This document includes:

• ASAM criteria for adolescents

• ASAM criteria for adults

Licensee's use and interpretation of the American Society of Addiction

Medicine’s ASAM Criteria for Addictive, Substance-Related, and Co-
Occurring Conditions does not imply that the American Society of
Addiction Medicine has either participated in or concurs with the
disposition of a claim for benefits.

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The ASAM Criteria
Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions

Third Edition

The Change Companies

David Mee-Lee, MD
Chief Editor

Gerald D. Shulman, MA, FACATA

Marc J. Fishman, MD FASAM
David Gastfriend, MD
Deputy Editors

Michael M. Miller, MD, FASAM

Managing Editor

Scott M. Provence, MA, MFA

Publication Editor

American Society of Addiction Medicine Inc.

Chevy Chase, MD 20815
2013
ASAM Criteria - Adolescent Levels of Care

Adult Levels of Care DIMENSION 1 DIMENSION 2 DIMENSION 3 DIMENSION 4 DIMENSION 5 DIMENSION 6

Acute Intoxication Biomedical Conditions Emotional, Behavioral or Readiness to change Relapse, Continued Use Recovery/Living
and/or Withdrawal and Complications Cognitive Conditions and Or Continued Problem Environment
Potential Complications A) Potential
Dangerousness/Lethality,
B) Interference with
Addiction and/or Mental
Health Recovery Efforts,
C) Social Functioning, D)
Ability for Self-Care, E)
Course of Illness
Level 0.5 No withdrawal risk None or very stable None or very stable. Any Willingness to explore Needs an Adolescents risk of
Early Intervention Dimension 3 issues are how current alcohol, understanding of, or initiation of or
being addressed through tobacco, medication, skills to change current progression in
concurrent mental health other drug use, and/or alcohol, tobacco, other substance use and/or
services and do not high-risk behaviors drug or medication use high-risk behaviors is
interfere with early may affect achievement patterns, and/or high- increased by substance
intervention addiction of personal goals risk behaviors use or values about use.
treatment services High-risk behaviors of
family, peers, or others
in adolescent’s social
support system
Level 1 No withdrawal risk None or very stable, or The adolescents status in Willing to engage in Able to maintain Family and
Outpatient Services is receiving concurrent dimension 3 features one treatment, and is at abstinence or control environment can
medical services of more of the following: least contemplating use and pursue support recovery with
A) the adolescents is not change, but needs recovery or limited assistance
at risk of harm, B) There motivating and motivational goals with
is minimal interference, monitoring strategies minimal support
C) Minimal to mild
impairment, D) the
adolescent is
experiencing mild to
moderate difficulties
with activities of daily
living, but there is
significant risk of
deterioration E) The
adolescent is at minimal
imminent risk, which
predicts a need for some
monitoring or
interventions
Level 2.1 Experiencing minimal None are stable or The adolescents status in Requires close Significant risks of Adolescent
Intensive Outpatient Services withdrawal distracting from dimension 3 features one monitoring or support relapse or continued environment is
Experiencing mild treatment at a less of more of the following: several times a week to use or continued impeding his or her
withdrawal, or is at risk intensive level of carte. a) the adolescents is at promote progress problems and recovery, and
of withdrawal Such problems are low risk of harm, and he through the stages of deterioration in level of adolescent requires
manageable at Level 2.5 or she is safe between change because of functioning. Has poor close monitoring or
sessions, b) mild variable treatment prevention skills and support to overcome
interference requires the engagement, or no needs monitoring or that barrier
intensity of this level of interest in getting support
care to support assistance
treatment engagement, c)
mild to moderate
impairment but her can
sustain responsibilities)
the adolescent is
experiencing moderate
difficulties with activities
of daily living and
requires near/daily
monitoring or
interventions, e) the
adolescent history
(combined with the
present situation)
predicts the need for
near daily monitoring or
interventions
LEVEL 2.5 Experiencing mild None are stable or The adolescents status in Requires a near daily High risk of relapse or Adolescent’s
Partial Hospitalization withdrawal, or is at risk distracting from Dimension 3 features one structured program to continued use comma environment renders
Services of withdrawal treatment at a less of more of the following: promote progress or continued problems recovery unlikely
intensive level of carte. A) The adolescents is at through the stages of in deterioration in level without near/daily
Such problems are low risk of harm, and he change because of little of functioning. Has monitoring or support,
manageable at Level 2.5 or she is safe overnight, treatment engagement minimal prevention or frequent relief from
B) Moderate interference or escalating use or skills and needs near his or her home
requires the intensity of impairment, or no daily monitoring and environment
this level of care to awareness of the role of support
support treatment alcohol, tobacco and/or
engagement, C) Moderate other drugs play in
impairment but can his/her present
sustain responsibilities, problems
D) The adolescent is
experiencing moderate
difficulties with activities
of daily living and
requires near/daily
monitoring or
interventions, E) The
adolescent’s history
(combined with the

LEVEL 3.1
Clinically Managed Low-
Intensity Residential Services
LEVEL 3.5
Clinically Managed
Medium Intensity Residential
Service
present situation)
predicts the need for
near daily monitoring or
interventions
The adolescent state of None or stable, or The adolescents status in Open to recovery, but Understand the Environment poses a
withdrawal (or risk of receiving concurrent Dimension 3 features one needs limited 24-hour potential for continued risk to his or her
withdrawal) is being medical monitoring as of more of the following: supervision to promote use and/or has recovery so that he or
managed concurrently needed A) The adolescent needs or sustain change emerging recovery she requires alterative
at another level of care a stable living skills but needs residential, secure
environment, B) supervision to reinforce placement or support
Moderate interference recovery and relapse
requiring limited 24-hour prevention skills,
supervision to support limited exposure to
treatment engagement, substances and/or
C) Moderate impairment environmental triggers
needing limited 24-hour or maintain therapeutic
supervision to sustain gains
responsibilities, D)
Moderate difficulties
with activities of daily
living requiring 24-hour
supervision and
prompting, E) The
adolescent’s history
(combined with the
present situation)
predicts instability
without limited 24-hour
supervision
Adolescent is None or stable, or The adolescents status in The adolescent needs High risk or relapse or Environment is
experiencing mild to receiving concurrent Dimension 3 features one intensive motivating continued use, or dangerous to his or her
moderate to severe medical monitoring as of more of the following: strategies in a 24-hour continued problems recovery, so that he or
withdrawal (or is at needed A) Moderate but stable structured program to and deterioration in she requires residential
risk of withdrawal), but risk of harm, B) address minimal level of functioning. Has treatment to promote
does not need Moderate to severe engagement in, or minimal prevention recovery goals, or for
pharmaco-logical interference requiring opposition to, skills and needs near protection
management or nursing medium-intensity treatment, or to daily monitoring and
monitoring residential treatment to address his or her lack support
support engagement, C) of recognition of
Moderate to severe current severe
impairment that cannot impairment
be managed at a less
intensive level of care,
D) Moderate to severe
difficulties with activities
of daily living requiring
24-hour supervision and
medium-intensity staff
assistance, E) The

LEVEL 3.7
Clinically Managed
Population Specific High
Intensity Residential Service
LEVEL 4
Medically Monitored
Intensive Inpatient Services
adolescent’s history
(combined with the
present situation)
predicts destabilization
without medium-
intensity residential
treatment
Adolescent is Requires a 24-hour The adolescents status in
experiencing moderate medical monitoring, but Dimension 3 features one
to severe withdrawal not intensive treatment of more of the following:
(or is at risk of A) Moderate risk of
withdrawal), but this is harm, needing high-
manageable at Level 3.7 intensity 24-hour
monitoring or treatment,
B) Severe interference
requiring high-intensity
residential treatment to
support engagement, C)
Severe impairment that
cannot be managed at a
less intensive level of
care, D) Severe
difficulties with activities
of daily living requiring
24-hour supervision and
high-intensity staff
assistance, E) The
adolescent’s history
(combined with the
present situation)
predicts destabilization
without high-intensity
residential treatment
Adolescent is Requires 24-hour The adolescent’s status in
experiencing severe medical and nursing Dimension 3 features one
withdrawal (or is at care and the full of more of the following:
risk of withdrawal) and resources of a licensed A) The adolescent is at
requires intensive hospital severe risk of harm, B)
active medical Very severe, almost
management overwhelming
interference renders the
adolescent incapable of
participating in
treatment at a less
intensive level of care, C)
Very severe, dangerous
impairment requiring
frequent medical and
nursing interventions, D)
The adolescent needs Unable to interrupt Environment is
motivating strategies in high-severity or high- dangerous to his or her
a 24-hour medically frequency pattern of recovery, and he or she
monitored program due use/or behaviors and requires residential
to no treatment avoid dangerous treatment to promote
engagement associated consequences without recovery goals, or for
with a biomedical, high-intensity 24-hour protection, and to help
emotional or behavioral interventions (because him or her establish a
condition, or because of an emotional, successful transition to
he or she actively behavioral, or cognitive a less intensive level of
opposes treatment, condition; severe care
requiring secure impulse control
placement remain safe; problems; withdrawal
or because he or she symptoms; and the like)
needs high-intensity
case management to
create linkages that
would support
outpatient treatment
Problems in this Problems in this Problems in this
dimension do not dimension do not dimension do not
qualify the patient for qualify the patient for qualify the patient for
Level 4 services. If the Level 4 services. If the Level 4 services. If the
patient’s only severity patient’s only severity patient’s only severity
is in Dimension 4, 5, is in Dimension 4, 5, is in Dimension 4, 5,
and /or 6 without high and /or 6 without high and /or 6 without high
severity in Dimensions severity in Dimensions severity in Dimensions
1,2 and/or 3, then the 1,2 and/or 3, then the 1,2 and/or 3, then the
patient does not quality patient does not quality patient does not quality
for Level 4 for Level 4 for Level 4
Very severe difficulties
with activities of daily
living requiring frequent
medical and nursing
interventions, E) The
adolescent’s history
(combined with the
present situation)
predicts destabilization
without medical
management
The ASAM Criteria
Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions

Third Edition

The Change Companies

David Mee-Lee, MD
Chief Editor

Gerald D. Shulman, MA, FACATA

Marc J. Fishman, MD FASAM
David Gastfriend, MD
Deputy Editors

Michael M. Miller, MD, FASAM

Managing Editor

Scott M. Provence, MA, MFA

Publication Editor

American Society of Addiction Medicine Inc.

Chevy Chase, MD 20815
2013
ASAM Criteria - Adult Levels of Care

Adult Levels of Care DIMENSION 1 DIMENSION 2 DIMENSION 3 DIMENSION 4 DIMENSION 5 DIMENSION 6

Acute Intoxication Biomedical Conditions Emotional, Behavioral or Readiness to change Relapse, Continued Use Recovery/Living
and/or Withdrawal and Complications Cognitive Conditions or Or Continued Problem Environment
Potential Complications Potential
Level 0.5 No withdrawal risk None or very stable None or very stable Willing to explore how Needs an understanding Social support system or
Early Intervention current alcohol, tobacco, of skills, or skills to significant others
other drug or medication change, current alcohol, increase the risk of
use and/or other high tobacco, or other drug or personal conflict about
risk behaviors may affect medication use patterns alcohol, tobacco or other
personal goals and/or high risk behavior drug use
OTP – LEVEL 1 Physiologically None or manageable None or manageable in Ready to change the At high risk of relapse or Recovery environment is
Opioid Treatment program dependent on opioids with outpatient medical an outpatient structured negative effects of opioid continued use without supportive and/or the
and requires OTP to monitoring environment us, but is not ready for OTP and structured patient has skills to cope
prevent withdrawal total abstinence from therapy to promote
illicit prescription or non- treatment progress
prescription drug use
LEVEL 1 Not experiencing None or very stable, or is None or very stable, or is Ready for recovery but Able to maintain Recovery environment is
Outpatient Services significant withdrawal, or receiving concurrent receiving concurrent needs motivating and abstinence or control use supportive and/or the
at minimal risk of severe medical monitoring medical health monitoring strategies to and/or addictive patient has skills to cope
withdrawal. Manageable monitoring strengthen readiness. Or behaviors and pursue
at level 1 -WM (See needs on-going recovery or motivational
Withdrawal monitoring and disease goals with minimal
Management Criteria) management. Or high support
severity in this dimension
but not in other
dimensions. Needs Level
1 motivational
enhancement strategies
LEVEL 2.1 Minimal risk of severe None or not a distraction Mild severity, with Has variable engagement Intensification of Recovery environment is
Intensive Outpatient Services withdrawal. Manageable from treatment. Such potential to distract from in treatment, addiction or mental not supportive but with
at level 2-WM (See problems are recovery; needs ambivalence, or lack of health symptoms structure and support
withdrawal management manageable at Level 2.1 monitoring awareness of the indicate a high likelihood and relief from the home
criteria) substance use or mental or relapse or continued environment, the patient
health problems, and problems without close can cope
requires a structured monitoring and support
program several times a several times a week
week to promote
progress through the
stages of change
LEVEL 2.5 Moderate risk of severe None or not sufficient to Mild or moderate Open to recovery, but Understands relapse but Environment is
Patient Hospitalization Services withdrawal. Manageable distract from treatment. severity, with potential needs a structured needs structure to dangerous, but recovery
at level 2-WM (See Such problems are to distract from recovery, environment to maintain maintain therapeutic is achievable if Level 3.1
withdrawal management manageable at Level 2.5 needs stabilization therapeutic gains gains 24-hour structure is
criteria) achievable
LEVEL 3.1
Clinically Managed
Low Intensity Residential
Service
LEVEL 3.3
Clinically Managed
Population Specific High
Intensity Residential Service
LEVEL 3.5
Clinically Managed
High Intensity Residential
Service
LEVEL 3.7
Medically Monitored
Intensive Inpatient Services
No withdrawal risk, or None or stable, or None or minimal, not
minimal or stable receiving concurrent distracting to recovery. If
withdrawal. medical monitoring stable, a co-occurring
Concurrently receiving capable program is
Level 1-WM (minimal) or appropriate. If not, a co-
Level 2-WM (moderate) occurring enhanced
services. (See withdrawal program is required
management criteria)
At minimal risk of severe None or stable, or Mild to moderate
withdrawal. If receiving concurrent severity; needs structure
withdrawal is present, medical monitoring to focus on recovery.
manageable at Level 3.2 Treatment should be
WM. (See withdrawal designed to address
management criteria) significant cognitive
deficits. If stable, a co-
occurring capable
program is appropriate,
If not, a co-occurring
enhanced program is
required.
At minimal risk of severe None or stable, or Demonstrates repeated
withdrawal. If receiving concurrent inability to control
withdrawal is present, medical monitoring impulses, or unstable
manageable at Level 3.2 and dangerous
WM. (See withdrawal signs/symptoms require
management criteria) stabilization. Other
functional; deficits
require stabilization and
a 24-hour setting to
prepare for community
integration and
continuing care. A co-
occurring enhanced
setting is required for
those with severe and
chronic mental illness
At high risk of Requires 24-hour Moderate severity;
withdrawal, but medical monitoring but needs a 24-hour
manageable at Level 3.7 not intensive treatment structured setting. If the
WM and does not patient has a co-
require the full resources occurring mental
of a licensed hospital. disorder, requires
(See withdrawal concurring mental health
management criteria) services in a medically
monitored setting
Open to recovery, but Has little awareness and Environment is
needs a structured needs interventions dangerous and patient
environment to maintain available only at Level 3.3 needs 24-hour structure
therapeutic gains to prevent continued to learn to cope
use, with imminent
dangerous
consequences, because
of cognitive deficits or
comparable dysfunction
Has little awareness and Has no recognition of the Environment is
needs interventions skills needed to prevent dangerous and the
available at Level 3.3 to continued use, with patient has skills to cope
engage and stay in imminently dangerous outside of a highly
treatment. If there is consequences structured 24-hour
high severity in setting
Dimension 4 but not in
any other dimension,
motivational
enhancement strategies
should be provided in
Level 1
Has marked difficulty Unable to control use, Environment is
with, or opposition to, with imminently dangerous, but recovery
treatment with dangerous is achievable if Level 3.1
dangerous consequences, despite 24-hour structure is
consequences. If there is active participation at achievable
a severity in Dimension 4 less intensive levels of
but not in any other care
dimension, motivational
enhancement strategies
should be provided in
Level 1
Low interest in treatment Unable to control use, Environment is
and impulsive control is with imminently dangerous, but recovery
poor, despite negative dangerous is achievable if Level 3.1
consequences; needs consequences, despite 24-hour structure is
motivating strategies active participation at achievable
only safely available in a less intensive levels of
24-hour structured care
setting. If there is high
severity in Dimension 4
but not in any other

LEVEL 4
Medically Monitored
Intensive Inpatient Services
dimension, motivational
enhancement strategies
should be provided in
Level 1
At high risk of withdrawal Requires 24-hour Because of severe and Problems in this Problems in this Problems in this
and requires Level 4 – medical and nursing care unstable problems, dimension do not qualify dimension do not qualify dimension do not qualify
WM and the full and the full resources of requires 24 hour the patient for Level 4 the patient for Level 4 the patient for Level 4
resources of a licensed a licensed hospital psychiatric care with services. If the patient’s services. See further services. See further
hospital (See withdrawal concomitant addiction only severity is in explanation in Dimension explanation in Dimension
management criteria) treatment (co-occurring Dimension 4, 5, and /or 6 4 4
enhanced) without high severity in
Dimensions 1,2 and/or 3,
then the patient does not
quality for Level 4