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TO DIAGNOSE SUD USING ASAM

The Six Dimensions of the ASAM Criteria


1. Acute Intoxication and/or Withdrawal Potential

The first dimension explores an individual’s past and current experiences of substance use and withdrawal. No longer called “detoxification,” withdrawal management encompasses a range of services designed to meet a person’s biopsychosocial needs.

2. Biomedical Conditions and Complications

The second dimension explores an individual’s health history and current physical condition. The goal is to determine whether the person needs additional physical health services, from acute stabilization to ongoing management of a chronic condition.

3. Emotional, Behavioral or Cognitive Conditions and Complications

The third dimension explores an individual’s thoughts, emotions and mental health issues. This may include cognitive, behavioral, psychiatric and trauma-related conditions.

When considering the third dimension, it’s important to determine whether signs and symptoms can be addressed safely through addiction treatment (i.e., mood swings due to drug use) or warrant additional mental health services (i.e., mood swings due to concurrent bipolar disorder).

Dimension 3 also identifies five subcategories known as risk domains. These include: dangerousness/lethality, interference with addiction recovery efforts, social functioning, ability for self-care and course of illness.

4. Readiness to Change

The fourth dimension explores an individual’s readiness and interest in changing. Leaning on the transtheoretical model of behavior change (TTM), this dimension helps clinicians develop individualized care for people based on their readiness to change. The goal is to engage people in their own behavior change, providing motivational enhancement services as necessary.

It’s important to recognize people may show different levels of readiness to change for different issues. An individual may be already making changes in one area of his or her life while still seeing no problem with another self-destructive behavior.

5. Relapse, Continued Use or Continued Problem Potential

The fifth dimension explores an individual’s unique relationship with relapse, continued use or continued problems. This dimension is relevant at any stage of treatment – even if a person has not achieved a level of recovery that would seem to allow for relapse.

6. Recovery Environment

The sixth dimension explores an individual’s recovery or living situation, including the surrounding people, places and things. A person’s needs could include housing, financial, vocational, educational, legal, transportation or child care services. Clinicians also examine whether family members, significant others or school, work and living situations pose a threat to the person’s treatment and recovery.



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