ASAM Levels of Care, Explained

March 2, 2022

4 mins

Dane O'Leary


The addiction rehabilitation process frequently requires more than just a 28-day program. According to data, those who achieve the greatest success in recovery leverage many of the ASAM levels of care.

When you are checking in yourself or a loved one into substance abuse treatment, it's easy to feel overwhelmed and not sure what to expect. While these feelings are normal,  we believe that understanding what goes on behind closed doors can help to explain the process a bit better. Learning how medical professionals in the field consider various treatment options and how they make the decisions behind their recommendations is key. 

The American Society of Addiction Medicine (ASAM) has created standardized criteria for assessing substance abuse treatment needs. Even though these guidelines aren’t the only ones available, the ASAM Levels of Care have become the most widely used standard of practice when it comes to assessment, treatment planning, placement, intake, and an individual’s transfer/discharge. 

The Guiding Principles of the ASAM Criteria

These principles can help to better explain the mindset of your care provider when they assess you and in determining the best course of treatment. 

Consider the Whole Person

The treatment provider will take a multidimensional approach to assess your current situation. This means they will look at the different dimensions of your everyday life, and the different risks that come with them. They will determine the patient’s risks, needs, strengths, and resources needed for the best chance for success in recovery.

Individualize the Treatment Plan

There is no such thing as a one-size-fits-all approach within the ASAM levels of care. Every patient’s treatment plan is based on their needs and will require a variety of types of intensities of care. Additionally, there is no standard treatment timeline, such as 28-days, 3 months, etc. Rather, the ASAM principle is that the treatment length is a unique factor dependent on the patient’s progress and changing needs.

Come Despite Your Past

Your recovery success rate should not be a factor in creating a treatment plan. It is a wide held belief by treatment providers that failures from previous treatments are not prerequisites for approving a more intense type of care.

Assessing the Patient to Make Appropriate Care Decisions 

The ASAM Criteria outlines a “decisional flowchart” to aid treatment professionals in their clinical decisions. It can be split into three sections; assessing, identifying, and providing/evaluating. Here are the steps for each.

1: Assessing

  • What does the patient want? And why do they want it in this period in their life?
  • Does the patient have any immediate needs?
  • Assess risk, needs, and strengths in all the patient’s life areas.

2: Identifying 

  • Identify the severity and level of daily functioning. 
  • Identify which life areas are currently the most important to determine treatment priorities. 
  • Choose a priority for each life area.
  • Identify what specific services are needed for each priority.

3: Providing/Evaluating 

  • Identify the intensity of the services needed for each life area.
  • Identify where these services can be provided.
  • Evaluating the progress of treatment.

What Are the Levels of Care for Addiction?

According to the American Society of Addiction Medicine, there are six levels of the Criteria of Care. For perspective, you might think of these levels as existing on a spectrum where more intensive treatment on one side of the spectrum will transition into less intensive treatment on the other.

Dimension 1: Acute Intoxication and/or Withdrawal Potential 

This explores your experience of substance abuse, as well as how you are feeling currently and if you’re at risk for withdrawal.

Dimension 2: Biomedical Conditions/Complications

Look at your current physical health, level of physical activity, your nutrition, and if you have any existing medical problems.

Dimension 3: Emotional/Behavioral/Cognitive Conditions and Complications

This area is to help you explore your thoughts, emotions, and current mental health issues. Your treatment provider will dig in deep to see if any of these conditions are triggers for substance abuse, and how they can be treated properly.

Dimension 4: Readiness to Change 

Here you will identify what motivates you, if you have any interest in changing your life, and if you are ready to commit to lasting change. 

Dimension 5: Relapse/Continued Use/ Continued Problem Potential

This will address the concerns you may have about your continued substance use, mental health, or the possibility of a relapse. Relapse is very common during your journey to sobriety, and understanding this can help change your emotions about relapse as a whole.

Dimension 6: Recovery Environment

Your treatment providers will explore your living situation as well as the people, places, and things that are the most important to you. 

The Continuum of Care 

It's common to think of substance abuse treatment as a linear journey that starts at detox and ends with sustainable sobriety. This isn’t the case, however, as a continuum of care means you can step down and transition into less intensive levels of care as you recover. 

The continuum of care includes the following levels:

Level 0.5: Early Intervention

Includes DUI programs and other educational programs.

Level 1: Outpatient Services

For an adult, no more than 9 hours of outpatient care per week. For adolescents, less than 6 hours of outpatient care a week.

Level 2.1: Intensive Outpatient Services

More than 9 hours of outpatient care for an adult, and more than 6 hours of outpatient care for adolescents.

Level 2.5: Partial Hospitalization

This means the patient will seek 20 hours or more per week of outpatient services.

Level 3.1: Clinically Managed Low-Intensity Residential

This typically includes halfway houses, with 24-hour living support. Must have 5 hours of clinical services per week, whether it is provided on-site or in an outpatient services program. 

Level 3.3: Clinically Managed Population Specific High-Intensity Residential Treatment

This is for adults only and it includes 24-hour care for adults with significant cognitive impairments in a less-intense environment. 

Level 3.5: Clinically Managed Residential - High Intensity for Adults, Medium Intensity for Adolescents

Includes 24-hour care for both adults and adolescents, including addiction counselors, social workers, and nursing staff.

Level 3.7: Medically Monitored Inpatient - Intensive for Adults, High-Intensity for Adolescents

This stage provides highly structured 24-hour services, with a physician available on-site around the clock alongside addiction counselors.

Level 4: Medically Managed Intensive Inpatient

Provides daily direct care from a physician in a hospital-based setting.

Get Your Loved One's Life Back with Never Alone Recovery

Getting an ASAM assessment by a trained professional is a great way to start your journey to recovery. Let the Never Alone Recovery team help you with this, we can provide you with the resources on drug and alcohol rehabs near you that match your needs and provide you the care you crave.

We can help you, so please get in touch today.

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