Clinically Managed Population-Specific High-Intensity Residential Services. 

1. These services provide a structured recovery environment in combination with high-intensity clinical service provided in a manner to meet the functional limitations of patients to support recovery from substance-related disorders. For the typical patient in a Level 3.3 program, the effects of substance use or other addictive disorder or a co-occurring disorder resulting in cognitive impairment on the individual’s life are so significant, and the resulting level of impairment so great, that outpatient motivational and/or relapse prevention strategies are not. Similarly, the patient’s cognitive limitations make it unlikely that he or she could benefit from other levels of residential care.
2. The functional limitations seen in individuals who are appropriately placed at Level 3.3 are primarily cognitive and can be either temporary or permanent. They may result in problems in interpersonal relationships, emotional coping skills or comprehension. For example, temporary limitations may be seen in the individual who suffers from an organic brain syndrome as a result of his/her substance use and who requires treatment that is slower paced, more concrete, and more repetitive until his or her cognitive impairment subsides.
3. When assessment indicates that such an individual no longer is cognitively impaired, he or she can be transferred to another level of care (such as a Level 3.5 program) or a less intensive level of care (such as a Level 1, 2.1, 2.5, or 3.1 program), based on a reassessment of his or her severity of illness and rehabilitative needs. (Transfer to a Level 3.7 or more intensive level of care would not be considered except in the presence of unstable or acute medical or psychiatric problems that require medical and nursing care.)
4. By contrast, the individual who suffers from chronic brain syndrome, or the older adult who has age and substance-related cognitive limitations, or the individual who has experienced a traumatic brain injury, or the patient with developmental disabilities would continue to receive treatment in a Level 3.3 program. For such an individual, the effects of the addictive disorder or co-occurring condition are so significant, and the level of his or her impairment so great, that outpatient or other levels of residential care would not be feasible or effective. 
5. Some individuals have such severe limitations in interpersonal and coping skills that the treatment process is one of habilitation rather than rehabilitation. Treatment of such individuals is directed toward overcoming their lack of awareness of, or ambivalence about, the effects of substance-related problems or addiction on their lives, as well as enhancing their readiness to change. Treatment also is focused on preventing relapse, continued problems, and/or continued use, and promoting the eventual reintegration of the individual into the community. In every case, the individual should be involved in planning continuing care to support recovery and improve his or her functioning. 
6. Level 3.3 program generally are considered to deliver high-intensity services, which may be provided in a deliberately repetitive fashion to address the special needs of individuals for whom a Level 3.3 program is considered medically necessary. Such individuals often are elderly, cognitively impaired, or developmentally delayed, or are those for who the chronicity and intensity of the primary disease process requires a program that allows sufficient time to integrate the lessons and experiences of treatment into their daily lives. Typically, they need a slower pace of treatment because of mental health problems or reduced cognitive functioning (Dimension 3), or because of the chronicity of their illness (Dimensions 4 and 5). They also may be homeless, although homelessness is not, in itself, a sufficient indication for admission to a Level 3.3 program.