ASAM 101: How to complete the ASAM Placement Form

ASAM 101:
How to complete the
ASAM Placement Form
What is the ASAM?
The ASAM Placement Form is a
document required by contract
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
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
Level I
Level II.1
Level II.5
Level III.1
Level III.3
Level III.5
Level I-D
Intensive Outpatient
Level IV Residential
Level III Residential
Level I & II Residential
Outpatient Levels of Care & Services
Level 0.5
Early Intervention
Level I
Level II.1
Intensive Outpatient
Level II.5
less than 9 contact hours/week ~
~ 1-2/week
9 or more contact hours/week in a Structured
Program (6hrs for adolescent)
~ 3/week 9-19hrs total
Partial Hospitalization (Day/Night)
12 or more contact hours/week in a Structured
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
Services provided by a licensed hospital only,
medical or psychiatric needs, e.g. patients acutely
ASAM & Treatment Levels Crosswalk
Adolescent Clients
Level 0.5
Level I
Level II.1
Level II.5
Level III.5
Level III.2-D
Level III.7-D
Intensive Outpatient
Level I & II Residential
Addiction Receiving Facilities
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
Correlation between ASI/ASAM
ASI Assessment Areas
ASAM Dimensions
Medical Status
Acute Intoxication/Withdrawal
Employment/Support Status
Biomedical Conditions &
Conditions & Complications
Legal Status
Readiness to Change
Family/Social Status
Relapse/Continued Used/Problem
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
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
Factors affecting Dimension II
Biomedical Conditions & Complications
Does the client have
any current untreated
severe medical
problems that may
interfere with
Does the client have any
illness or requires medical
attention that may interfere
with treatment? E.g.,
hypertension, diabetes, the
need for dialysis or
Is the client being treated with
narcotic analgesics for chronic
Factors affecting Dimension III
Conditions & Complications
Are there current psychiatric
illness, psychological,
behavioral or emotional
problems? Is it being
What is the client’s current
mental status? Client’s
orientation to all three
spheres (person, place,
Impulse with regards to
suicide, homicide or other
behaviors that pose a
risk/threat to self or
Is the client currently on
psychiatric medications and are
they complying with treatment?
Factors affecting Dimension IV
Readiness to Change
How ready is the client
to change (stage of
readiness to change)?
• Pre-contemplation • Maintenance
• Contemplation
• Preparation
• Action
Is the client compliant with
treatment to avoid negative
consequences? E.g., enter
drug treatment or go to jail
for 6 months
• Relapse and
• Termination
How accepting is the client
towards treatment?
Factors affecting Dimension V
Relapse/Continued Used/Problem Potential
Compliance vs. Adherence
client maybe willing but unable
What is the client’s
history of treatment
compliance in areas of
medical, mental health
and/or substance abuse?
How aware is the client
of relapse triggers,
ways to cope with
craving and skills to
control impulses to use?
Is the client in immanent
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
that threatens treatment
engagement and success?
Does the client have
supportive friendship,
financial or
resources to improve
the likelihood of
successful treatment?
Are there barriers to
access to treatment? E.g.,
transportation, child care
What is the client’s
motivation for treatment
and does the client see
value in recovery?
ASAM Recommendations/Notes
Insufficient and generalized client
“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
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
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