ASAM 101:

How to complete the

ASAM Placement Form
 What is the ASAM?

 The ASAM Placement Form is a

document required by contract
 The ASAM Form is an ASSESSMENT
tool as well as a PLACEMENT tool
 It seeks to match intensity of
treatment to severity of illness
 Method for justifying clinical decisions
 What is the ASAM not?

 The equivalent of the DSM-IV

 A substitute for clinical judgment

 A checklist or cookbook

 A replacement for the ASI

 Common Errors
 No client identification numbers
 Incorrect level of ASAM forms used
 Characteristics are not selected (circled)
for all six dimensions
 Dimensions are not validated in the “yes”
or “no” box
 Summaries are generalized and
insufficient
 ASAM forms are not signed or dated
 Client does not meet criteria but are
“forced” into specific level of care
 On Top of the Form…

 Make sure handwritings are LEGIBLE

 The Client ID can be the client’s SSN, MIS #
or client’s agency’s ID
 Tells you which form you are using: Admission,
Continued Stay or Discharge/Transfer
 Using the Correct ASAM Form

 Adult or Adolescent client?

 Level of care to which the client is being
assessed for?
 The correct ASAM level that corresponds to
the program’s level of care
ASAM &Treatment Levels Crosswalk
Adult Clients
Level 0.5 Intervention
Level I Outpatient
Level II.1 Intensive Outpatient
Level II.5 Day/Night
Level III.1 Level IV Residential
Level III.3 Level III Residential
Level III.5 Level I & II Residential
Level I-D Detoxification
 Outpatient Levels of Care & Services
Level 0.5 Early Intervention

Level I Outpatient
less than 9 contact hours/week ~
~ 1-2/week

Level II.1 Intensive Outpatient

9 or more contact hours/week in a Structured
Program (6hrs for adolescent)
~ 3/week 9-19hrs total
~

Level II.5 Partial Hospitalization (Day/Night)

12 or more contact hours/week in a Structured
Program
Residential Levels of Care & Services
Level III.1 Residential Level IV
~
~ 5 hours/week (halfway house)

Level III.3 Residential Level III

For clients requiring extended care due to
cognitive disabilities, brain injuries/disorders.

Level III.5 Residential Levels I & II

Provides residential treatment, includes all
services except medical services.

Level I-D Detoxification

Services provided by a licensed hospital only,
medical or psychiatric needs, e.g. patients acutely
suicidal
ASAM & Treatment Levels Crosswalk
Adolescent Clients
Level 0.5 Intervention
Level I Outpatient
Level II.1 Intensive Outpatient
Level II.5 Day/Night
Level III.5 Level I & II Residential
Level III.2-D Addiction Receiving Facilities
Level III.7-D Detoxification
ASAM criteria for all levels of care
 Examples of ASAM Requirements
Adult Intervention Level .05 (Admission)
Must meet one of the Dimensions of 4,5, or 6 and any
identifiable problems in Dimensions 1,2, or 3 that are
stable or being addressed through appropriate outpatient
medical or mental health services.

Adolescent Intensive Outpatient Level II.1 (Continued Stay)

The client is sufficiently stable in Dimensions 2 and 3 to allow
participation in this level of care, and the client meets the criteria in
one of Dimensions 4,5, or 6.

Adult Residential Level III.5 (Discharge)

The client meets criteria in at least one of the six
Dimensions
 Correlation between ASI/ASAM
ASI Assessment Areas ASAM Dimensions
Medical Status Acute Intoxication/Withdrawal
Potential

Employment/Support Status Biomedical Conditions &

Complications

Alcohol/Drugs
Emotional/Behavioral/Cognitive
Conditions & Complications
Legal Status
Readiness to Change

Family/Social Status Relapse/Continued Used/Problem

Potential

Psychiatric Status Recovery Environment

 Factors affecting Dimension I
Acute Intoxication/Withdrawal Potential

What are the risks

associated with the client’s
current level of acute
intoxication? Current signs
of withdrawal?
What are the client’s
frequency and amount of
substance(s) use and the
history of withdrawal
symptoms?

Client’s drug(s) of choice in relation to the

drug’s withdrawal symptoms. Substances that
may require medically managed detox due to
the possibility of death if stopped
immediately: barbiturates, alcohol and
benzodiazepines.
 Factors affecting Dimension II
Biomedical Conditions & Complications

Does the client have

any current untreated Does the client have any
severe medical illness or requires medical
problems that may attention that may interfere
interfere with with treatment? E.g.,
treatment? hypertension, diabetes, the
need for dialysis or
chemotherapy?

Is the client being treated with

narcotic analgesics for chronic
pain?
 Factors affecting Dimension III
Emotional/Behavioral/Cognitive
Conditions & Complications

Are there current psychiatric

illness, psychological,
behavioral or emotional What is the client’s current
problems? Is it being mental status? Client’s
addressed? orientation to all three
spheres (person, place,
time).
Impulse with regards to
suicide, homicide or other
behaviors that pose a
risk/threat to self or Is the client currently on
others? psychiatric medications and are
they complying with treatment?
 Factors affecting Dimension IV
Readiness to Change

• Pre-contemplation • Maintenance
How ready is the client
to change (stage of • Contemplation • Relapse and
readiness to change)? Recycling
• Preparation
• Termination
• Action

Is the client compliant with

treatment to avoid negative
consequences? E.g., enter How accepting is the client
drug treatment or go to jail towards treatment?
for 6 months
 Factors affecting Dimension V
Relapse/Continued Used/Problem Potential

How aware is the client

of relapse triggers,
Compliance vs. Adherence ways to cope with
client maybe willing but unable craving and skills to
control impulses to use?

What is the client’s Is the client in immanent

history of treatment
compliance in areas of
medical, mental health
and/or substance abuse?
danger of continued severe
distress and substance use
or other high-risk behavior
due to a co-occurring
mental problem?
 Factors affecting Dimension VI
Recovery Environment

Is client surrounded by
individuals or situations Are there barriers to
that threatens treatment access to treatment? E.g.,
engagement and success? transportation, child care
responsibilities?
Does the client have
supportive friendship,
financial or
education/vocational What is the client’s
resources to improve motivation for treatment
the likelihood of and does the client see
successful treatment? value in recovery?
 ASAM Recommendations/Notes
Insufficient and generalized client
summaries:
“Client will benefit from this level of care.”
“Client meets the criteria for admission.”
“Client appears ready to continue with
residential treatment.”

“Client is a 40 y/o male. Client will benefit

from outpatient treatment due to history of
substance abuse.”
 ASAM Recommendations/Notes
Example of Summary: Paragraph Format

CL is a 33 y/o male, referred to res. tx from JMH

detox. CL reported a 6yr hx of cocaine use at approx.
5g of cocaine 3x/day. CL also reported that he drinks a
6pk of beers and 3 magnum bottles of vodka per day.
CL stated that his last use was 5 days ago prior to
detox at JMH. CL denied any medical problems. CL
denied hx of psychiatric treatment. CL is married with 2
kids but was kicked out of the house 3 months ago due
to his use. CL was oriented to all spheres at the time of
assessment. Based on the information provided, CL
meets ASAM criteria for Residential Substance Abuse
Treatment.
 ASAM Recommendations/Notes
Example of client summary: Dimension Format
D1 – Client reported smoking 1 joint of marijuana and drinking 4-6
beer 2/wk and reported last used 7 days ago.
D2 – Client stated that he suffers from hypertension and is
compliant with medication.
D3 – Client stated that he feels depressed due to his drug use but
has never see a psychiatrist or treated with medication.
D4 – Client appears to be in the contemplation stage of change due
to his DUI charge and court order status.
D5 – Client is not aware of his triggers and is predisposed to
continued use due to his cycle of substance use.
D6 – Client stated that he has been staying with a friend b/c
mother does not want him at her house.
Client meets the criteria for outpatient treatment and his
appointment is next Wednesday.
Questions and Comments
 Reference
Department of Children and families Substance Abuse
program, (2006). Florida Supplement to the American
Society of Addiction Medicine patient Placement Criteria
for the Treatment of Substance-Related Disorders Second
Edition (ASAMPPC-2R).

Shulman, G. D., (2007). Using the ASAM PPC-2R

Throughout the Treatment Process.

©2008 SFPC Strategic Planning & Development Department