Using The ASAM Criteria for People Struggling with Addiction

Millions of people struggle with substance use issues, and some of them seek help from behavioral health professionals. 

How do we know what level of care to provide or recommend to a person coping with substance use issues? 

Experts in the field of addiction medicine have put together a compassionate and comprehensive guide called The ASAM Criteria.

What is The ASAM Criteria, and how can it help guide our treatment plans for substance use disorders in young people and adults?

The ASAM Criteria

The ASAM Criteria was developed by the American Society of Addiction Medicine (ASAM) as a way to standardize treatment planning for people struggling with addiction, substance use disorders, and co-occurring conditions. 

The publication was developed by doctors and professionals in the mental health and addiction treatment field. It presents mental and behavioral health professionals with a set of best practices for treating substance use issues. It is currently in its third edition.

Clinicians use The ASAM Criteria as a tool to augment their own clinical experience and knowledge. It is meant to dovetail with the direction and goals clinicians develop with each client. 

Aetna’s guide to The ASAM Criteria explains the use of the criteria as follows: “Many professionals use The ASAM Criteria to assist them in filtering all of this knowledge and data, and in determining what kind of services can be provided to the patient at the least intensive, but safe, level of care.”

In other words, The ASAM Criteria does not dictate a course of action for treatment. However, it is an important tool that informs the independent judgment of clinicians. 

In this CWC training video, Marc J. Fishman, MD, explains ways to apply The ASAM Criteria to treat substance use issues in adolescents. The doctor explains the way the criteria are used to organize the material gathered from patients or their families to assess the severity of the issue and the treatment needs.

Most clinicians begin with an assessment to determine the level of treatment that is appropriate for the situation. The ASAM Criteria recommends exploring the following six dimensions to create a multidimensional assessment.

Six Assessment Dimensions

1. Intoxication/withdrawal potential—A person’s past and current experiences of substance use and withdrawal.
2. Biomedical conditions and complications—A person’s health history and current physical health needs.
3. Emotional/behavioral/cognitive conditions—A person’s mental health history and current cognitive and mental health needs. 
4. Readiness to change—A person’s readiness for and interest in changing.
5. Relapse/continued use/continued problem potential—A person’s unique needs that influence their risk for relapse or continued use.
6. Recovery/living environment—Their living situation and the people and places that can support or interfere with their recovery.

When clients are assessed on these dimensions, clinicians can use that information to match the individual to the right level of treatment. 

Levels of Treatment

The ASAM Criteria spells out the various levels of treatment for adolescents. 

• Level 0.5: Early intervention
• Level 1: Outpatient
• Level 2: Intensive outpatient and day program/PHP
• Level 3: Residential/Inpatient
• 3.1: Clinically monitored low intensity
• 3.5: Clinically monitored medium intensity
• 3.7: Medically monitored high intensity

• Level 4: Hospital

How did the professionals arrive at this understanding of appropriate interventions? It’s worth looking at the guiding philosophy and principles that inform The ASAM Criteria.

Guiding Principles of The ASAM Criteria

1. Treat the Whole Person

The ASAM Criteria views patients, clients, or participants in their entirety. Humans are more than our illnesses or psychological conditions. Clinicians working with clients with substance use disorders pay attention to the entire human being, including all their life areas, their strengths, needs, and risks. Most important, effective treatment involves shared goal setting.

2. Design Treatment for the Specific Patient

Effective treatment is different for each individual, and each person may respond to different types or intensities of care.

3. Individualize Treatment Times

Treatment length should be considered a unique factor that depends on the individual’s goals, progress, and changing needs. 

4. “Failure” Is Not a Treatment Prerequisite

Some providers look at a patient’s history to see if they have “failed” out of less-intensive services before approving another level of care like a residential program or hospital. The ASAM Criteria discourages this method of determining the level of care.

5. Provide a Spectrum of Services

The five levels of service in The ASAM Criteria are all linked to one another, and clients should be able to move among and between them according to their current needs.

6. Reconceptualize the Definition of “Addiction”

The ASAM Criteria developed a definition of “addiction” that is based on clinical and research discoveries. 

When clinicians are familiar with this holistic definition and approach to addiction treatment, they are better equipped to address the many intersecting needs of people who struggle with substance use.

Defining Addiction

ASAM’s definition of addiction is a key foundation for holistic treatment approaches. The definition is available on ASAM’s website: 

“Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences.”

Using The ASAM Criteria

The ASAM Criteria provides a road map for clinicians to determine the least intensive treatment plan that can keep someone safe as they work to make changes toward a healthier lifestyle. 

The ASAM Criteria provides a helpful flowchart designed to help clinicians make decisions about treatment plans.

Step 1: Assessing 

• What does the patient want? Why now?
• Does the patient have any immediate needs?
• Assess risks, needs, and strengths in all life areas.
• Identify any diagnoses.

Step 2: Identifying

• Identify the severity and level of functioning.
• Identify which life areas are currently most important to determine treatment priorities.
• Choose a specific focus and target for each priority life area.
• What specific services are needed for each life area?

Step 3: Providing/Evaluating

• Identify the intensity of services needed for each life area.
• Identify where these services can be provided, in the least intensive but safe level of care.
• What is the progress of treatment?

The client is an active participant in every step of this process, helping to develop and assess shared treatment goals. 

Healing the Whole Human

The ASAM Criteria is an important tool for behavioral health professionals, helping to recognize the full spectrum of needs and strengths in each person. 

When we understand the complex interactions between the brain, body, community, and history, we can develop effective treatment plans that take into account the whole person.