Mastering The ASAM Criteria for Addiction Treatment is More Important Than Ever Before

ASAM six dimensions assessment biopsychosocial addictiont treatment assessment

Whether you refer to it as the “Six Dimensions,” The ASAM Criteria or simply a “biopsychosocial,” the ASAM Criteria has come to dominate the landscape of multidimensional assessment in the addiction treatment community. As health care reform continues to drive evidence-based, outcomes-oriented standardization in addiction medicine, over 30 states and most insurance providers have officially adopted the ASAM Criteria as the go-to method for determining appropriate levels of care for people with Substance Use Disorder (SUD). 

Why Have So Many States Adopted the ASAM Criteria for Addiction Treatment? 

Developed by addiction treatment professionals in the 1980’s, the ASAM Criteria is considered to be an effective tool for preventing the under- and over-treatment of SUD patients. Using 6 dimensions - essentially areas of patient assessment - the ASAM Criteria represents a decision-making system that can drive standardized level of care assignments. 

Today, let’s look at each of the 6 ASAM Criteria dimensions and learn what they tell us about the treatment needs of a potential SUD patient. 

ASAM Criteria Dimension #1: Acute Intoxication and/or Potential for Withdrawal

addiction treatment asam dimension 1 intoxication and withdrawal

This dimension concerns the physical condition of the patient in terms of present intoxication and current or future potential for withdrawal over the course of treatment. Put simply, patients who are currently intoxicated require different care than those who aren’t. Some substances like alcohol, can cause life-threatening symptoms in physically dependent patients who must undergo withdrawal before other types of treatment may begin. Therefore, patients like these need a higher level of care in the short-term than those whose substance of choice does not cause life-threatening withdrawal symptoms. 

ASAM Criteria Dimension #2: Biomedical Conditions or Complications

ASAM dimension 2 health conditions addiction treatment assessment

This dimension is all about “comorbid” or “co-occurring” conditions in patients who suffer from both SUD and some other type of physical medical condition. Certainly, treatment for SUD must take into account the full biological picture of the patient in order to be effective. There are myriad ways that other medical problems can interact with addiction treatment and many of those interactions can result in differing needs in terms of levels of care. 

ASAM Criteria Dimension #3: Emotional, Behavioral or Cognitive Conditions and Complications

Dimension three concerns itself with the mental, rather than physical, health of the patient. It is well documented that most SUD patients have at least one “comorbid” or “co-occurring” mental health disorder that they struggle with in addition to addiction. These patients are frequently referred to as “dual diagnosis” patients. In nearly all cases, a co-occuring mental health issue will have a strong influence on the treatment needs of the patient. It’s best treatment practice for mental and behavioral health issues to be addressed simultaneously, as they often create a negative feedback loop and reinforce one another.  

ASAM Criteria Dimension #4: Readiness to Change

readiness for change dimension 4 ASAM criteria addiction treatment assessment

This dimension draws heavily on the “stages of change” or “transtheoretical” model of addiction recovery. Readiness to change indicates where a patient is in terms of readiness for behavioral change. The stages of change are usually described as: precontemplation, contemplation, preparation, action, maintenance and relapse. 

ASAM Criteria Dimension #5: Potential for Relapse, Continued Use or Continued Problem

This dimension evaluates the patient’s awareness of and ability to execute recovery skills, like trigger identification, coping with cravings, and dealing with impulse control. For SUD patients who are new to addiction treatment, the potential for relapse is obviously very high, as they are generally unfamiliar with how to practice recovery skills. This dimension also concerns the potential for self-harm (including suicide) or other harmful behaviors that go along with mental health and addiction issues. 

ASAM Criteria Dimension #6: Recovery Environment 

ASAM dimension 6 environment criteria addiction treatment assessment

This final dimension is all about the setting that the patient finds themselves in at the time of the assessment. It concerns all the practicalities of life, like: employment, housing, relationships, family, finances, education, legal concerns and logistical issues like transportation and childcare. Is the general environment supportive of recovery? Are the material conditions of recovery available to the patient? These are some of the biggest stumbling blocks for many SUD patients who might otherwise be successful in treatment and their presence - or lack of presence - can influence level of care decision making. 

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