An Introduction To The ASAM Criteria For Patients And Families
An Introduction to The ASAM Criteriafor Patients and FamiliesThis document has been created to provide youinformation about how some of the decisionsregarding your available treatment or service optionsmay have been made. It can help you understandhow The ASAM Criteria is used in treatment, andhow professionals such as physicians, providers, andfunders of care rely on it to determine what serviceswill best match a patient’s individual needs. It is nota clinical document and cannot be used to diagnoseor identify care. The information provided in thisdocument is intended to help you become an activeparticipant in your own care, but should not beconsidered medical advice, nor is it comprehensiveor definitive. For more information, consult a skilled,trained professional in substance use, mental healthand/or other addictive disorders who uses The ASAMCriteria in their work.What is The ASAM Criteria?The ASAM Criteria is a collection of objective guidelines that give clinicians a way to standardize treatmentplanning and where patients are placed in treatment, as well as how to provide continuing, integrated care andongoing service planning. The criteria were developed by the American Society of Addiction Medicine (ASAM),and presented in a book written by a group of renowned doctors and professionals, working in a variety ofmental health and addiction treatment fields. The ASAM Criteria has“The least intensive, but safe, levelbecome the most widely used set of criteria in the United States forof care.”the treatment of substance-use issues, and it has been continuallyrevised and updated over the years with the newest science in the fieldA “level of care” can refer to the intensityof addiction. Currently in its third edition (2013), The ASAM Criteria of treatment you might receive, such ashas been in use since 1991, and its foundations extend back eventhe difference between a walk-in clinicfurther into history.and a 24-hour hospital stay. It is theTreatment professionals use a lot of information to decide how to best goal of treatment providers to make surethe care you receive keeps you safe, andprovide care to their patients. They rely on clinical knowledge, theiraddresses all risks, but also that the careexperience in the field, and, perhaps most importantly, the directionis as “least intensive,” as possible, whichand goals developed collaboratively with the patient him or herself.helps you avoid unnecessary or wastefulMany professionals use The ASAM Criteria to assist them in filteringtreatment.all of this knowledge and data, and in determining what kind ofservices can be provided to the patient at the least intensive, but safe,level of care.One important aspect of The ASAM Criteria is that it views patients in theirentirety, rather than a single medical or psychological condition. This meansthat, when determining service and care recommendations, The ASAM Criteriapays attention to the whole patient, including all of his or her life areas, aswell as all risks, needs, strengths, and goals.Keep in mind that The ASAM Criteria is an educational tool. It doesnot dictate a particular standard of care or specific treatment decisions.Treatment professionals are responsible for the care of their patients andmust make independent judgments about whether and how to use TheASAM Criteria in their treatment decisions. 2015 by The American Society of AddictionMedicine (“ASAM”). All rights reserved.This pamphlet may only be reproduced for personal purposes and may not beotherwise reproduced in any form without the prior written consent of ASAM.
Guiding Principles of The ASAM CriteriaThere are many principles that guided the development of The ASAM Criteria. Some of these principles canbetter explain the mindset of your physician or care provider, and help you understand how these criteria areused in determining the best treatment services for you.Consider the whole person. Rather than basing treatment decisions around a single element ordiagnosis from your life, The ASAM Criteria takes a “multidimensional” approach, meaning itrecognizes the many different areas of life that make up who you are, and how these life areas, or“dimensions,” contain different risks and needs, as well as strengths and resources. A patient’s risks,needs, strengths and resources provide the basis for creating a treatment plan.Design treatment for the specific patient. The ASAM Criteria recognizes that effective treatmentcannot take a one-size-fits-all approach. Every individual’s treatment plan is based on his or herunique needs, and therefore may be different, or require a variety of types or intensities of care.Individualize treatment times. Some programs use the same treatment timeline for all of theirpatients (such as putting everyone in a “28-day program”). The ASAM Criteria views treatmentlength as a unique factor—one that depends on the individual’s progress and changing needs.“Failure” is not a treatment prerequisite. Some providers look at a patient’s history to see if he orshe has first “failed” out of less-intense services before approving a more intense type of care (suchas a residential program or hospital stay). The ASAM Criteria does not see “failures” from treatmentas an appropriate way to approve the correct level of care.Provide a spectrum of services. Although five broad levels of service are described in The ASAMCriteria, these levels represent benchmarks along a single continuum of care. These levels are linkedto one another, and patients can move among and between them based on their current needs.Reconceptualize the definition of “addiction.” In 2011, ASAM proposed a definition of“addiction” designed to be consistent with both clinical wisdom and the latest research discoveries.To read more, visit the following link: ddiction.At first, I couldn’t understand why I was being sent to a residential center to address my alcoholuse. I mean, it wasn’t like I was drinking a bottle a day. I had thought the treatment decisionwould only be based on the average number of drinks I had: the more drinks per night, thegreater the risk.Turns out, the amount I was drinking was only part of the story. My doctor pointedout that some of my other health problems were not only quiteserious, but actually related to my drinking. She saw otherpatterns I hadn’t noticed, too: the stress from work that sent me tothe bar, the repeated promises to quit, even some physical signs ofwithdrawal.When my doctor made her treatment recommendation, she waslooking at the “whole me,” not just the amount of alcohol thatwas going in. 2015 by The American Society of AddictionMedicine (“ASAM”). All rights reserved.This pamphlet may only be reproduced for personal purposes and may not beotherwise reproduced in any form without the prior written consent of ASAM.
These are steps providers and professionalswork through together when discussingwhat type of care to offer—and fund—foran individual. Following this decisionalflow helps ensure that treatment is beingeffectively managed, and that patients receivethe appropriate intensity of care.DOES THE PATIENT HAVE ANY IMMEDIATE NEEDS?ASSESS RISKS, NEEDS, AND STRENGTHS IN ALL LIFE AREASIDENTIFY ANY DIAGNOSESIDENTIFYINGThis “decisional flowchart” has beenprovided here, and each of its three maincomponents (Assessing, Identifying, andProviding/Evaluating) is discussed on thefollowing pages.WHAT DOES THE PATIENT WANT? WHY NOW?IDENTIFY THE SEVERITY AND LEVEL OF FUNCTIONINGIDENTIFY WHICH LIFE AREAS ARE CURRENTLY MOST IMPORTANT TO DETERMINETREATMENT PRIORITIESCHOOSE A SPECIFIC FOCUS AND TARGET FOR EACH PRIORITY LIFE AREAWHAT SPECIFIC SERVICES ARE NEEDED FOR EACH LIFE AREA?PROVIDING/EVALUATINGThe ASAM Criteria provides treatmentprofessionals with objective standards theycan use to help identify the least intensivetreatment services that can help keep aparticipant safe as he or she works to makepersonal life changes. But identifying themost appropriate services is just one step ina much more intricate process. The ASAMCriteria actually outlines a detailed flowchartthat treatment providers and professionalscan use to assist them in their clinicaldecisions.ASSESSINGUsing the Criteria to MakeDecisions About CareIDENTIFY THE INTENSITY OF SERVICES NEEDED FOR EACH LIFE AREAIDENTIFY WHERE THESE SERVICES CAN BE PROVIDED, IN THE LEASTINTENSIVE BUT SAFE LEVEL OF CAREWHAT IS THE PROGRESS OF TREATMENT?Why are they onlyseeing me twice aweek? I’m havingsuch a hard timewith this. I shouldbe in the hospital! 2015 by The American Society of AddictionMedicine (“ASAM”). All rights reserved.This decision-making chart showshow providers and funders of yourcare can create an overall treatmentplan with the help of The ASAMCriteria. Take a look at what happensin each step.The patient is an activemember throughout the process.This pamphlet may only be reproduced for personal purposes and may not beotherwise reproduced in any form without the prior written consent of ASAM.
“Assessing” with The ASAM CriteriaThe “assessment” phase of treatment represents theearly information-gathering phase, in which patientand physician work together to determine what signsand symptoms are present, and what they point to.The ASAM Criteria begins this phase by asking “Whatdoes the patient want?” and “Why now?” If there isn’tgood agreement and understanding on these earlyquestions, it can significantly impact the later stagesof treatment.The ASAM Criteria is also unique in how it guidestreatment professionals to conduct assessments.Rather than simply focusing on a diagnosis, or anisolated symptom, The ASAM Criteria uses what’scalled a “multidimensional” assessment. Thisassessment is a way to see how treatment might affectmultiple life areas of an individual.There are six major life areas (or “dimensions”)detailed in The ASAM Criteria, and each oneinfluences the others. Your treatment providers lookat these dimensions fromevery angle, consideringthem separately andtogether, and exploringboth risks and strengthsin each.ASSESSINGPhysicians use theirclinical knowledge togather information aboutthese dimensions, andcombine this with anyother diagnoses (such as asubstance use disorder) tocomplete the “Assessing”phase. (Some levels of carerequire that a patient have a specific diagnosis in orderto be admitted. The ASAM Criteria specifies that aprofessional can use a reference tool such as the DSM 5 or ICD-10 in order to help determine a diagnosis.)Here are the six dimensions of The ASAM Criteria, with a brief description of each one.Think ofeach dimension like the side of a cube, showing something different about who you are, and anessential part to what makes you, you.123Dimension 1: Acute Intoxicationand/or Withdrawal Potential4This life area explores your past andcurrent experiences of substance useand withdrawal.Dimension 2: BiomedicalConditions/ComplicationsDimension 4: Readiness to ChangeThis life area identifies what you aremotivated for and your readiness andinterest in changing.5Dimension 5: Relapse/Continued Use/Continued Problem PotentialIn this life area, think about yourphysical health, medical problemsand physical activity and nutrition.This life area addresses concerns youmight have about your continuedsubstance use, mental health or a relapse.Dimension 3: Emotional/Behavioral/Cognitive Conditions and Complications6Dimension 6: RecoveryEnvironmentThis life area helps explore yourthoughts, emotions and mental healthissues. 2015 by The American Society of AddictionMedicine (“ASAM”). All rights reserved.This life area explores your livingsituation and the people, places andthings that are important to you.This pamphlet may only be reproduced for personal purposes and may not beotherwise reproduced in any form without the prior written consent of ASAM.
“Identifying” with The ASAM CriteriaOnce the information about a patient’s wants, immediate needs, and different lifeareas have been gathered, treatment professionals move into the second phase ofthe decision-making process. This phase helps them identify what issues are of thehighest severity, and of the highest priority, to address in treatment.Treatment professionals rely on their clinical knowledge and training to helpdetermine which issues and which life areas pose the biggest challenges. TheASAM Criteria helps them rank these areas and choose which ones to targetduring treatment. From here, professionals and providers can work with thepatient to figure out the specific services needed, and what goals to set. Noservices are recommended that do not refer back to the patient’s needs and goals.IDENTIFYINGI don’t have a lot of support people in my life, and my living situation isn’t very healthy right now, soI can understand being at a high risk in that particular area. What I didn’t notice is that my personalmotivation and my physical health are the strongest they’ve ever been. And those strengths can actuallylower my overall risk.So it turns out my treatment plan includes a lot of goals about finding a better place to live—one thatsupports the other healthy areas of my life. The type of care I receive is determined by my risks, but alsoby my strengths.123456PATIENTEach life area can carry its own level of risk, but these lifeareas also interact with each other. The ASAM Criteria helpsrate and rank these risks, and determine which ones willbe the most important to focus on within treatment. 2015 by The American Society of AddictionMedicine (“ASAM”). All rights reserved.This pamphlet may only be reproduced for personal purposes and may not beotherwise reproduced in any form without the prior written consent of ASAM.
“Providing/Evaluating” with The ASAM CriteriaThe final phase of The ASAM Criteria treatment process takes the assessmentinformation, and the identified priorities and services, and establishes whatintensity of services should be provided. In other words, this is where serviceproviders and patients decide how much (and how often) treatment is needed.Patients may require weekly, daily, or even hourly services (which might requirea residential program or hospital stay). Again, this intensity is determined bya patient’s unique, individual needs, and provided in the least intensive, butsafe treatment setting. Once this has been done, the final step is to track theprogress of treatment, including any recommendations for discharge, transfer, orcontinuing serviceDischarge, Transfer, and Continuing ServiceAll decisions about when to end services, when to change services, and whento continue services are based on the progress the patient is making. The ASAMCriteria does not support any treatment that has dates of “graduation” or“completion” that can be assigned before treatment has even begun. The length oftreatment depends upon the progress made, in clearly defined and agreed-upongoals, rather than a result of a program’s preset structure.PROVIDING/EVALUATINGWhen to Discharge from TreatmentWhen the patient has fulfilled the goals of the treatment services and no otherservice is necessary.When to Tr ansferThere are many reasons a patient may be transferred to a different type of service.Two common ones are.1. The patient is not able to achieve the goals of their treatment, but could achievetheir goals with a different type of treatment.2. The patient has achieved their original treatment goals, but they have developednew treatment challenges that can be achieved in a different type of treatment.When to Continue ServiceWhen the patient is making progress toward their goals, and it is reasonable tobelieve they will continue making progress with their existing treatment, it isappropriate to continue service.The following pages include a condensed description of different “levels of care” a patient might beprovided (such as an “outpatient clinic” or a “24-hour care” environment).These pages also include moredetailed charts that illustrate a small part of the decision-making that providers and professionals can useto help them determine an appropriate level of care (including how the severity of different dimensionscan point to different levels of care). 2015 by The American Society of AddictionMedicine (“ASAM”). All rights reserved.This pamphlet may only be reproduced for personal purposes and may not beotherwise reproduced in any form without the prior written consent of ASAM.
Levels of Care: Adolescents and AdultsThough the intensity of treatment is often split into “levels” of care, these levels connect to each other, actingmore like “benchmarks” along a single spectrum. Patients can move between levels, depending on their uniqueneeds. ASAM also uses separate criteria and levels of care benchmarks for adult patients and adolescent patients.This is because adolescents can be in different stages of emotional, mental, physical, and social development thanadults. For this reason, certain adolescent services, such as withdrawal management, are bundled together withthe rest of their treatment, whereas adults are able to enter into withdrawal management treatment separately.Benchmark Levels of Care for Adolescents and AdultsLevel ofCare0.5OTP(Level 1)Adolescent TitleAdult TitleDescriptionEarly Intervention*Not specified foradolescentsAssessment and educationOpioid Treatment ProgramDaily or several times weekly opioid medicationand counseling available1Outpatient ServicesAdult: Less than 9 hours of service per weekAdolescent: Less than 6 hours of service per week2.1Intensive Outpatient ServicesAdult: More than 9 hours of service per weekAdolescent: More than 6 hours of service per week2.5Partial Hospitalization Services20 or more hours of service per week3.1Clinically Managed Low-intensity Residential Services24-hour structure with available personnel, at least5 hours of clinical service per week3.3*Not available becauseall adolescent levelsattend to cognitive/other impairmentsClinically ManagedPopulation-specific Highintensity ResidentialServices24-hour care with trained counselors, less intenseenvironment and treatment for those withcognitive and other impairments3.5Clinically ManagedMedium-intensityResidential ServicesClinically Managed Highintensity ResidentialServices24-hour care with trained counselors3.7Medically MonitoredHigh-intensity InpatientServicesMedically MonitoredIntensive Inpatient Services24-hour nursing care with physician availability, 16hour per day counselor availability4Medically Managed Intensive Inpatient Services24-hour nursing care and daily physician care,counseling availableBenchmark Withdrawal Management Levels of Care for AdultsLevel of Withdrawal Management for AdultsLevelDescriptionAmbulatory Withdrawal Management withoutExtended On-site Monitoring(Outpatient Withdrawal Management)1-WMMild withdrawalAmbulatory Withdrawal Management withExtended On-site Monitoring(Outpatient Withdrawal Management)2-WMModerate withdrawalClinically Managed Residential WithdrawalManagement(Residential Withdrawal Management)3.2-WMModerate withdrawal requiring 24-hour supportMedically Monitored Inpatient WithdrawalManagement3.7-WMSevere withdrawal requiring 24-hour nursing care,physician visits as neededMedically Managed Intensive InpatientWithdrawal Management4-WMSevere, unstable withdrawal requiring 24-hour nursingcare and daily physician visits 2015 by The American Society of AddictionMedicine (“ASAM”). All rights reserved.This pamphlet may only be reproduced for personal purposes and may not beotherwise reproduced in any form without the prior written consent of ASAM.
The following information cannot be used as a distillation of the fullprinciples, concepts and processes within The ASAM Criteria. Manyelements of a clinical decision are extremely abbreviated here and manyparts of the decision-making process have been excluded for ease ofpatient understanding. This is not a clinical document.Example Chart for Adult Levels of CareLevel of CareD
ongoing service planning. he criteria were developed by the American Society of Addiction Medicine (ASAM), and presented in a book written by a group of renowned doctors and professionals, working in a variety of mental health and addiction treatment ields. he ASAM Criteria. has become the most widely used set of criteria in the United States for
May 02, 2018 · D. Program Evaluation ͟The organization has provided a description of the framework for how each program will be evaluated. The framework should include all the elements below: ͟The evaluation methods are cost-effective for the organization ͟Quantitative and qualitative data is being collected (at Basics tier, data collection must have begun)
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History of ASAM Criteria 1991: First edition of ASAM’s Patient Placement Criteria for the Treatment of Psychoactive Substance Use Disorders 1996: ASAM PPC-2 : Included Continuing Stay and Discharge Criteria 1998/99 ASAM PPC endorsed by 30 states, Dept of Defense, & some MCOs 2001: ASAM
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and ASAM. The ASAM Resource User Guide. Intake/Assessment. Intervention/Treatment Outcomes. The information provided here will help you best implement ASAM’s criteria. The products and services offered under the collaborative partnership of ASAM and The Change Companies provide treatment teams and clinicians with support throughout the .
ASAM Criteria must require more staff, expense, and administration to provide all the levels ASAM Criteria is a medical model and requires everyone to hire a medical director ASAM Criteria is biased to advocate for more inpatient treatment ASAM Criteria is biased to advocate for more outpatient treatmentFile Size: 556KB
