ASAM Criteria Assessment | 6-Dimension Level of Care Determination

The ASAM Criteria: Matching Substance Use Treatment to Clinical Need

The ASAM (American Society of Addiction Medicine) Criteria are the gold standard for determining appropriate level of care in substance use treatment. They answer a crucial question: Does this client need outpatient therapy, intensive outpatient care, residential treatment, or medically managed intensive inpatient care? Without clear criteria, level-of-care decisions are often driven by insurance coverage or client preference rather than clinical need. The ASAM Criteria force clinical reasoning: assess the client across six dimensions (intoxication/withdrawal, biomedical, emotional/behavioral, readiness for change, relapse/continued use risk, and recovery environment), and the assessment itself determines the minimum necessary level of care.

ASAM Criteria are used by addiction medicine specialists, treatment programs, and insurance companies. Many treatment programs use ASAM assessment as part of their intake and transfer processes. Understanding and documenting ASAM Criteria demonstrates clinical rigor and is essential for managed care justification.

What are the ASAM Criteria?

The ASAM Criteria are a set of dimensions and indicators used to assess the severity of a client's substance use disorder and determine the appropriate level of care. The most recent version (ASAM Criteria, Third Edition) uses six dimensions:

Dimension 1 — Acute Intoxication & Withdrawal Potential: Can the client safely withdraw from substances, or are they at medical risk?

Dimension 2 — Biomedical Conditions & Complications: What medical conditions are present? Are they stable? Do they require medical monitoring?

Dimension 3 — Emotional, Behavioral, & Cognitive Conditions: Is there psychiatric illness? Suicidal ideation? Cognitive impairment? Behavioral dyscontrol?

Dimension 4 — Readiness for Change: Is the client motivated for treatment? In denial? Ambivalent?

Dimension 5 — Relapse, Continued Use, & Continued Problem Potential: How high is the risk of relapse? What are the triggers? Are protective factors present?

Dimension 6 — Recovery Environment: Is the recovery environment supportive or harmful? Are there adequate social support, stable housing, employment, and safety from domestic violence or criminal activity?

Levels of Care

Based on the assessment across these six dimensions:

• Level 0.5 — Early Intervention: Minimal risk; client does not meet SUD criteria but shows signs of risky substance use.
• Level I — Outpatient: Client can maintain treatment in outpatient sessions (1+ per week) while living in the community.
• Level II — Intensive Outpatient (IOP): Client requires structured treatment, typically 9+ hours per week, but lives in the community; usually weekday evenings or daytime sessions.
• Level II.5 — Partial Hospitalization (PHP): Client requires day program treatment (6+ hours/day, 5 days/week) with medical monitoring; returns home evenings.
• Level III — Residential/Inpatient: Client requires 24-hour residential care; treatment on-site; for significant medical/psychiatric risk, withdrawal management, or acute relapse risk.
• Level IV — Medically Managed Intensive Inpatient: Client requires acute medical or psychiatric stabilization; typically hospitalization for detoxification or psychiatric crisis.

What goes in the template

A comprehensive ASAM assessment includes:

Dimension 1 — Acute Intoxication & Withdrawal Potential:

• Is the client currently intoxicated? (affects immediate safety)
• Withdrawal risk: Can the client safely manage withdrawal in outpatient setting, or is medical monitoring needed?
• Substances that carry high withdrawal risk (alcohol, benzodiazepines, opioids)
• Prior withdrawal severity and seizure/delirium tremens history
• Medical comorbidities that increase withdrawal risk

Dimension 2 — Biomedical Conditions & Complications:

• Acute medical conditions (hepatitis, endocarditis, infections from injection use, overdose history)
• Chronic conditions (liver disease, HIV, cardiac disease)
• Medication-related issues
• Pregnancy status (if applicable)
• Ability to perform self-care and follow medical regimen
• Need for medical monitoring or medication management

Dimension 3 — Emotional, Behavioral, & Cognitive Conditions:

• Current psychiatric symptoms (depression, anxiety, psychosis, PTSD)
• Psychiatric diagnoses
• Cognitive impairment (from substance use or other causes)
• Suicidal/homicidal ideation
• Capacity to follow treatment (can the client understand and comply?)
• Capacity to handle stress (will they relapse under stress?)
• Impulse control and behavioral dyscontrol

Dimension 4 — Readiness for Change:

• Stage of change (precontemplation, contemplation, preparation, action, maintenance)
• Motivation level (low, moderate, high)
• Ambivalence about change
• Treatment compliance in past (if applicable)
• External vs. internal motivation (legal pressure vs. personal desire)

Dimension 5 — Relapse, Continued Use, & Continued Problem Potential:

• Prior treatment episodes and outcomes
• Relapse history (frequency, triggers)
• Coping skills and protective factors
• Cognitive and emotional capability to cope with cravings
• Pattern of use (binges vs. steady use) and control over quantity/frequency
• Risk of continued substance use despite treatment

Dimension 6 — Recovery Environment:

• Housing stability and safety
• Family support (or family enabling use?)
• Peer support or peer pressure toward use
• Employment or school engagement
• Community involvement (church, clubs, activities)
• Presence of abuse, violence, or criminal activity
• Access to transportation and resources

Overall Assessment: Integrate findings across all six dimensions. Identify which dimension requires the highest level of care; that dimension often determines the minimum necessary level of care for the client.

When to use the ASAM assessment

• SUD treatment intake: Determine appropriate level of care
• Treatment planning: Justify choice of outpatient vs. IOP vs. residential
• Step-down decisions: When transitioning from higher to lower levels of care
• Insurance authorization: ASAM assessment justifies medical necessity of the level of care
• Dual diagnosis treatment: When psychiatric and SUD treatment must be coordinated

How to use the ASAM assessment with Scriber

During session: Administer the ASAM assessment as part of the comprehensive intake. Move through the six dimensions systematically, gathering information on each.

After session: When you record and transcribe with Scriber, the assessment conversation is fully captured. Scriber's clinical AI can extract:

• Findings across all six ASAM dimensions
• Identified risks and protective factors
• Severity ratings in each dimension
• Recommended level of care with clinical justification
• Medical, psychiatric, and social needs identified
• Referrals needed (detoxification, psychiatric, medical, case management)

Scriber auto-generates the ASAM assessment note with level-of-care determination and clinical justification.

Sample ASAM assessment summary

Client: 31-year-old female, presenting for SUD treatment evaluation after DUI arrest.

Dimension 1 — Acute Intoxication & Withdrawal: Client not currently intoxicated. Primary substance is alcohol (8–12 drinks daily); secondary substance is benzodiazepines (not prescribed, obtained from peers). High withdrawal risk. Prior withdrawal experiences: shaking, sweating, insomnia; no prior seizures or DTs. Medically risky to detox in outpatient setting without medical monitoring. Recommendation: Medical detoxification or medically monitored outpatient withdrawal indicated.

Dimension 2 — Biomedical Conditions: Multiple DUI-related injuries (fracture, contusions); liver function tests abnormal (AST 78, ALT 92); no other acute medical conditions. Chronic: migraine headaches (treated), no HIV/hep C screening done. Generally healthy other than alcohol consequences. Self-care adequate. Needs medical evaluation, labs, monitoring during withdrawal.

Dimension 3 — Emotional/Behavioral/Cognitive: Moderate depression and anxiety; reports depressed mood since DUI arrest 3 weeks ago; not on psychiatric medication. Denies suicidal ideation. No psychosis. Some memory difficulties (reports blackouts from drinking). Cognitive capacity appears intact; can understand treatment recommendations. Impulse control variable — impulsive decisions around alcohol use. Stress tolerance low; responds to stress with drinking.

Dimension 4 — Readiness for Change: Client in Preparation stage. Motivation level is moderate-to-high; motivated by legal consequences (DUI), parental pressure, and concern about health. Extrinsic motivation (legal) is primary, but client shows some intrinsic motivation ("I'm tired of waking up ashamed"). Prior treatment: None.

Dimension 5 — Relapse/Continued Use Risk: First SUD treatment episode; reports 8-year history of escalating use. High-risk triggers: stress, conflict with partner, social situations. Coping skills: limited; uses alcohol to manage emotions. Protective factors: concerned about daughter's perception, wants to be a better parent. Relapse risk is moderate-to-high if only outpatient support without intensive structure.

Dimension 6 — Recovery Environment: Housing: stable, living with partner; relationship functional but partner also uses alcohol, which is a relapse risk. Family: Adult daughter (age 12) lives with client; motivated by desire to model recovery to daughter. Employment: Employed part-time; concerned about job security post-DUI. Social: Social network centered on drinking; few non-using friends. Transportation: Has vehicle (currently suspended due to DUI). No domestic violence or imminent safety risks.

Level of Care Determination: Level II.5 — Partial Hospitalization (PHP) or Level III — Residential is indicated.

Justification: Dimension 1 (withdrawal risk) requires medical monitoring. Dimension 3 (depression, low stress tolerance, moderate cognitive impairment from use) indicates need for psychiatric support. Dimension 5 (high relapse risk, limited coping skills, brief sobriety period) indicates need for intensive structure. Dimension 6 (partner who uses, social network centered on drinking) means recovery environment is not sufficiently supportive for lower level of care.

Recommendation: Medical detoxification (4–7 days inpatient), followed by PHP (6 weeks) with psychiatric medication evaluation, individual therapy, group therapy, family therapy, and relapse prevention. After PHP, transition to outpatient + AA/SMART Recovery based on progress.

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Why ASAM Criteria matter

ASAM Criteria force clinicians to make level-of-care decisions based on clinical need, not on client preference or insurance coverage. A client might want outpatient treatment, but if they have high withdrawal risk and unstable recovery environment, outpatient care sets them up to fail. Conversely, a client might need residential care for psychological/motivational reasons, but if they have stable housing and strong motivation, intensive outpatient is appropriate and more cost-effective. ASAM Criteria ensure the right match between client needs and treatment intensity.

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Download the ASAM Criteria Assessment template — PDF and DOCX formats available. Use to assess all SUD clients and determine appropriate level of care. The six-dimension structure ensures comprehensive evaluation.

Start a 7-day trial — Record your ASAM assessment session, Scriber transcribes the full evaluation across all six dimensions, and auto-generates a level-of-care determination with clinical justification.