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

Three additional volumes in the Fourth Edition are planned: Adolescents and Transition Age Youth (est. 2026), Correctional Settings and Community Reentry (est. 2027), and Behavioral Addictions (est. 2028).

The ASAM Criteria, 4th edition, will be split into different volumes. A separate adolescent volume is needed to develop a comprehensive set of standards and decision rules for the adolescent population. Development of the Adolescent Criteria has started and the proposed standards have been released for public comment (see here). We anticipate its release in about two years following the Adult Criteria.  Until then, please continue using the Adolescent Criteria in The ASAM Criteria, 3rd edition. 

Please continue using the Third Edition criteria for adolescents.

ASAM is not a regulatory body. The ASAM 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. 

3rd edition WM levels	4th 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 ASAM 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 4^th 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 3^rd Edition of The ASAM 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 4^th 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 available, and other resources can be downloaded for free from our website.

The ASAM 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. 

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 will be available by the end of 2024. A treatment planning assessment is also in development (est Q2 2025). Sign up for updates 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 ASAM Criteria education page 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.

We are always interested in hearing what would be beneficial to the field. If you have feedback or ideas to share, please contact us. 

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The ASAM Criteria^® is the most respected, comprehensive and widely used set of clinical standards for providing outcome-oriented care in the treatment of addiction. The ASAM 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 ASAM 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 ASAM 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 Age Youth volume is released. 

The ASAM 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 ASAM 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 ASAM Criteria.
• The standard patient placement decision rules in The ASAM 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 ASAM 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 ASAM Criteria to support effective decision making.

 

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

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