growth and reduce or abstain from substance misuse.

According to SAMHSA, there are four core dimensions to recovery12:

• Health: Overcoming or managing substance misuse and making informed, healthy 

choices

• Home: Having a safe, stable living environment

• Purpose: Conducting meaningful daily activities and participating in society

• Community: Having supportive, loving relationships and social networks 

Recovery support services include a wide range of opportunities that support these dimensions; 

examples include mutual aid groups (e.g., 12-step programs), peer support services, recovery 

community centers, and recovery housing.13
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REFERENCES

1. National Research Council and Institute of Medicine. Preventing Mental, Emotional, and Behavioral Disorders 

Among Young People: Progress and Possibilities. National Academies Press; 2009:12480. doi:10.17226/12480

2. World Health Organization. Health promotion. https://www.who.int/health-topics/healthpromotion#tab=tab_1

3. Brellenthin AG, Lee D chul. Physical Activity and the Development of Substance Use Disorders: Current 

Knowledge and Future Directions. Prog Prev Med. 2018;3(3):e0018. doi:10.1097/pp9.0000000000000018

4. Centers for Disease Control and Prevention. Promoting health for adults. Published online 2022. 

https://www.cdc.gov/chronicdisease/resources/publications/factsheets/promoting-health-for-adults.htm

5. Centers for Disease Control and Prevention. Prevention Strategies. Published online 2023. 

https://www.cdc.gov/violenceprevention/aces/prevention.html

6. Substance Abuse and Mental Health Services Administration. Prevention of substance use and mental 

disorders. Published online 2023. https://www.samhsa.gov/find-help/prevention

7. National Institute on Drug Abuse. Prevention. Published online 2023. https://nida.nih.gov/researchtopics/prevention

8. Substance Abuse and Mental Health Services Administration. Substance misuse prevention for young adults 

[Publication No. PEP19-PL-Guide-1]. Published online 2019. https://odp.idaho.gov/wpcontent/uploads/2021/09/SAMHSA-EBP-Guide-pep19-pl-guide-1.pdf

9. National Institute on Drug Abuse. Investing in prevention makes good financial sense. Published 2022. 

https://nida.nih.gov/about-nida/noras-blog/2022/04/investing-in-prevention-makes-good-financial-sense

10. Miller T, Lauer A, Mihok B, Haywood K. A Continuum of Care Approach: Western Pennsylvania’s Response to the 

Opioid Epidemic. Institute of Politics, University of Pittsburgh; 2016. https://dscholarship.pitt.edu/29950/1/IOPOpioidReport2016.pdf

11. American Society for Addiction Medicine. About the ASAM Criteria. Published online 2023. 

https://www.asam.org/asam-criteria/about-the-asam-criteria

12. Substance Abuse and Mental Health Services Administration. Recovery and recovery support. Published online 

2023. https://www.samhsa.gov/find-help/recovery

13. U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. Facing Addiction in 

America: The Surgeon General’s Report. HHS; 2016. 

https://www.ncbi.nlm.nih.gov/books/NBK424857/pdf/Bookshelf_NBK424857.pdf