91抖阴

The digital version was released in October 2023. The print version became available in December 2023. Please to purchase. 

The digital and print version are !

Two additional volumes in the Fourth Edition are planned: Correctional Settings and Community Reentry (est. 2027), and Behavioral Addictions (est. 2028).

The ASAM Criteria is developed using a rigorous methodology including structured literature reviews, expert consensus with a modified Delphi method, stakeholder comment and reconciliation, and narrative development. Each volume is led by an editorial subcommittee of experts. All contributors were required to disclose all current relevant relationships with industry and other entities that may represent conflicts of interest. ASAM conducts multiple public comment periods for each volume, seeking input from diverse stakeholders. Finally, the standards are approved by the 91抖阴 Criteria Strategy Steering Committee and Quality Improvement Council; the high-level framework is approved by the Board of Directors. Read more about the methodology . 

Please continue using the Third Edition criteria for adolescents.

The 91抖阴 Criteria defines adolescent as youth under 18 years of age. Transition-aged youth is defined as people ages 16 to 25 years who are in the process of transitioning to adulthood, which includes navigating numerous psychosocial transitions such as gaining and maintaining independence, forming one's self-identity, exploring sexuality and relationships, and pursuing post-secondary education and career development.

The 91抖阴 Criteria defines transition-aged youth as young people aged 16 to 25 years; this definition aligns with the definition of transitional-age period used by the American Academy of Child and Adolescent Psychiatry (AACAP). Transition-aged youth may receive treatment in adolescent or adult programs. Often, this determination is based strictly on chronological age, with no consideration for developmental stage. Ideally, the selection of an appropriate treatment setting for transition-aged youth should be based on each patient’s developmental characteristics with consideration of the patient’s current circumstances. For example:

• Does the patient live at home?

• Is the patient financially reliant on their caregivers?

• Is the patient still in high school?

• How disruptive will the transition to the adult treatment system be to the patient’s care?

ASAM encourages payers to support flexibility in the timing of the adult care transition for patients with substance use disorder.

91抖阴 is not a regulatory body. The 91抖阴 Criteria is a tool that can be used by clinicians, payers, policy makers, and other stakeholders. Public entities, including state and local regulatory bodies, and payers will determine if and when they want to implement these standards in their networks or embed them in their regulatory frameworks. 

Third Edition Withdrawal Management Levels	Fourth Edition
Level 1 WM	Level 1.7
Level 2 WM	Level 2.7
Level 3.2 WM	Level 3.5*
Level 3.7 WM	Level 3.7

* The Third Edition of The 91抖阴 Criteria included Level 3.2 WM: Clinically Managed Residential Withdrawal Management. These services have been integrated into Fourth Edition Level 3.5: Clinically Managed High- Intensity Residential Treatment. Patients who are in withdrawal or expected to experience withdrawal should have a medical evaluation prior to admission to determine if clinically managed withdrawal is appropriate. Level 3.5 programs have a medical director who is able to provide sufficient medical oversight.

It is important to note that the medically managed levels of care in the Fourth Edition also provide comprehensive psychosocial services for SUD. For an overview of the changes to levels of care, please see Appendix A in the Fourth Edition. 

 

Readiness to Change does not contribute independently to the recommended level of care; rather, it impacts clinical judgments related to risks in other dimensions and influences the services that should be delivered at any level of care and should be carefully considered in treatment planning. As such, readiness to change is no longer included as a separate dimension. Instead, readiness to change should be considered when assessing risks and needs within the  other dimensions and subdimensions. 

The Third Edition of The 91抖阴 Criteria includes a framework for rating risks in each dimension as well as dimensional admission criteria for each level of care. However, the dimensional admission criteria do not reference the risk ratings. The Fourth Edition integrates risk ratings into the Dimensional Admission Criteria with a goal of making the decision rules easier to understand and follow reproducibly.

 The Dimensional Admission Criteria are designed to identify the least intensive level of care where a patient can be safely and effectively treated. Risk ratings within each subdimension indicate the minimum level of care at which the patient should be treated to address needs in that subdimension. Risk ratings may indicate a minimum level of care or services provided in addition to or within the recommended level of care (eg, EVAL for prompt medical evaluation).

To make an initial recommendation, the assessor will determine the risk rating for each subdimension based on the associated descriptions of clinical presentation. After determining the subdimensional Risk Ratings, the assessor applies the integrated Level of Care Determination Rules across dimensions to arrive at the clinically indicated – or recommended – level of care. The initial recommendation is made based on Dimensions 1 to 5. After an initial recommendation, the clinician engages in a shared decision-making process with the patient to consider Dimension 6: Person-Centered Considerations and determine where the patient is willing and able to engage in treatment.

For more information on the Dimensional Admission Criteria, please see Chapter 10: Dimensional Admission Criteria and Algorithm. Additionally, on-demand trainings are , and other resources can be downloaded for free from our website.

The 91抖阴 Criteria service characteristic standards set the expectation that all programs will be co-occurring capable. Co-occurring capability means that:

• Program services are designed with the expectation that most patients have co-occurring conditions.
• The program has the ability to manage mild to moderate acuity, instability, and/or functional impairment, providing symptom management support and referrals to treatment as needed.
• There is at least one staff member qualified to assess and triage mental health conditions.
• Treatment plans integrate SUD and mental health treatment needs.
• Programs coordinate with external mental health providers, as needed.
• Program content addresses co-occurring conditions.

Programs are not expected to be able to provide skilled mental health treatment services. In addition, they are not expected to manage patients with more severe and/or complex mental health disorders – these patients would typically be supported by co-occurring enhanced (COE) programs. They should be able to support patients with common low acuity mental health problems and coordinate with external service providers. 

The Fourth Edition promotes more integrated care for co-occurring mental health conditions by incorporating standards for co-occurring capable care into the core standards for all levels of care. In the adolescent continuum of care, co-occurring capability includes providing fully integrated mental health treatment. This includes mental health-focused interventions, psychiatric oversight at Level 2Y and more intensive, and integrated treatment plans. Separate standards are included for Co-occurring Enhanced (COE) levels of care.

No. However we are using different terminology. High Intensity Outpatient is used to refer to Level 2.5. PHP is a misnomer as these services are not delivered in a hospital setting. 

Inpatient means a hospital with a broad regulatory framework that oversees the hospital. So ASAM Level 4 is a hospital level of care. 

Residential is less intensive than inpatient. A patient could receive Level 3.7 in a hospital setting,. However, most 3.7s are residential and ASAM uses that as a foundation for the standards for that level of care, and for defining the related Dimensional Admission Criteria.  

A standardized level of care assessment form is available. Treatment planning assessment and reassessment forms are also in development . to be notified when these are available.

We offer both an updated foundations course for the Fourth Edition and a Utilization Management course Further courses are in development. Please see the for more information.

You can view our implementation tools here. Among other resources, there is a free downloadable 300+ slide deck on the Fourth Edition. 

Please view our training licensing page for more information on licensing for training.

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The 91抖阴 Criteria^® is the most respected, comprehensive and widely used set of clinical standards for providing outcome-oriented care in the treatment of addiction. The 91抖阴 Criteria plays a critical role in national efforts to advance treatment standards for the disease of addiction. The common language and universal standards set by The 91抖阴 Criteria establish a framework to help payers and healthcare systems ensure they are offering the full continuum of care to meet patients’ needs.

ASAM does not specify the requirements of who can complete the Level of Care Assessment. Assessors should be operating within the scope of practice as defined by state or other local authority. In general, ASAM recommends that assessments are completed by clinical staff. They should also be trained in application of The 91抖阴 Criteria.

In the Fourth Edition, for each level of care, the standards discuss the frequency of treatment plan reassessment. For example, Levels 2.1, 2.5, 3.1, and 3.5 recommend monthly formal reassessments. Treatment planning should be continuous. If a patient reveals new information that impacts their treatment needs, the treatment plan should be updated with consideration for that new information. Frequency of assessment is also subject to state regulations.

Not currently. We plan to develop an adolescent assessment tool after the Adolescent and Transition-Aged Youth volume is released. 

The 91抖阴 Criteria includes standards for multiple components of care, including: (1) a standardized multidimensional assessment; (2) standard decision rules for interpreting the multidimensional assessment and matching the patient to the right level of care to meet their treatment needs; and (3) standard service characteristics that define each level of care in the care continuum. These components all work in tandem to ensure that the patient is matched to the right level of care to meet their individual needs.

To fully implement The 91抖阴 Criteria within the addiction treatment system all elements should be in place:

• Patients entering addiction treatment should receive a standard multidimensional assessment that covers all six dimensions described in The 91抖阴 Criteria.
• The standard patient placement decision rules in The 91抖阴 Criteria should be used to interpret the assessment and match the patient to the right level of care to meet their treatment needs.
• Payers and managed care organizations should use the same standard decision rules to determine what level of care will be covered for an individual patient.
• The treatment program should meet all the standard service characteristics for the level(s) of care that they provide.
• The treatment system should provide access to all levels of care in the care continuum as described in The 91抖阴 Criteria standards.
• The multidimensional assessment and patient placement decision rules should be re-used as the patient progresses through treatment to determine when they should be moved to another level of care (either more or less intensive depending on the individual patient’s symptoms and circumstances).
• Healthcare providers and utilization review managers should be well trained in The 91抖阴 Criteria to support effective decision making.

 

ASAM supports a range of programs and tools designed to support effective implementation of The 91抖阴 Criteria, including:

• Standardized assessment tools
• A treatment planning template
• Standardized service request forms for communicating with payers
• 91抖阴 Criteria software for providers and for payers
• A robust  on The ASAM Criteria
• The ASAM Level of Care Certification Program™