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

DIMENSION 1: Acute Intoxication DIMENSION 2: Biomedical DIMENSION 3: Emotional, Behavioral, or DIMENSION 4: DIMENSION 5: Relapse, Continued DIMENSION 6: Recovery/Living
Adult Levels of Care and/or Withdrawal Potential Conditions and Complications Cognitive Conditions and Complications Readiness to Change Use, or Continued Problem Potential Environment

LEVEL 0.5 Willing to explore how current alcohol, Needs an understanding of, or skills to Social support system or significant
tobacco, other drug, or medication use, change, current alcohol, tobacco, other others increase the risk of personal
No withdrawal risk None or very stable None or very stable
and/or high-risk behaviors may affect drug, or medication use patterns, and/or conflict about alcohol, tobacco, and/or
Early Intervention personal goals high risk behavior other drug use

OTP – LEVEL 1 Ready to change the negative effects of

Physiologically dependent on opioids At high risk of relapse or continued use
None or manageable with outpatient None or manageable in an outpatient opioid use, but is not ready for total Recovery environment is supportive
and requires OTP to prevent without OTP and structured therapy to
medical monitoring structured environment abstinence from illicit prescription or non- and/or the patient has skills to cope
withdrawal promote treatment progress
Opioid Treatment Program prescription drug use

Not experiencing significant

LEVEL 1 Ready for recovery but needs motivating and monitoring Able to maintain abstinence or control
withdrawal, or at minimal risk of severe strategies to strengthen readiness. Or needs ongoing
None or very stable, or is receiving None or very stable, or is receiving use and/or addictive behaviors and Recovery environment is supportive
withdrawal. Manageable at Level 1- monitoring and disease management. Or high severity in
concurrent medical monitoring concurrent mental health monitoring this dimension but not in other dimensions. Needs Level 1 pursue recovery or motivational goals and/or the patient has skills to cope
WM (See withdrawal management
Outpatient Services motivational enhancement strategies with minimal support
criteria)

LEVEL 2.1 Intensification of addiction or mental health

Minimal risk of severe withdrawal, None or not a distraction from Has variable engagement in treatment, ambivalence, or a Recovery environment is not
symptoms indicate a high likelihood of
Mild severity, with potential to distract from lack of awareness of the substance use or mental health
manageable at Level 2-WM (See treatment. Such problems are problem, and requires a structured program several times a
relapse or continued use or continued supportive, but with structure and
recovery; needs monitoring problems without close monitoring and
withdrawal management criteria) manageable at Level 2.1 week to promote progress through the stages of change support, the patient can cope
Intensive Outpatient Services support several times a week

LEVEL 2.5 Has poor engagement in treatment, significant ambivalence, Intensification of addiction or mental health Recovery environment is not
Moderate risk of severe withdrawal None or not sufficient to distract from or a lack of awareness of substance use or mental health symptoms, despite active participate in a Level 1 or
Mild to moderate severity, with potential to supportive, but with structure and
manageable at Level 2-WM (See treatment. Such problems are problem, requiring a near-daily structured program or 2.1 program, indicates a high likelihood of relapse or
distract from recovery; needs stabilization intensive engagement services to promote progress through continued use or continued problems without near- support and relief from the home
withdrawal management criteria) manageable at Level 2.5
Partial Hospitalization Services the stages of change daily monitoring and support environment, the patient can cope

LEVEL 3.1 No withdrawal risk, or minimal or stable

withdrawal. Concurrently receiving Level 1- None or minimal; not distracting to Environment is dangerous, but recovery
None or stable, or receiving concurrent Open to recovery, but needs a structured Understands relapse but needs structure
WM (minimal) or Level 2-WM (moderate) recovery. If stable, a co-occurring enhanced is achievable if Level 3.1 24-hour
services (See withdrawal management medical monitoring environment to maintain therapeutic gains to maintain therapeutic gains
Clinically Managed Low-Intensity program is required structure is available
criteria)
Residential Services

LEVEL 3.3 At minimal risk of severe withdrawal. If Mild to moderate severity; needs structure to focus on Has little awareness and needs interventions available only
Has little awareness and needs interventions available
recovery. Treatment should be designed to address at Level 3.3 to engage and stay in treatment. If there is high
withdrawal is present, manageable at None or stable, or receiving concurrent significant cognitive deficits. If stable, a co-occurring severity in Dimension 4 but not in any other dimension,
only at Level 3.3 to prevent continued use, with Environment is dangerous and patient
Level 3.2-WM (See withdrawal medical monitoring imminent dangerous consequences, because of needs 24-hour structure to learn to cope
Clinically Managed Population capable program is appropriate. If not, a co-occurring motivational enhancement strategies should be provided in
cognitive deficits or comparable dysfunction
–Specific High-Intensity Residential management criteria) enhanced program is required. Level 1

Services

Demonstrates repeated inability to control impulses, or

LEVEL 3.5 At minimal risk of severe withdrawal. If unstable and dangerous signs/symptoms require Has marked difficulty with, or opposition to, treatment, Has no recognition of the skills needed Environment is dangerous and the
withdrawal is present, manageable at None or stable, or receiving concurrent stabilization. Other functional deficits require stabilization with dangerous consequences. If there is high severity in
and a 24-hour setting to prepare for community integration Dimension 4 but not in any other dimension, motivational to prevent continued use, with patient lacks skills to cope outside of a
Level 3.2-WM (See withdrawal medical monitoring
Clinically Managed High-Intensity and continuing care. A co-occurring enhanced setting is enhancement strategies should be provided in Level 1 imminently dangerous consequences highly structured 24-hour setting
management criteria) required for those with severe and chronic mental illness
Residential Services

At high risk of withdrawal, but Moderate severity; needs a 24-hour Low interest in treatment and impulse control is poor,
LEVEL 3.7 despite negative consequences; needs motivating strategies Unable to control use, with imminently
manageable at Level 3.7-WM and does structured setting. If the patient has a co- Environment is dangerous and the
Requires 24-hour medical monitoring only safely available in a 24-hour structured setting. If there dangerous consequences, despite active
not require the full resources of a occurring mental disorder, requires is high severity in Dimension 4 but not in any other
patient lacks skills to cope outside of a
but not intensive treatment participation at less intensive levels of
Medically Monitored Intensive Inpatient licensed hospital (See withdrawal concurrent mental health services in a dimension, motivational enhancement strategies should be highly structured 24-hour setting
provided in Level 1
care
Services management criteria) medically monitored setting

LEVEL 4 At high risk of withdrawal and requires Because of severe and unstable problems, Problems in this dimension do not qualify the patient for
Requires 24-hour medical and nursing Level 4 services. If the patient’s only severity is in Problems in this dimension do not Problems in this dimension do not
Level 4-WM and the full resources of a requires 24-hour psychiatric care with
care and the full resources of a licensed Dimension 4, 5, and/or 6 without high severity in qualify the patient for Level 4 services. qualify the patient for Level 4 services.
licensed hospital (See withdrawal concomitant addiction treatment (co- Dimensions 1, 2, and/or 3, then the patient does not qualify
Medically Managed Intensive Inpatient hospital See further explanation in Dimension 4 See further explanation in Dimension 4
management criteria) occurring enhanced) for Level 4
Services