Minnesota’s current framework follows the ASAM Third Edition. In that framework, Level 3.7-WM is medically monitored inpatient withdrawal management. It takes place in a residential setting with a registered nurse on site 24 hours a day. The ASAM Criteria Fourth Edition is different. There, Level 3.7 has been widened into Medically Managed Residential Treatment, and it is no longer limited to withdrawal management. If a comprehensive assessment recommended 3.7, it means withdrawal was judged risky enough to need medical monitoring rather than a lower level.
The number causes confusion, partly because the same level carries two different official names right now. Addiction treatment is organized into various levels, and matching a person to the right level is the whole purpose of the numbering. This article covers what medical detox involves, what 3.7 requires, how it differs from 3.5, and what the ASAM 4th Edition changed. Drug detox is the service this level describes.
What Is Medical Detox?
Medical detox, called withdrawal management in clinical and licensing language, is the process of clearing substances from the body under medical supervision while withdrawal symptoms are treated. The goal is narrow and important: get a person through the acute phase safely, and leave them well enough to start treatment.
It is worth being clear about what detox does not do. Withdrawal management treats the physical event of withdrawal. It does not treat a substance use disorder, and finishing it is not finishing treatment. That distinction is the single most common misunderstanding about this level of care.
What happens during the stay is mostly monitoring and adjustment. Vital signs are checked on a schedule, withdrawal severity is scored with standardized tools, and medication is adjusted as symptoms rise and fall. Between checks, there is food, fluids, and rest. The longer arc that follows is covered in our post on emotional sobriety.
A note on vocabulary: terminology varies by setting and statute. Minnesota’s Chapter 245F withdrawal-management law uses “patient,” while other Minnesota SUD treatment statutes and many behavioral health providers use “client.” Both terms may therefore appear in documents referring to the person receiving care.
What Is ASAM 3.7 Level of Care?
ASAM 3.7 is a residential level of care. It is for people with moderate to severe withdrawal who need nursing and medical oversight but not a hospital. In Minnesota statute, this level is called Withdrawal Management 3.7, Medically Monitored Inpatient. Withdrawal management at this level must be provided under the state’s withdrawal management licensure chapter [1]. Older ASAM material calls the same level medically monitored intensive inpatient services. That older phrase still turns up in insurance and training documents.
The practical description: a residential setting, 24-hour nursing, daily medical availability, and medication management for withdrawal. It sits above the clinically managed levels, which have less medical coverage, and below hospital-based care.
What the ASAM Criteria Are
ASAM stands for the American Society of Addiction Medicine. The ASAM Criteria are its standards for matching a person to a level of care. They give a standard way to connect people to treatment, instead of leaving placement to whoever answers the phone. The approach looks at the whole person: the criteria assess medical, psychological, and social factors together. ASAM’s stated aim is to improve engagement and treatment outcomes by getting the level right the first time.
The criteria organize care into a continuum based on intensity, running from Level 0.5 early intervention through to Level 4. The 3.7 in the middle of that range is what this post is about.
Medically Monitored Inpatient or Medically Managed Residential?
The names are related, but they come from different ASAM editions. Do not treat them as fully interchangeable. When you review an assessment, insurance authorization, or program description, check two things. Check the level number, and check which ASAM edition or service designation it uses. In Minnesota today, 3.7-WM is still the statutory medically monitored withdrawal management service. The ASAM Fourth Edition uses 3.7 Medically Managed Residential Treatment instead.
This is not a trivial labeling quirk. A person can receive an assessment summary using one name, an insurance authorization using the other, and a state licensing description using a third phrasing, all for the same bed. If the documents in front of you disagree, check the number rather than the words. The 3.7 is the part that stays constant.
What the ASAM 4th Edition Changed
The ASAM Criteria 4th Edition was released digitally in October 2023 and in print that December. The change that matters most here is structural: withdrawal management is no longer a separate track running alongside treatment. It was integrated into the x.7 levels, with the expectation that those levels also provide biomedical and psychosocial services [2].
The old withdrawal management levels converted as follows: Level 1 WM became 1.7, Level 2 WM became 2.7, Level 3.2 WM became 3.5, and Level 3.7 WM stayed 3.7. The 4th Edition also added a 3.7 BIO designation, and Level 4 is now Medically Managed Inpatient Treatment.
On August 1, 2026, Minnesota made several changes to SUD services and billing. Some of these changed terms and service descriptions so they better match parts of the ASAM Fourth Edition. However, Minnesota DHS states that the state’s statutory levels of care and six-dimensional framework still follow the ASAM Third Edition. Full Fourth Edition implementation is planned for the future [3]. Because this is so recent, plenty of published material still describes the older structure as current, including material from treatment providers.
What ASAM 3.7 Requires
Two things determine whether a program can call itself 3.7 and whether a person belongs there: what the program staffs, and how the assessment rates that person. Clinicians assess a person’s medical, psychological, and social needs, then recommend a level of care based on what those needs require rather than on what is available.
Staffing and Medical Oversight
Minnesota licensure draws a firm line between the two kinds of withdrawal management programs. A medically monitored withdrawal management program is a residential setting staffed by a registered nurse and a medical director. A registered nurse is on site 24 hours a day, and a licensed practitioner is available seven days a week and reachable by a client within 24 hours [4].
A clinically managed program is lighter: a licensed practical nurse on site around the clock, with a licensed practitioner available by telephone or in person for consultation. Both are real levels of care. The difference is how much medical capacity is physically present, which is what matters when withdrawal turns complicated.
Staffing is not only about headcount. The professionals in a 3.7 program, including nurses and the physicians providing oversight, need training in addiction medicine and in the evidence-based practices used during withdrawal, because recognizing a complication early is what the level exists for.
The Six Dimensions That Decide the Level
Nobody is placed at 3.7 because of what they used. Placement comes from a comprehensive assessment that rates risk across six dimensions, which Minnesota specifies in statute [5]:
- Dimension 1: Acute intoxication and withdrawal potential
- Dimension 2: Biomedical conditions and complications
- Dimension 3: Emotional, behavioral, and cognitive conditions and complications
- Dimension 4: Readiness for change
- Dimension 5: Relapse, continued use, and continued problem potential
- Dimension 6: Recovery environment
Three of the six do most of the work at this level. Dimension 1 evaluates intoxication and withdrawal risk severe enough to need 24-hour nursing observation or medication management. Dimension 2 assesses co-occurring physical health issues that require daily medical monitoring and nursing care. Dimension 3 covers psychiatric symptoms or cognitive instability that need a structured 24-hour environment.
Dimension 1 usually drives a 3.7 recommendation, but Dimension 2 often decides it. A person with a moderate withdrawal risk and an unmanaged heart condition can land at 3.7, while someone with heavier use and no medical complications does not. If you want the mechanics of how that assessment happens now that Minnesota uses Direct Access, our post on the rule 25 assessment covers it.
One current wrinkle worth knowing: the ASAM 4th Edition removed readiness to change as an independent contributor to the level-of-care recommendation [2], but Minnesota statute still lists it as Dimension 4 [5]. In Minnesota, it still gets rated.
Who Needs Medically Monitored Withdrawal Management?
Medical supervision is about risk, not willpower or severity of use. If you are weighing this for yourself or for a loved one, the critical question is medical danger rather than how much someone drinks or uses. The situations that most often point to 3.7:
- Physical dependence on alcohol, benzodiazepines, or opioids, where withdrawal carries genuine medical danger
- A history of severe withdrawal symptoms, especially seizures or delirium
- Biomedical conditions that withdrawal would destabilize, including pregnancy, cardiac conditions, and poorly controlled diabetes
- Mental health symptoms severe enough that co-occurring enhanced programs are the safer setting
- Previous attempts to stop that ended in medical crisis or immediate return to use
Alcohol and benzodiazepine withdrawal deserve particular caution, because unlike most substances they can be fatal without medical support. If you are trying to work out whether your own situation qualifies, the signs of addiction are a more useful starting point than a level number.
Where mental health symptoms are part of the picture, they change the recommendation rather than sitting beside it, which is why an integrated setting matters at this stage. For the question of whether withdrawal itself needs supervision, our guidance on the alcohol withdrawal timeline works on a case-by-case basis.
ASAM 3.5 vs. 3.7
Under ASAM Fourth Edition, the former 3.2-WM service is integrated into Level 3.5. Minnesota has not yet fully implemented the Fourth Edition structure; current Minnesota law still recognizes 3.2-WM separately.
ASAM 3.5 is clinically managed high-intensity residential treatment. It is a full residential program with substantial clinical hours, but its medical coverage is lighter. ASAM 3.7 is medically monitored, with the round-the-clock registered nurse and daily practitioner availability described above.
In practice, they are often sequential rather than alternatives. A person may enter at 3.7 for a few days of withdrawal management, then step down to 3.5 for the treatment itself, in the same organization and sometimes the same building. Minnesota’s 3.5 programs also absorbed the old 3.2 withdrawal management level under the conversion described above, so some withdrawal support now happens inside 3.5.
ASAM Level of Care Certification is an independent check. It confirms that a program can deliver the services that match a given ASAM level. It is not the same as full accreditation, and it is not a general rating of treatment quality.
How Long Medical Detox Takes and What Comes After
Withdrawal management at 3.7 is short by design, measured in days rather than weeks.
The length is not the point, and this is where a lot of care falls apart. Withdrawal management is the shortest and most medically intensive stage of a much longer arc. Leaving at the end of it without a next step is among the highest-risk things a person can do, because tolerance has dropped while the reasons for use have not.
A step down usually means residential treatment at 3.5, then intensive outpatient, then outpatient. Treatment planning for that transition should start on the first day or two rather than the last, and it moves with an individual’s progress rather than on a fixed timetable. Education about what withdrawal will feel like is part of it too, since knowing what is coming makes the days easier.
Dimension 6, the recovery environment, is often what decides whether someone goes home or into structured housing, which is why the benefits of living in sober homes come up so often at discharge planning.
NorthStar Regional’s withdrawal-management program is designed to provide ASAM 3.7 medically monitored care. Check the current bed-availability page or contact admissions for the program’s current operating status.
Common Questions About Medical Detox
What Medications Are Used During Medical Detox?
Medication is used to reduce symptom severity and lower medical risk during withdrawal, and what gets used depends entirely on the substance involved and a person’s medical history. Alcohol and benzodiazepine withdrawal are managed differently from opioid withdrawal, and both are managed differently again when other health conditions are present.
Medication-assisted treatment options, including naltrexone and buprenorphine, may be started during or after withdrawal management for opioid use disorder. Which medication fits, and whether one is appropriate at all, is a prescribing decision made by a medical professional who has assessed the person, not something to plan from an article.
What Is ASAM Level 4?
Level 4 is Medically Managed Inpatient Treatment, the most medically intensive level in the continuum. It is hospital-based care for people whose withdrawal or medical condition needs the resources of an acute care setting.
The distinction from 3.7 is the setting and the depth of medical capability. A person at 3.7 is in a residential program with nursing and daily access to a practitioner. A person at Level 4 needs a hospital. Insurance coverage and payers use these same level numbers, which is part of why the labels matter beyond clinical documentation.
Sources
- Minnesota Statutes 254B.19, ASAM Standards of Care. Amended 1Sp2025 c 9 art 4 s 37 and s 55. https://www.revisor.mn.gov/statutes/cite/254B.19
- American Society of Addiction Medicine. The ASAM Criteria FAQ, Fourth Edition. https://www.asam.org/asam-criteria/criteria-faq
- Minnesota Department of Human Services. Information on 2026 Changes. Updated July 13, 2026. https://mn.gov/dhs/assets/Information%20on%202026%20Changes%20Updated%20July%2013%2C%202026_tcm1053-754379.pdf
- Minnesota Statutes 245F.02, Withdrawal Management Programs, Definitions. Amended 2024 c 108 art 4 s 2 and 2026 c 95 art 5 s 6. https://www.revisor.mn.gov/statutes/cite/245F.02
- Minnesota Statutes 254B.04, subdivision 4, Level of Care Determination. Amended 2023 c 50 art 2 s 47. https://www.revisor.mn.gov/statutes/cite/254B.04
