Addictions Counselor Core Skills, Part III: Applying ASAM Criteria

Summary

The video script offers an in-depth look at the ASAM Criteria, guidelines by the American Society of Addiction Medicine for assessing and treating substance use disorders. It outlines six bio-psycho-social dimensions for client evaluation, including acute intoxication, medical conditions, psychological issues, readiness to change, relapse potential, and recovery environment. The script also explains various levels of care, from outpatient to medically managed inpatient, tailored to the severity and needs of the individual, emphasizing continuous assessment and adjustment throughout the treatment process.

Takeaways

• 📊 ASAM Criteria are guidelines by the American Society of Addiction Medicine for assessing and determining the appropriate level of care for clients with substance use disorders.
• 🧬 The assessment process is based on a bio-psycho-social (BPS) model, which involves looking at six different dimensions of a client's background and needs.
• 🍷 Dimension 1 focuses on acute intoxication or withdrawal potential, assessing the client's current state of intoxication and the risk associated with withdrawal from substances.
• 🏥 Dimension 2 examines general medical conditions and complications that could affect the treatment and need for medical monitoring during the recovery process.
• 🧠 Dimension 3 addresses cognitive, behavioral, and emotional conditions, including mental illnesses and psychological issues that may complicate treatment.
• 🚀 Dimension 4 evaluates the client's readiness to change, including their motivation and stage of change, which is crucial for tailoring the treatment approach.
• 🔄 Dimension 5 looks at the potential for relapse and continued use, considering the client's environment and support system that could influence their recovery.
• 🏡 Dimension 6 assesses the recovery environment, including the client's living situation, family dynamics, and access to community resources and support.
• 🔄 Assessment is an ongoing process that should be continuously re-evaluated throughout the treatment to ensure the client receives the appropriate level of care.
• 🏢 The levels of care range from Level 0.5 (early intervention) to Level 4 (medically managed intensive inpatient care), with varying intensities and types of support.
• 💊 Special mention is given to opioid maintenance therapy programs that combine medication-assisted treatment with comprehensive clinical support.

Q & A

What are the ASAM Criteria?

The ASAM Criteria are guidelines established by the American Society of Addiction Medicine for assessing and placing clients into appropriate levels of addiction treatment based on a bio-psycho-social model.

How many dimensions does the ASAM assessment model consist of?

The ASAM assessment model consists of six dimensions that cover biological, psychological, and social aspects of a client's situation.

What does Dimension 1 of the ASAM assessment focus on?

Dimension 1 focuses on acute intoxication or withdrawal potential, assessing the client's current state of intoxication, the last time of use, and the severity of symptoms that may interfere with functioning.

Why is it important to assess general medical conditions and complications in Dimension 2?

Assessing general medical conditions and complications in Dimension 2 is important to determine how they may affect the type of treatment the person will receive and to ensure these medical issues are addressed throughout their care.

What psychological issues are considered in Dimension 3 of the ASAM assessment?

Dimension 3 considers cognitive, behavioral, and emotional conditions, including current mental illnesses or psychological/behavioral problems that may affect treatment or create risks.

Can you explain the concept of 'readiness to change' in Dimension 4?

In Dimension 4, 'readiness to change' refers to the client's motivation and willingness to receive services, including whether they are mandated into treatment or voluntarily seeking help, and their stage of change from pre-contemplation to maintenance.

What factors are evaluated in Dimension 5 regarding relapse and continued use potential?

Dimension 5 evaluates factors such as immediate danger of distress, continued drug use, relapse triggers, and the client's ability to cope with high-risk situations.

How does Dimension 6, the recovery environment, relate to the client's living situation?

Dimension 6 assesses the client's family and living situation, including the presence of drugs, supportive or harmful influences, educational and vocational status, legal issues, and the availability of community supports.

What is the significance of ongoing assessment in the ASAM model?

Ongoing assessment in the ASAM model is significant as it allows clinicians to continuously evaluate and adjust the level of care needed by the client, ensuring the treatment remains appropriate throughout the recovery process.

Can you provide an example of a level of care according to the ASAM Criteria?

An example is Level 3.5, high-intensity residential care, which involves 24-hour care with trained staff, suitable for clients who can tolerate a high-intensity therapeutic environment and require a stable living situation with group support.

What is the role of opioid maintenance therapy programs in the ASAM framework?

Opioid maintenance therapy programs, using medications like methadone or suboxone, provide pharmaceutical assistance along with case management and clinical support to help individuals with opioid addiction, offering a comprehensive approach to recovery.

Outlines

00:00

📚 Introduction to ASAM Criteria and Dimensions of Treatment

The video script introduces the American Society of Addiction Medicine (ASAM) criteria, focusing on the dimensions used to assess clients for addiction treatment. It outlines a bio-psycho-social (BPS) model encompassing six dimensions: acute intoxication or withdrawal potential (Dimension 1), general medical conditions (Dimension 2), cognitive, behavioral, and emotional conditions (Dimension 3), readiness to change (Dimension 4), and social dimensions including relapse potential and recovery environment (Dimensions 5 and 6). The script emphasizes the importance of a holistic assessment to determine the appropriate level of care for clients.

05:00

🔍 Assessing Client Needs and Determining Levels of Care

This paragraph delves deeper into the ASAM criteria, explaining the process of assessing a client's condition across the six dimensions. It discusses the importance of evaluating acute intoxication, medical stability, psychological issues, readiness for change, relapse risks, and the recovery environment. The script also introduces the concept of ongoing assessment throughout treatment, highlighting the fluid nature of client needs and the necessity for adjusting care levels accordingly.

10:03

🏥 Exploring the Range of ASAM Levels of Care

The script outlines the various levels of care as defined by ASAM, starting from Level 0.5 (early intervention) to Level 4 (medically managed intensive inpatient care). It describes the services and intensity of treatment provided at each level, such as outpatient services (Level 1), intensive outpatient (Level 2.1), partial hospitalization (Level 2.5), residential care (Levels 3.1 and 3.5), and inpatient hospital care (Level 4). The paragraph also discusses the criteria for assigning a client to a specific level of care based on the severity of their condition and the need for medical monitoring or support.

15:05

💊 Special Considerations for Detoxification and Opioid Maintenance Therapy

The final paragraph addresses special considerations in ASAM criteria, such as the need for medical monitoring during detoxification and the role of opioid maintenance therapy programs using methadone or suboxone. It emphasizes the comprehensive support these programs provide, including counseling, case management, and medical services, to aid in the recovery process for individuals with opioid addiction.

Keywords

💡ASAM Criteria

The ASAM Criteria refer to the guidelines established by the American Society of Addiction Medicine. These criteria are pivotal in the video as they provide a structured approach to assess and determine the appropriate level of care for individuals struggling with addiction. The script discusses the ASAM dimensions for assessment and the levels of care, emphasizing the importance of a comprehensive evaluation to guide treatment decisions.

💡Biopsychosocial Model

The biopsychosocial model is a holistic approach to understanding a client's background and needs, as mentioned in the script. It encompasses biological, psychological, and social factors to form a comprehensive assessment. In the context of the video, this model is used to gather information during the assessment process, which aids in making informed clinical judgments about the type of care required for addiction treatment.

💡Acute Intoxication

Acute intoxication is a biological dimension in the ASAM Criteria, which involves assessing whether a client is currently intoxicated and the severity of symptoms related to substance use. The script explains that this dimension is crucial for determining the risk of intoxication and the need for medically monitored withdrawal, especially with substances like alcohol and benzodiazepines.

💡Withdrawal Potential

Withdrawal potential is another aspect of the biological dimension discussed in the script. It refers to the risk and severity of withdrawal symptoms that a client may experience after chronic substance use. The assessment of withdrawal potential is vital for deciding whether detoxification can be safely managed in a non-medical setting or requires medical supervision.

💡General Medical Conditions

General medical conditions are part of the biological dimension in the ASAM assessment. The script highlights the importance of identifying any medical history or current health issues that could affect the type of treatment a person receives. This includes ensuring that medical issues are addressed and monitored throughout the treatment process.

💡Cognitive Behavioral and Emotional Conditions

This psychological dimension from the ASAM Criteria is focused on assessing mental health and behavioral issues that may affect treatment. The script discusses the need to evaluate whether there are any psychological or behavioral problems that could complicate treatment or create a risk, emphasizing the importance of understanding a client's mental health status and their ability to function in daily life.

💡Readiness to Change

Readiness to change is a psychological dimension that assesses a client's motivation and willingness to engage in treatment. The script explains that understanding a client's stage of change, from pre-contemplation to maintenance, is crucial for determining the appropriate level of care and their likelihood of successful treatment outcomes.

💡Relapse Potential

Relapse potential is a social dimension in the ASAM Criteria, which evaluates the likelihood of a client returning to substance use after leaving a treatment setting. The script describes the importance of considering the client's environment, support system, and coping skills to determine the risk of relapse and the need for a more intensive level of care.

💡Recovery Environment

The recovery environment is the final social dimension discussed in the script. It involves assessing the client's living situation, family dynamics, and community supports, which can significantly impact the recovery process. The script emphasizes the need to consider factors such as access to drugs, the influence of peers, and the presence of legal or educational issues when determining the appropriate level of care.

💡Levels of Care

Levels of care are classifications within the ASAM Criteria that match the assessment dimensions to specific treatment services. The script outlines various levels, from early intervention to medically managed intensive inpatient care, detailing the intensity and type of services provided at each level. The levels of care are crucial for clinicians to make informed decisions about the most appropriate treatment setting for a client based on their assessed needs.

Highlights

Introduction to ASAM Criteria, the guidelines by the American Society of Addiction Medicine.

Exploration of two main elements of ASAM: dimensions for client assessment and levels of care.

Explanation of the six dimensions of treatment using a bio-psycho-social (BPS) model for a holistic assessment.

Dimension 1 focuses on acute intoxication or withdrawal potential and its impact on client functioning.

The importance of medical monitoring for chronic use of substances like alcohol and benzodiazepines during withdrawal.

Dimension 2 assesses general medical conditions and their impact on treatment type and monitoring.

Cognitive, behavioral, and emotional conditions are the focus of Dimension 3, assessing mental health and daily living activities.

Dimension 4 evaluates readiness to change, including motivation and stage of change for treatment.

Dimension 5 examines relapse and continued use potential, considering the client's environment and coping skills.

Dimension 6 assesses the recovery environment, including family, living situation, and community support.

The ongoing nature of assessment as a critical part of the treatment process.

Different levels of care ranging from Level 0.5 (early intervention) to Level 4 (medically managed intensive inpatient care).

Level 1 outpatient services and the role of group counseling in recovery and prevention.

Level 2.1 intensive outpatient programs addressing multi-dimensional instability.

Level 2.5 partial hospitalization programs providing structured day programming for clients.

Level 3.1 low-intensity residential care, such as halfway houses and recovery homes.

Level 3.5 high-intensity residential programs requiring 24-hour care and trained staff.

Level 4 inpatient care for clients with severe substance use issues and medical needs.

Special designation for opioid maintenance therapy programs combining medication with clinical support.

Assessment of severity and its correlation with the appropriate level of care for the client.

Transcripts

hi everyone welcome to today's

presentation on asam criteria

this is the american society of

addiction medicines guidelines

we're going to look at two different

elements of asam

the first is going to be the actual

dimensions that we use to assess clients

and then we're also going to look at the

specific levels of care

where we place clients so first of all

the dimensions of treatment

are basically six different categories

on which we assess

clients what we're doing is gathering

information during the assessment

process which then

guides what level of care we would

recommend

for a client so what we're using here is

a

bio psychosocial or sometimes called bps

model of assessment

it's a great holistic way of looking at

a client's background and trying to

gather information

and make a a good clinical judgment

about what type of care they need

so a way to break down those six

different dimensions is to think of each

of those

areas bio psycho and social so the bio

biological dimensions

really are referring to one and two

on the asam dimensions dimensions three

and four are going to be looking at

psychological issues

and finally dimensions 5 and 6

are referring to social dimensions for

the client

so starting off with dimension 1 which

is one of the biological issues

the name of this is acute intoxication

or withdrawal potential

so here we're assessing whether the

client is currently intoxicated

when the last time he or she used was

and how much that's interfering with

their functioning and what the risk is

of intoxication so that will partly be

based on the severity of the symptoms

as well as what type of drug they've

used we know that with drugs like

alcohol and benzodiazepines

chronic use can actually be fatal during

the withdrawal process

and so that may need to be medically

monitored so we also want to know if

there's any history of withdrawal if

they've experienced

seizures or other type of withdrawal

experiences

how often are they using how frequently

how much all of those issues are going

to be relevant here

you're also going to have to physically

observe whether you see any signs of

withdrawal

and if you do think that detoxification

can be done

safely in what's called an ambulatory

setting so that means non-medical

setting

you want to be sure that it is medically

safe and if you're not sure to check

with somebody else

to verify that either another colleague

or if there's a physician available

so with certain drugs we probably if

they've been chronically using

we're probably going to recommend some

kind of medically monitored withdrawal

but in some cases it's not necessary so

you want to be able to make a good

judgment there

in dimension two we're still in the

biological section

we're looking at general medical

conditions and complications

anything that's going to affect the type

of treatment the person's going to

receive that

that could possibly be an issue that

needs to be addressed so you want to

make sure

any any medications any medical history

is identified

and find out whether they're stable in

those categories whether they need

additional support and how much that

needs to be monitored

in order to make a good recommendation

for what type of treatment they're going

to receive

and also to make sure those medical

issues are being addressed throughout

their care

getting into dimension three we're now

looking at psychological issues so the

title of this is cognitive

behavioral and emotional conditions so

here we're asking whether there are

any current mental illnesses or if

there's any psychological or behavioral

problems that will need to be addressed

or they may create a risk or complicate

treatment

so if you think about the intense kind

of environments that might be

experienced in a residential setting

where clients are living together

there's certain clients

with history of behavioral problems or

cognitive problems

who would not be appropriate that

environment would simply be too intense

for them to function successfully and so

we want to be very

aware and cautious of that so we want to

know what those conditions are and how

they're going to affect treatment as

well as how we're going to address them

in the treatment environment

evaluate the person's mental health and

mental health status

and then find out how how well they

function

when you talk about activities of daily

living that's you know can you take care

of yourself can you

get dressed feed yourself

you know get transportation all those

kinds of things that we might take for

granted as activities of daily living

but you want to evaluate

where the client's at in those

dimensions and how well they're

actually coping with those so somebody

may have a mental illness

or a history of cognitive problems but

maybe they've addressed those they're

coping with those in some way

so you want to evaluate their level of

functioning

dimension 4 still in the psychological

category here

we're really looking at readiness to

change so how motivated is the person

what's driving them to

receive services are they being mandated

into treatment

are they willing to cooperate with

treatment or do they feel like they're

being forced to be there you also want

to look at what the client's actual

stage of change is so that would be are

they in pre-contemplation

contemplation preparation action

or maintenance so at the very bottom

where you see pcp am

you're trying to figure out and assess

the actual stage of change

what their goals are and what their

willingness to participate in treatment

is

now getting into the final two

dimensions which is the social category

dimension 5 is looking at relapse and

continued use potential

one of the things i think of here is

after this assessment is done if the

client

leaves this office and goes home and

leaves our agency

what's going to happen to that client

what's the most likely outcome are they

immediately going to go

and relapse are they returning to

a high risk environment with a lot of

triggers does this person have

any kind of support or coping skills in

order to deal with any high risk

situations

so you want to be evaluating all of

those in this dimension

is there immediate danger of distress

and continued drug use

and finding out what the client in terms

of relapse triggers and ability to cope

with that as well

finally dimension six the last social

category this is the recovery

environment

so very closely related to dimension

five

what is the client's family situation

living situation

is the person living in an environment

either the immediate home

or surrounding neighborhood where

there's easy access to drugs where maybe

it's in the home or other people

are using around the client does the

clients

do all the clients friends also use

drugs or

engage in criminal activity that's going

to complicate treatment and complicate

the recovery process

what's the person's educational and

vocational situation are they working

are they in school

you also want to look at legal issues

and if there are any other community

supports

or social service agencies involved in

the client's life right now

a couple other big issues that we often

overlook at the very bottom there

transportation and child care so

sometimes we make good referrals to

treatment but it's for

a very hard to reach program that might

be far away from somebody who doesn't

have access to a car

or good public transportation so they

can't physically get to the site all the

time

or if somebody's taking care of a child

and doesn't have resources

to look after their kids they're going

to have a really hard time showing up in

treatment if they don't have child care

so those are the six dimensions and

that's part of the assessment process

and getting a real good feel for what's

going on with the client

once we've gathered that information we

can start to formulate a picture of

where the client's at and what services

they need and what the appropriate level

of care is

so in addition to those assessment

dimensions

asam also has us look at what level of

care matches

with that assessment so as a clinician

you're actually making a determination

about the appropriate level of care

and then you're also evaluating that on

an ongoing basis

so initially you might think they need a

certain level of care but

we're continuingly continuously

evaluating whether that's still

the appropriate level of care we're

making adjustments as needed

and so always remember assessment is an

ongoing process

it's not something that just happens in

one day or one session

it's ongoing throughout treatment

so here are the different levels of care

starting with level 0.5

this is the lowest level this is sort of

the very introduction

into the process it's called early

intervention

it consists of basic risk education

typically you might see this done

at a school like a college for example

or some dui providers do an early

intervention stage

the client at this stage doesn't meet

criteria for a substance use disorder

so they may be early on in their drug

use

history or they may have had some kind

of consequence related to

like drinking and driving but it was a

first incident

and they otherwise don't meet criteria

for substance use disorder so this is to

try to raise awareness of a problem for

the person

um often consists of a group meeting a

few times

to try to provide some education and

awareness raising

level one is called outpatient services

for adults this is less than nine hours

per week and for adolescents less than

six hours

per week this also consists of group

counseling

where you're discussing recovery and

motivational enhancement strategies

i'm trying to look at ways to avoid

future problems with the behavior

in level 2.1 we have intensive

outpatient

so we had outpatient now we have

intensive outpatient

so this is nine or more hours per week

for adults

six or more hours per week for

adolescents

in this case a sam is identifying

multi-dimensional instability so that

means there's issues in more than one of

those six categories or six dimensions

that we looked at

and so there's problems in at least a

couple of different areas in the

person's life

that need to be addressed and stabilized

at level 2.5 it's a little more intense

so you notice as we're going up here

we're getting higher in

intensity level and treatment services

2.5 is called partial hospitalization

you'll sometimes hear people refer to

php

or partial hospitalization program this

is what they're talking about at that

level

here they're doing 20 hours or more per

week of treatment services

usually what you're looking at is a

client attending a hospital or clinic

setting

for day programming several days often

five days per week

and they're doing multiple hours of

programming per day attending different

types of group

therapeutic activities recreational

activities

and they're doing that on-site

throughout the day but at the end of the

day

they do go home to their own house once

programming is done

now in level three we're talking about

residential levels of care

so level 3.1 is a low-intensity

residential

these would be our halfway houses and

our recovery homes

they do require that there's 24-hour

staff available

so some type of hired clinical staff

for example a cadc who lives on site and

is available to clients

at these levels of care clients are a

little more independent a lot of times

it's used as a step down

from either incarceration or from a

higher level

of residential treatment where clients

have a stable living environment and

they have access to supportive services

with some group programming

often they're going to work paying some

rent for the house

following group rules attending 12-step

meetings and doing drug tests on site

then at level 3.5 we're looking at

high-intensity residential

so these are longer-term residential

programs for example the 28-day programs

that you might be familiar with here

there's 24-hour care

there's trained staff at all times on

duty

in order to be placed in this level of

care remember when we were talking about

dimension

three with cognitive behavioral and

emotional issues

you have to evaluate and be sure the

client can tolerate

this intensity remember it's this is

high intensity residential so there's

always going to be clients there's

always going to be staff around

there's groups kind of non-stop

throughout the day

it is a milieu approach where

the community and the group itself is

providing

some level of therapeutic support

and so a client has to be able to

tolerate that and interact successfully

with peers

in order to stay at this level of care

finally level four is our medically

managed intensive inpatient

so this is actually a hospital-based

setting where you have 24-hour nursing

care

physicians are available every day if

not

24 hours per day this requires in order

to stay at this level of care

doing a daily continued stay review so

every 24 hours we'd be required

to do a new continued stay review to

evaluate whether the person is still

appropriate here so this person would

have substance use issues as well as

medical issues that needed to be

monitored

until they were ready to step down to a

lower level of care

a couple of things to note as far as

severity when you're assessing

how severe things are for somebody on

the different dimensions of us

of the assessment somebody who's

generally low

severity and has minimal current

difficulty in

most of the areas and their acute or

chronic problems are mostly stabilized

would be most appropriate for an

outpatient setting that level one

somebody who kind of falls into a medium

severity with moderate difficulty and

impairment

some difficulty coping but they are able

to function if they have clinical

support

that person probably falls into level

two which is

iop or the partial hospitalization

program

and then a high severity would be

somebody has more

severe difficulty or impairment who has

poor ability to cope

with their problems this person would be

looking more at a residential or a

hospitalization setting

so that's one way to conceive of turning

that assessment

and those dimensions into an actual

recommendation

as far as level of care if somebody

needs detoxification they can of course

do that in a hospital setting

but technically we can assign that to

any level of care so if somebody is

a little more stable and you're not as

concerned about the risk for

withdrawal but they still need to go

through some detoxification period

you can still technically recommend

level one or level two

but making sure they're medically

monitored during that time for

safe detoxification and withdrawal

and then there's a special designation

for opioid maintenance therapy programs

and this is where you're using either

methadone or suboxone

in addition to case management and other

clinical support

in order to help somebody who has an

opioid addiction

these are actually very solid programs

that in addition to

providing a pharmaceutical or medication

assisted therapy

are providing wrap around support and

services to connect somebody with

counseling

case management any other medical

services they might not might need

to help support their recovery process

all right i hope that helped give you a

good sense of what a sam is all about

both in terms of the asam dimensions of

assessment

and the asam levels of care where we

place somebody or recommend somebody

into

a level of treatment