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This document includes: ASAM criteria for adolescents ASAM criteria for adultsLicensee's use and interpretation of the American Society of AddictionMedicine’s ASAM Criteria for Addictive, Substance-Related, and CoOccurring Conditions does not imply that the American Society ofAddiction Medicine has either participated in or concurs with thedisposition of a claim for benefits.This excerpt is provided for use in connection with the review of aclaim for benefits and may not be reproduced or used for any otherpurpose.

The ASAM CriteriaTreatment Criteria for Addictive, Substance-Related, and Co-Occurring ConditionsThird EditionThe Change CompaniesDavid Mee-Lee, MDChief EditorGerald D. Shulman, MA, FACATAMarc J. Fishman, MD FASAMDavid Gastfriend, MDDeputy EditorsMichael M. Miller, MD, FASAMManaging EditorScott M. Provence, MA, MFAPublication EditorAmerican Society of Addiction Medicine Inc.Chevy Chase, MD 208152013

ASAM Criteria - Adolescent Levels of CareAdult Levels of CareDIMENSION 1Acute Intoxicationand/or WithdrawalPotentialDIMENSION 2Biomedical Conditionsand ComplicationsLevel 0.5Early InterventionNo withdrawal riskNone or very stableLevel 1Outpatient ServicesNo withdrawal riskNone or very stable, oris receiving concurrentmedical servicesDIMENSION 3Emotional, Behavioral orCognitive Conditions andComplications A)Dangerousness/Lethality,B) Interference withAddiction and/or MentalHealth Recovery Efforts,C) Social Functioning, D)Ability for Self-Care, E)Course of IllnessNone or very stable. AnyDimension 3 issues arebeing addressed throughconcurrent mental healthservices and do notinterfere with earlyintervention addictiontreatment servicesThe adolescents status indimension 3 features oneof more of the following:A) the adolescents is notat risk of harm, B) Thereis minimal interference,C) Minimal to mildimpairment, D) theadolescent isexperiencing mild tomoderate difficultieswith activities of dailyliving, but there issignificant risk ofdeterioration E) Theadolescent is at minimalimminent risk, whichpredicts a need for somemonitoring orinterventionsDIMENSION 4Readiness to changeDIMENSION 5Relapse, Continued UseOr Continued ProblemPotentialDIMENSION 6Recovery/LivingEnvironmentWillingness to explorehow current alcohol,tobacco, medication,other drug use, and/orhigh-risk behaviorsmay affect achievementof personal goalsNeeds anunderstanding of, orskills to change currentalcohol, tobacco, otherdrug or medication usepatterns, and/or highrisk behaviorsWilling to engage intreatment, and is atleast contemplatingchange, but needsmotivating andmonitoring strategiesAble to maintainabstinence or controluse and pursuerecovery ormotivational goals withminimal supportAdolescents risk ofinitiation of orprogression insubstance use and/orhigh-risk behaviors isincreased by substanceuse or values about use.High-risk behaviors offamily, peers, or othersin adolescent’s socialsupport systemFamily andenvironment cansupport recovery withlimited assistance

Level 2.1Intensive Outpatient ServicesExperiencing minimalwithdrawalExperiencing mildwithdrawal, or is at riskof withdrawalNone are stable ordistracting fromtreatment at a lessintensive level of carte.Such problems aremanageable at Level 2.5LEVEL 2.5Partial HospitalizationServicesExperiencing mildwithdrawal, or is at riskof withdrawalNone are stable ordistracting fromtreatment at a lessintensive level of carte.Such problems aremanageable at Level 2.5The adolescents status indimension 3 features oneof more of the following:a) the adolescents is atlow risk of harm, and heor she is safe betweensessions, b) mildinterference requires theintensity of this level ofcare to supporttreatment engagement, c)mild to moderateimpairment but her cansustain responsibilities)the adolescent isexperiencing moderatedifficulties with activitiesof daily living andrequires near/dailymonitoring orinterventions, e) theadolescent history(combined with thepresent situation)predicts the need fornear daily monitoring orinterventionsThe adolescents status inDimension 3 features oneof more of the following:A) The adolescents is atlow risk of harm, and heor she is safe overnight,B) Moderate interferencerequires the intensity ofthis level of care tosupport treatmentengagement, C) Moderateimpairment but cansustain responsibilities,D) The adolescent isexperiencing moderatedifficulties with activitiesof daily living andrequires near/dailymonitoring orinterventions, E) Theadolescent’s history(combined with theRequires closemonitoring or supportseveral times a week topromote progressthrough the stages ofchange because ofvariable treatmentengagement, or nointerest in gettingassistanceSignificant risks ofrelapse or continueduse or continuedproblems anddeterioration in level offunctioning. Has poorprevention skills andneeds monitoring orsupportAdolescentenvironment isimpeding his or herrecovery, andadolescent requiresclose monitoring orsupport to overcomethat barrierRequires a near dailystructured program topromote progressthrough the stages ofchange because of littletreatment engagementor escalating use orimpairment, or noawareness of the role ofalcohol, tobacco and/orother drugs play inhis/her presentproblemsHigh risk of relapse orcontinued use commaor continued problemsin deterioration in levelof functioning. Hasminimal preventionskills and needs neardaily monitoring andsupportAdolescent’senvironment rendersrecovery unlikelywithout near/dailymonitoring or support,or frequent relief fromhis or her homeenvironment

LEVEL 3.1Clinically Managed LowIntensity Residential ServicesThe adolescent state ofwithdrawal (or risk ofwithdrawal) is beingmanaged concurrentlyat another level of careNone or stable, orreceiving concurrentmedical monitoring asneededLEVEL 3.5Clinically ManagedMedium Intensity ResidentialServiceAdolescent isexperiencing mild tomoderate to severewithdrawal (or is atrisk of withdrawal), butdoes not needpharmaco-logicalmanagement or nursingmonitoringNone or stable, orreceiving concurrentmedical monitoring asneededpresent situation)predicts the need fornear daily monitoring orinterventionsThe adolescents status inDimension 3 features oneof more of the following:A) The adolescent needsa stable livingenvironment, B)Moderate interferencerequiring limited 24-hoursupervision to supporttreatment engagement,C) Moderate impairmentneeding limited 24-hoursupervision to sustainresponsibilities, D)Moderate difficultieswith activities of dailyliving requiring 24-hoursupervision andprompting, E) Theadolescent’s history(combined with thepresent situation)predicts instabilitywithout limited 24-hoursupervisionThe adolescents status inDimension 3 features oneof more of the following:A) Moderate but stablerisk of harm, B)Moderate to severeinterference requiringmedium-intensityresidential treatment tosupport engagement, C)Moderate to severeimpairment that cannotbe managed at a lessintensive level of care,D) Moderate to severedifficulties with activitiesof daily living requiring24-hour supervision andmedium-intensity staffassistance, E) TheOpen to recovery, butneeds limited 24-hoursupervision to promoteor sustain changeUnderstand thepotential for continueduse and/or hasemerging recoveryskills but needssupervision to reinforcerecovery and relapseprevention skills,limited exposure tosubstances and/orenvironmental triggersor maintain therapeuticgainsEnvironment poses arisk to his or herrecovery so that he orshe requires alterativeresidential, secureplacement or supportThe adolescent needsintensive motivatingstrategies in a 24-hourstructured program toaddress minimalengagement in, oropposition to,treatment, or toaddress his or her lackof recognition ofcurrent severeimpairmentHigh risk or relapse orcontinued use, orcontinued problemsand deterioration inlevel of functioning. Hasminimal preventionskills and needs neardaily monitoring andsupportEnvironment isdangerous to his or herrecovery, so that he orshe requires residentialtreatment to promoterecovery goals, or forprotection

LEVEL 3.7Clinically ManagedPopulation Specific HighIntensity Residential ServiceAdolescent isexperiencing moderateto severe withdrawal(or is at risk ofwithdrawal), but this ismanageable at Level 3.7Requires a 24-hourmedical monitoring, butnot intensive treatmentLEVEL 4Medically MonitoredIntensive Inpatient ServicesAdolescent isexperiencing severewithdrawal (or is atrisk of withdrawal) andrequires intensiveactive medicalmanagementRequires 24-hourmedical and nursingcare and the fullresources of a licensedhospitaladolescent’s history(combined with thepresent situation)predicts destabilizationwithout mediumintensity residentialtreatmentThe adolescents status inDimension 3 features oneof more of the following:A) Moderate risk ofharm, needing highintensity 24-hourmonitoring or treatment,B) Severe interferencerequiring high-intensityresidential treatment tosupport engagement, C)Severe impairment thatcannot be managed at aless intensive level ofcare, D) Severedifficulties with activitiesof daily living requiring24-hour supervision andhigh-intensity staffassistance, E) Theadolescent’s history(combined with thepresent situation)predicts destabilizationwithout high-intensityresidential treatmentThe adolescent’s status inDimension 3 features oneof more of the following:A) The adolescent is atsevere risk of harm, B)Very severe, almostoverwhelminginterference renders theadolescent incapable ofparticipating intreatment at a lessintensive level of care, C)Very severe, dangerousimpairment requiringfrequent medical andnursing interventions, D)The adolescent needsmotivating strategies ina 24-hour medicallymonitored program dueto no treatmentengagement associatedwith a biomedical,emotional or behavioralcondition, or becausehe or she activelyopposes treatment,requiring secureplacement remain safe;or because he or sheneeds high-intensitycase management tocreate linkages thatwould supportoutpatient treatmentUnable to interrupthigh-severity or highfrequency pattern ofuse/or behaviors andavoid dangerousconsequences withouthigh-intensity 24-hourinterventions (becauseof an emotional,behavioral, or cognitivecondition; severeimpulse controlproblems; withdrawalsymptoms; and the like)Environment isdangerous to his or herrecovery, and he or sherequires residentialtreatment to promoterecovery goals, or forprotection, and to helphim or her establish asuccessful transition toa less intensive level ofcareProblems in thisdimension do notqualify the patient forLevel 4 services. If thepatient’s only severityis in Dimension 4, 5,and /or 6 without highseverity in Dimensions1,2 and/or 3, then thepatient does not qualityfor Level 4Problems in thisdimension do notqualify the patient forLevel 4 services. If thepatient’s only severityis in Dimension 4, 5,and /or 6 without highseverity in Dimensions1,2 and/or 3, then thepatient does not qualityfor Level 4Problems in thisdimension do notqualify the patient forLevel 4 services. If thepatient’s only severityis in Dimension 4, 5,and /or 6 without highseverity in Dimensions1,2 and/or 3, then thepatient does not qualityfor Level 4

Very severe difficultieswith activities of dailyliving requiring frequentmedical and nursinginterventions, E) Theadolescent’s history(combined with thepresent situation)predicts destabilizationwithout medicalmanagement

The ASAM CriteriaTreatment Criteria for Addictive, Substance-Related, and Co-Occurring ConditionsThird EditionThe Change CompaniesDavid Mee-Lee, MDChief EditorGerald D. Shulman, MA, FACATAMarc J. Fishman, MD FASAMDavid Gastfriend, MDDeputy EditorsMichael M. Miller, MD, FASAMManaging EditorScott M. Provence, MA, MFAPublication EditorAmerican Society of Addiction Medicine Inc.Chevy Chase, MD 208152013

ASAM Criteria - Adult Levels of CareAdult Levels of CareDIMENSION 1Acute Intoxicationand/or WithdrawalPotentialNo withdrawal riskDIMENSION 2Biomedical Conditionsand ComplicationsNone or very stableDIMENSION 3Emotional, Behavioral orCognitive Conditions orComplicationsNone or very stableOTP – LEVEL 1Opioid Treatment programPhysiologicallydependent on opioidsand requires OTP toprevent withdrawalNone or manageablewith outpatient medicalmonitoringNone or manageable inan outpatient structuredenvironmentLEVEL 1Outpatient ServicesNot experiencingsignificant withdrawal, orat minimal risk of severewithdrawal. Manageableat level 1 -WM (SeeWithdrawalManagement Criteria)None or very stable, or isreceiving concurrentmedical monitoringNone or very stable, or isreceiving concurrentmedical healthmonitoringLEVEL 2.1Intensive Outpatient ServicesMinimal risk of severewithdrawal. Manageableat level 2-WM (Seewithdrawal managementcriteria)None or not a distractionfrom treatment. Suchproblems aremanageable at Level 2.1Mild severity, withpotential to distract fromrecovery; needsmonitoringLEVEL 2.5Patient Hospitalization ServicesModerate risk of severewithdrawal. Manageableat level 2-WM (Seewithdrawal managementcriteria)None or not sufficient todistract from treatment.Such problems aremanageable at Level 2.5Mild or moderateseverity, with potentialto distract from recovery,needs stabilizationLevel 0.5Early InterventionDIMENSION 4Readiness to changeWilling to explore howcurrent alcohol, tobacco,other drug or medicationuse and/or other highrisk behaviors may affectpersonal goalsReady to change thenegative effects of opioidus, but is not ready fortotal abstinence fromillicit prescription or nonprescription drug useReady for recovery butneeds motivating andmonitoring strategies tostrengthen readiness. Orneeds on-goingmonitoring and diseasemanagement. Or highseverity in this dimensionbut not in otherdimensions. Needs Level1 motivationalenhancement strategiesHas variable engagementin treatment,ambivalence, or lack ofawareness of thesubstance use or mentalhealth problems, andrequires a structuredprogram several times aweek to promoteprogress through thestages of changeOpen to recovery, butneeds a structuredenvironment to maintaintherapeutic gainsDIMENSION 5Relapse, Continued UseOr Continued ProblemPotentialNeeds an understandingof skills, or skills tochange, current alcohol,tobacco, or other drug ormedication use patternsand/or high risk behaviorAt high risk of relapse orcontinued use withoutOTP and structuredtherapy to promotetreatment progressDIMENSION 6Recovery/LivingEnvironmentAble to maintainabstinence or control useand/or addictivebehaviors and pursuerecovery or motivationalgoals with minimalsupportRecovery environment issupportive and/or thepatient has skills to copeIntensification ofaddiction or mentalhealth symptomsindicate a high likelihoodor relapse or continuedproblems without closemonitoring and supportseveral times a weekRecovery environment isnot supportive but withstructure and supportand relief from the homeenvironment, the patientcan copeUnderstands relapse butneeds structure tomaintain therapeuticgainsEnvironment isdangerous, but recoveryis achievable if Level 3.124-hour structure isachievableSocial support system orsignificant othersincrease the risk ofpersonal conflict aboutalcohol, tobacco or otherdrug useRecovery environment issupportive and/or thepatient has skills to cope

LEVEL 3.1Clinically ManagedLow Intensity ResidentialServiceNo withdrawal risk, orminimal or stablewithdrawal.Concurrently receivingLevel 1-WM (minimal) orLevel 2-WM (moderate)services. (See withdrawalmanagement criteria)None or stable, orreceiving concurrentmedical monitoringNone or minimal, notdistracting to recovery. Ifstable, a co-occurringcapable program isappropriate. If not, a cooccurring enhancedprogram is requiredOpen to recovery, butneeds a structuredenvironment to maintaintherapeutic gainsLEVEL 3.3Clinically ManagedPopulation Specific HighIntensity Residential ServiceAt minimal risk of severewithdrawal. Ifwithdrawal is present,manageable at Level 3.2WM. (See withdrawalmanagement criteria)None or stable, orreceiving concurrentmedical monitoringLEVEL 3.5Clinically ManagedHigh Intensity ResidentialServiceAt minimal risk of severewithdrawal. Ifwithdrawal is present,manageable at Level 3.2WM. (See withdrawalmanagement criteria)None or stable, orreceiving concurrentmedical monitoringHas little awareness andneeds interventionsavailable at Level 3.3 toengage and stay intreatment. If there ishigh severity inDimension 4 but not inany other dimension,motivationalenhancement strategiesshould be provided inLevel 1Has marked difficultywith, or opposition to,treatment withdangerousconsequences. If there isa severity in Dimension 4but not in any otherdimension, motivationalenhancement strategiesshould be provided inLevel 1LEVEL 3.7Medically MonitoredIntensive Inpatient ServicesAt high risk ofwithdrawal, butmanageable at Level 3.7WM and does notrequire the full resourcesof a licensed hospital.(See withdrawalmanagement criteria)Requires 24-hourmedical monitoring butnot intensive treatmentMild to moderateseverity; needs structureto focus on recovery.Treatment should bedesigned to addresssignificant cognitivedeficits. If stable, a cooccurring capableprogram is appropriate,If not, a co-occurringenhanced program isrequired.Demonstrates repeatedinability to controlimpulses, or unstableand dangeroussigns/symptoms requirestabilization. Otherfunctional; deficitsrequire stabilization anda 24-hour setting toprepare for communityintegration andcontinuing care. A cooccurring enhancedsetting is required forthose with severe andchronic mental illnessModerate severity;needs a 24-hourstructured setting. If thepatient has a cooccurring mentaldisorder, requiresconcurring mental healthservices in a medicallymonitored settingLow interest in treatmentand impulsive control ispoor, despite negativeconsequences; needsmotivating strategiesonly safely available in a24-hour structuredsetting. If there is highseverity in Dimension 4but not in any otherHas little awareness andneeds interventionsavailable only at Level 3.3to prevent continueduse, with imminentdangerousconsequences, becauseof cognitive deficits orcomparable dysfunctionHas no recognition of theskills needed to preventcontinued use, withimminently dangerousconsequencesEnvironment isdangerous and patientneeds 24-hour structureto learn to copeUnable to control use,with imminentlydangerousconsequences, despiteactive participation atless intensive levels ofcareEnvironment isdangerous, but recoveryis achievable if Level 3.124-hour structure isachievableUnable to control use,with imminentlydangerousconsequences, despiteactive participation atless intensive levels ofcareEnvironment isdangerous, but recoveryis achievable if Level 3.124-hour structure isachievableEnvironment isdangerous and thepatient has skills to copeoutside of a highlystructured 24-hoursetting

LEVEL 4Medically MonitoredIntensive Inpatient ServicesAt high risk of withdrawaland requires Level 4 –WM and the fullresources of a licensedhospital (See withdrawalmanagement criteria)Requires 24-hourmedical and nursing careand the full resources ofa licensed hospitalBecause of severe andunstable problems,requires 24 hourpsychiatric care withconcomitant addictiontreatment (co-occurringenhanced)dimension, motivationalenhancement strategiesshould be provided inLevel 1Problems in thisdimension do not qualifythe patient for Level 4services. If the patient’sonly severity is inDimension 4, 5, and /or 6without high severity inDimensions 1,2 and/or 3,then the patient does notquality for Level 4Problems in thisdimension do not qualifythe patient for Level 4services. See furtherexplanation in Dimension4Problems in thisdimension do not qualifythe patient for Level 4services. See furtherexplanation in Dimension4

American Society of Addiction Medicine Inc. Chevy Chase, MD 20815 2013 . ASAM Criteria - Adolescent Levels of Care Adult Levels of Care DIMENSION 1 Acute Intoxication and/or Withdrawal Potential DIMENSION 2 Biomedical Conditions a

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